Again? Why are we talking about this…

For the continued skeptics, I’m going to try to convince you this is an important topic in EM and should be discussed, the same way the heart score and cardiac observation units should be discussed.

TO START= Year after year emergency medicine trained EM physicians are among the top 3 groups of physicians that burnout. Critical care, surgery and internal medicine are the other usual contenders.

A recent poll suggests that at any given point in time, 50% of EM physicians report currently being burned out.

Physicians who report signs and symptoms of burnout…

  • have extremely high rates of premature attrition from the field

  • provide poorer quality of care

  • have higher rates of error

  • higher rates of substance abuse, depression, anxiety and physician suicide

 

And finally, recent statistics show that on average * 1-2 physicians per day commit suicide in the USA*. Do I have your attention now?


***RECOGNITION: When is it more than just normal stress and it’s actually burnout?***

Physical and Emotional Exhaustion

  • You are emotionally drained, depleted and worn out by work and not able to recover in your non-working hours

Depersonalization

  • The development of a constant negative, callous and cynical attitude toward patients and their concerns

Reduced Sense of Personal Accomplishment

  • The tendency to see your work negatively, without value or meaningless (“what’s the use?”) and see ourselves as incompetent (“there’s no point”).

Keep in mind that nothing in life is black or white. A physician is not constantly resilient or constantly burnt out. Rather we can easily move from one end of this spectrum to the other.


***PREVENTION AND RECOVERY***

So now that we know what burnout it, before we start feeling toasty what can we do to prevent it? Or what if you are already starting to feel it?  It’s okay! The same tips below are useful for prevention and recover from burnout.

Be mindful

  • Check in on yourself throughout the shift and recognize when you are starting to tense up. Recognize when you are feeling like work is taking over your life and there is no work-life balance.

  • Learn what your personal limitations are and create a plan to improve

Don’t fight stress, just notice it then release it

  • It’s physics! When you try to fight something, it will fight back even harder. When stress occurs, notice the negative emotions that come with it, then let it go.

  • Know what your professional demands entail and build acceptance of them… they aren’t changing after all. As we discussed before work WITH your stressors not against them.

Search for your sense of compassion and exercise it

  • Remember that little pre-med student? Why did they want to be a doctor?

  • Put yourself in your patient’s shoes… Like really do it. A different perspective changes everything

  • Restore balance in your life

Practice limit setting… Say NO!

  • You don’t have to take on every project that comes your way or every outing. Delegate personal and professional where you can. Say no to people and learn how to take things off your plate so you’re not constantly overwhelmed.

  • UTILIZE PEER SUPPORT AND REACH OUT TO YOUR PERSONAL SUPPORT

  • The more we build a culture of openness and support in our community the better we will be prepared for the struggles that come our way. Talk about that really sad case with a colleague and they will probably have a similar story that will help you realize it’s normal to feel the way you do and things will get better. I’m not talking about a sob fest here… even just a few minutes between shifts of chit chat can help ease up your tension.

And most importantly, ALWAYS PUT YOURSELF FIRST. Period.

  • It’s like we tell our patients. If you don’t take care of yourself how will you be able to help others? Make yourself a priority.

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ACEP created The “Emergency Medicine Wellness Week” in 2016 with a goal to remind us to take care of ourselves, and not just others. Hopefully the Wellness and Resiliency Curriculum at SIUH has helped introduce some ideas and topics over the year to help you do just that. Visit their website if interested for further discussion and articles

 

Frosso Adamakos, MD
Emergency Medicine Attending Physician
SIUH Wellness and Resiliency Curriculum Director


References

  • The Happy MD; “Physician Burnout, Why it’s Not a Fair Fight”
  • ACEP; “The Resilient Emergency Physician Manuscript”
  • December 2016 EMRAP LIN Session Resident Wellness
  • Physician Resilience: What It Means, Why It Matters, and How to Promote It”; R. Epstein, M. Krasner; Academic Medicine, Vol. 88, No. 3 / March 2013  
  • AMA; “How to beat burnout: 7 signs physicians should know”