Is "burnout" real or a myth? If real, how do you avoid it?

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StanleyCup7

StanleyCup7

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How much truth is there to the perception of a high burnout rate in emergency medicine?

My understanding is that it this perception is largely (though, not entirely) a myth perpetuated from FM/IM docs that used to run the ED and became burnt out b/c that was never their chosen specialty and were not as well trained in EM. So...

1. Just how much "burn-out" is there in emergency medicine (by that I mean, what percentage of EM attendings leave the field)?

and, more importantly...

2. How do you attendings that have been doing this for a while (or you residents that have talked to the veterans of EM) avoid burn-out?

and finally...

3. If they do get "burnt out" where do they go? Urgent care? Low volume ED in the middle of nowhere?

As an MS4, this "burn out" factor is the only thing that makes me nervous about EM as a specialty choice. Thanks for all of your responses and knowledge, I really appreciate it.
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From my understanding of the phenomenon (not specific to EM), burnout is caused when your expectations for your job do not meet the results over a period of time. It's really up to you to figure out if the realities of the job are what you want out of your job. If you can see all the negatives, and accept them as part of the job, you'll be fine. If you realize that you can't change the world, but only work on small steps to improving the field overall as part of a group, then you'll be fine. If you're expecting to move beyond 3AM chronic backpain, narcotic seekers, having all your patients love you, you're going to get burned out.
 
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I'm not that far into residency but I can already see junior residents "burning out" in their own way. It's usually easy to spot these unfortunate people -- they hate every rotation and are always stressed, they often fail to get along with colleagues.

I think that one of the unique problems of EM is its relative sexiness and its perception as being a real lifestyle field attracts students who are not really well suited to the MEDICINE.
 
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I got burned out last night halfway through a night shift, after having to talk to my fifth soul-sucking patient of the evening.
 
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GeneralVeers said:
But my burnout would be MUCH improved under a socialist system? You know, one where I work just as hard, but without soothing material possessions?
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Well, you wouldn't have to work as hard. Also, you'd experience schadenfreude from seeing that, finally, all the other specialties had to see everyone who walked in the door just like you.

Having just gotten a new iPhone and MacBook Pro, I'll admit there is something to that whole "soothing material possessions" thing. Damn, my future self is a generous guy, loaning me all this money...
 
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pseudoknot said:
Well, you wouldn't have to work as hard. Also, you'd experience schadenfreude from seeing that, finally, all the other specialties had to see everyone who walked in the door just like you.

Having just gotten a new iPhone and MacBook Pro, I'll admit there is something to that whole "soothing material possessions" thing. Damn, my future self is a generous guy, loaning me all this money...
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Any time you feel guilty, you can always give all your possessions to me. :smuggrin:
 
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Sidestepping the socialism thing for a bit, I think burnout is real. In any field.

I agree that the fundamental cause of burnout is an imbalance between expectations and experiences. I came into EM expecting to see some sick people and a lot of misplaced primary/urgent care stuff. I'm not disappointed about that and seeing minor stuff doesn't cause me burnout.

I didn't, however, foresee the huge population of Axis II personality disorders that I would have to deal with. The "life-force-stealing, soul-sucking, dementors-from-hell". These cause me no end of distress.

There are shifts that I feel burned out after my first patient. It is usually because I walk into a wall of whiney "my life sucks and its all your fault"-ism before I can even introduce myself.

After a little while seeing 'normal' patients, I get over it and back to normal.

Vacation is also the great burn out reducer for me. After a couple of days off, I'm good to go.

For me, knowing my weaknesses/biases, I think primary care would be infinitely more prone to burnout. I'd have to see these patients every day with little hope of many days off.

It's all about fit. I think EM is a good fit for me. Others fit better with FM/IM. We all, however, will have aspects of the job that lead towards burnout.

Take care,
Jeff

PS, if 'socialized medicine' could possibly 'cure' personality disorders I'd happily sign up.
 
