President's MessageAugust 2024
"A rock feels no pain, and an island never cries.” - Paul Simon On occasion I find myself wondering why we subject ourselves to the stress and increasing number of difficult shifts that the ED throws at us. Now well into the latter half of my career, I sometimes think, “can I continue to do this?” More recent grads may wonder “did I make the right decision?” Mid-career docs may think, “can I do this for another 20+ years?” I respond to these thoughts by reminding myself of why I went into medicine, and specifically EM, in the first place. Like many, I liked the fast pace, the ability to make a difference in a patient's life in such a small amount of time, as well as the diversity of presentations and pathology. I knew I wanted to use science to help people in a deeply personal way and admired the nobility of a career in medicine. (Secretly I may have wanted to be Doug Ross from “ER”, although unfortunately, and no offense to Anthony Edwards, my likeness is much more akin to that of Mark Green than any character played by George Clooney. Oh well...) As a resident I appreciated how EM could be a team sport, with my class working/suffering together with a common goal. Now, as a PGY…20, as that which drew me to EM fades in and out, I find that almost ironically a busy ED can be a lonely place. Those of us who work single coverage 12’s or 24’s in rural facilities or freestandings where we are the only doctor feel this every day. Even in larger facilities, we may sit next to another doc all day long, but the pressures of documentation, metrics, and throughput, on top of the almost darkly comedic “secondary” responsibility of often having people’s lives resting in our hands, can make us feel isolated on our own little island. In these times I remind myself to lean on our team of amazing nurses, techs, and ED staff for that sense of comradery. We work in a chaotic environment typically one step away from disaster on a daily basis, where the best way to survive is to double down on strengthening the team. Teamwork makes the dreamwork, right? Well, what if even a well-oiled machine of a team can’t help you from feeling that the light at the end of the tunnel isn’t just another train heading your way? Time to grow the team. I enjoy a good medical lightbulb joke now and again of which there are many that poke fun at particular specialties. A variation of my favorite is, “How many ER doctor's does it take to screw in a lightbulb?...Who cares, we'll just work in the dark.” And so goes the brain of an ER doc. ED docs typically have a “can-do” attitude as we solve problems every minute of every shift. “If not us, then who?” However, loneliness and isolation in our environment of low-resources and organized chaos can breed an attitude of resentment and learned helplessness which saps our energy to address systemic problems. As we put our heart and soul into taking care of the patient in front of us with our ED team, we often just learn to accept certain conditions and slog onward without seeing what’s around us. But why not use our “can-do” attitude to look outside the ED to grow our team and help reduce the need for “working in the dark?” Rather than accepting our situation in the ED with blinders on, we can develop relationships with others in the hospital. The simple step of meeting and speaking regularly with colleagues from other specialties, your C-suite, or your ED nurse manager creates immeasurable benefits for you, your team, and most of all, your patients. The easiest way to make this happen is to join a committee. Being at the table where the decisions are made can be enlightening and empowering. The concept is simple; walk a mile in someone else’s shoes. Sometimes just understanding the “why” from another colleague’s perspective is enough. Now I know our time is as precious as it is scarce, and most of the problems that plague our ED’s are huge systemic issues like boarding, medication shortages, nursing shortages and hospital metrics to name a few. None of these can be addressed, however, without the continuous involvement of our physician leaders from the ED, and I don’t just mean medical directors. Every one of us is a leader in the department. Since my time as a TCEP Leadership and Advocacy Fellow (TLAF), I have learned first-hand that 80% of life truly is just showing up. Start small. We are playing the long game where slow and steady is the key. An extra hour or two per month over years helps you develop strong and meaningful relationships within your hospital. When you’ve been sitting on peer review or pharmacy and therapeutics committee with your surgical colleagues, those 3 a.m. consults are received with a little more compassion. When your “vintage” video laryngoscope still hasn’t been replaced, it may help to know that your ED manager chose to add an additional nurse to Monday afternoons with the available budget, and the scope had to wait. Show up so things happen for you and your team, not to you. Now don’t get me wrong, you and your administration may have differing opinions on certain priorities, but being involved in the conversation is worth the effort. After seeing their challenges, restraints, and requirements, you are better equipped to see a path forward that is mutually beneficial. The more we develop relationships with our hospital leaders, the more we grow our team that can improve the environment where we take care of our patients. In my June message I discussed involvement with organized emergency medicine as an insurance policy for our specialty and a means to increase our happiness and career satisfaction. Similarly, building relationships throughout the hospital, not just in the ED, assure that we are involved in decisions that are being made either with us if we’re in the room, rather than for us if we are not. Our presence in the room insures us against negative impacts on our ability to care for patients in the ED, or at a minimum lets us see them coming so we can prepare and minimize the effects. So, can I continue to do this? Absolutely, just as long as I continue to show up, grow my team by taking a few steps in other people’s shoes now and again, and remember that I’m not a rock or an island. (or George Clooney) Looking forward to seeing you all at ACEP Council in September! All the best Doug |
