Jonathan Eisenberg, MD
It’s winter. The waiting room has had to bring in extra chairs to handle the overflow, and you are likely working your way through your 3rd or 4th URI of the season. The new staffing model for extra help during the busy season worked the first day but has since devolved into an extra doc following up on respiratory panels from last week. People are wearing their emotions as the next patient with a cough/congestion chief complaint gets checked in.
Physician wellness and its counterpart, burnout, are two of the buzzwords that have captured the medical zeitgeist of the past decade. Although they may be a little overused, their importance cannot be overstated—especially in these overworked, sun setting at 2pm, cold days. It has become so important that there is now a physician wellness fellowship at Stanford. Multiple research papers and physician groups have identified the issues that seem to affect us all: EMRs, documentation, patient loads, insurance nightmares, emotional exhaustion, and depersonalization. Some ways to combat burnout and promote wellness are obvious but may not feasible—cutting patient loads, taking a walk during lunch, or outsourcing your more nominal daily activities. But we are emergency medicine physicians, we do not have a say in patient loads, and I feel lucky when I can eat a sandwich at my computer on wheels in between patients (don’t take away our food in the ED…).
So, what can EM docs do to not flame out in the respiratory season and thereafter? First, understand what keeps us in balance between being well and not burning out. The literature on the subject repeatedly details self-compassion, mindfulness, resilience, and empathy as buffering features against burnout and thus improving wellness. To distill an entire field of research into a few sentence fragments, this all comes down to not being too hard on oneself, taking time to be in the moment, and remembering the origins as to why we became physicians.
Here are some more concrete and actionable things to do—because, in the end, EM docs have short attention spans and need a discrete assessment and plan. The first, and by far the easiest thing to do in practice but may run counter to those med school gunner days, is to just say “No.” It was easy for Nancy Reagan to say—should be easy for us too. And, this answering in the negative can be to anything you want. You don’t want to take on an extra research project; don’t want to sit on the work committee; don’t want to attend that conference—it is ok to say no. It can free up some mental capacity for you to accomplish something you really want to do.
Another easy, and less negative item on the list, is to show gratitude towards those around you. Not just saying thanks to the nursing staff on your way out of the ED, but rather giving a specific example of a charge well done. Research has shown that gratitude programs at different health centers resulted in a more positive work environment and fewer feelings of burnout. So, whether that means writing your coworker a gratitude-gram (a thing my residency actually did) or just taking a moment at a meeting to give someone a compliment—the positivity will come full circle.
Lastly, it does not have to be a Crossfit class or 90 minutes of yoga, but even ten minutes of stretching and movement can have a positive effect and decrease burnout and depression. So, move the body ever so slightly to stretch the legs after a long shift, take the steps to the car, and go for a family walk after dinner. The job is stressful and there are many surrounding factors that can increase feelings of burnout. Take a small amount of time during the day for yourself; your wellness will thank you.
Check out ACEP’s wellness website: http://www.acep.org/life-as-a-physician/wellness/
Olson K, Kemper KJ, Mahan JD. What factors promote resilience and protect against burnout in first-year pediatric and medicinepediatric residents? J Evid Based Complementary Altern Med. 2015;20:192-198.