There was a pretty good thread about 4 months ago on this

http://forums.studentdoctor.net/showthread.php?t=602899

I had one of those life-sucking patients the other day-

I saw her on one visit for 4 weeks of headaches, "sinusitis", and severe congestion.

To paint the picture, she was an older lady, about 6 feet tall. A little disheveled, with bad teeth. She was very hard to get a history from, rambling all over the place and usually ending the sentence with, "I'm just so sick doctor, I need to be admitted to the hospital." She had been on amoxicillin, a z-pac, and augmentin in the prior 4 weeks.

I CT'd her head and sinuses, looking for a fungus-ball, or sinusitis eroding away into her brain. She was so whiny, even after headache treatment that I lumbar punctured her looking for viral meningitis or partially treated meningitis. Everything was stone cold normal, except for a white count of 11.5. She complained of severe, intractable nausea (as she incessantly ate jello and drank juice for her 8 hour ER stay.

She came back with the exact same symptoms and the next ER doctor looked at my work-up and admitted her immediately to psych for 5 days.

She came back, requesting more antibiotics (a PCP had put her on penicillin (fourth course of antibiotics in 6 weeks), and when I refused, she wanted to be admitted to psych, because of sleeplessness. I talked to her mother (equally crazy and in her 70's, who demanded that she be admitted to psych because she was so annoying that visitors at their house couldn't stand her. Her mom said that she laid in bed with the lights out all day long, blowing her nose incessantly (had used up every kleenex box and toilet-paper roll in the house). She had a stuffy nose, and was distressed that blowing her nose a hundred times in a row didn't make it better.

The patient had been put on an atypical anti-psychotic on discharge from the psych ward, but recently found out that it wasn't covered by insurance and she couldn't afford the several hundred dollars a month that it cost. I discussed various options for drugs with the psychiatrist, and he recommended some haldol. I went to tell the patient that, and she said that had caused a psychotic reaction in the past and refused it. I ended up talking to the psychiatrist and asking him to admit her. He was willing to, but told me to warn her that it probably wouldn't fulfill admission criteria and wouldn't be covered by insurance.

She finally decided to go home. (with klonopin and some steroid nasal drop prescriptions.

Is insomnia, and a stuffy nose a reason to go to the ER? Three times?

She has been seeing an out-patient counselor for weeks. In the end, I realized that they had family in town visiting at her house, and she was making their visit unpleasant, so they dropped her off at the ER and told her to get admitted. Her mother told me that it would be "convenient" if she were admitted. I was so irritated that I ended up yelling at her and telling her to stop blowing her stinking nose and to go outside in the sunshine and get some exercise. The nurses were laughing their butts off at me. That was my first patient on a long night shift. I spent 40 minutes talking with the patient, the parents, and the psychiatrist, (each, at least two different conversations). Between the paper-work and the time talking to patient, I would bet I spent at least an hour, all for some when who is simply crazy.

I have insufficient knowledge and experience with psychiatry to deal with these kind of ridiculous issues in an efficient manner, at least, now.

I just came off 4 nights, I am definitely burnt.

But, hey, what percent of physicians in the nation have the next 3 days off and are wasting their time on the internet?
 
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Our job is a pain sometimes, but what job isn't?

Either jobs are incredibly stressful, and financially rewarding, or they are inane and financially unrewarding. OK, I guess I could add those physically demanding jobs like construction that usually don't may much unless you have your own business, or a really unique skill that you have practiced and honed for years, making yourself great at fulfilling a specific niche.

I repeat, with emphasis...ALL JOBS SUCK. THEY ARE WORK!

By and large, society pays you what you are worth. If you do a job that just any Joe Schmoe can do, you aren't going to get paid much.

(At least, until we are completely socialized, and we can join the masses of the proudly mediocre Europeans, where nobody works hard, and nobody gets paid good.)
 
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Jarabacoa said:
Is insomnia, and a stuffy nose a reason to go to the ER? Three times?

She has been seeing an out-patient counselor for weeks. In the end, I realized that they had family in town visiting at her house, and she was making their visit unpleasant, so they dropped her off at the ER and told her to get admitted. Her mother told me that it would be "convenient" if she were admitted. I was so irritated that I ended up yelling at her and telling her to stop blowing her stinking nose and to go outside in the sunshine and get some exercise. The nurses were laughing their butts off at me. That was my first patient on a long night shift. I spent 40 minutes talking with the patient, the parents, and the psychiatrist, (each, at least two different conversations). Between the paper-work and the time talking to patient, I would bet I spent at least an hour, all for some when who is simply crazy.

I have insufficient knowledge and experience with psychiatry to deal with these kind of ridiculous issues in an efficient manner, at least, now.

I just came off 4 nights, I am definitely burnt.
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You spent far more effort on this lady than I would have. If she'd been seen before, worked up, and came back demanding "admission" I would have turfed her in 5 minutes.

Like the back pain guy last night. He'd been drunk driving earlier in the day, crashed into someone else (he was at twice the legal limit). Complaining of severe "back pain". My partner did a complete workup including a CT of his whole body and spine, all of which was negative. Police as usual didn't arrest him and issued a citation. He was discharged, but then called 911 on my shift because he wanted to be "admitted" and to be given IV narcotics. His exam was totally normal with the exception of some low back spasm on the right side. He was barely off the gurney before I discharged him back home. It took 2 security guards, our nursing supervisor, and a threat to call the cops to get him out the door.

THAT is a soul-sucking patient.
 
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GeneralVeers said:
You spent far more effort on this lady than I would have. If she'd been seen before, worked up, and came back demanding "admission" I would have turfed her in 5 minutes.

Like the back pain guy last night. He'd been drunk driving earlier in the day, crashed into someone else (he was at twice the legal limit). Complaining of severe "back pain". My partner did a complete workup including a CT of his whole body and spine, all of which was negative. Police as usual didn't arrest him and issued a citation. He was discharged, but then called 911 on my shift because he wanted to be "admitted" and to be given IV narcotics. His exam was totally normal with the exception of some low back spasm on the right side. He was barely off the gurney before I discharged him back home. It took 2 security guards, our nursing supervisor, and a threat to call the cops to get him out the door.

THAT is a soul-sucking patient.
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So this is the aspect of our jobs that I still don't quite understand. Why is there a pervasive need to "do something" for the patient. At the end of the day I don't think we need to solve all of a patients issues and problems. Are we not in the EMERGENCY department to rule out emergencies? If some one comes in with a headache and we are confident that it is not a massive ICH and we deem them safe for outpatient, why cant we just give them the boot?

I think that we are partially responsible for this in EM. We have accepted to broad of a mandate. I think we try to do too much.
 
Speed Racer said:
So this is the aspect of our jobs that I still don't quite understand. Why is there a pervasive need to "do something" for the patient. At the end of the day I don't think we need to solve all of a patients issues and problems. Are we not in the EMERGENCY department to rule out emergencies? If some one comes in with a headache and we are confident that it is not a massive ICH and we deem them safe for outpatient, why cant we just give them the boot?

I think that we are partially responsible for this in EM. We have accepted to broad of a mandate. I think we try to do too much.
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Some doctors don't, and to intervene can be harmful. I had an older gentleman come in last night because his blood pressure was "high" at 190/102. His doctor had been tinkering with his doses and it was out of control. He had absolutely no symptoms. I told him to resume his prior dose of blood pressure meds and call his doctor tomorrow. I know some of my colleagues would have checked a creatinine on him (what do you do if it's high?) and given him clonidine.
 
I am still very young in all this (3rd year resident in a four year program) and ever since becoming committed to EM and having been attempted to be talked out of it by my medical schools FM program, at the end of the day, there are few specialties where I can literally stop working tomorrow (well, maybe not so much as a resident... but I mean once your through that part) and start working again whenever I want. I can work AS LITTLE or AS MUCH as I want to. Lets face it, 3-4 shifts PER MONTH will make a VERY livable income for a family of four. I think ANYONE can do ANYTHING for 3-4 'days' each month... heck I could watch grass grow if your going to pay me a few hundred an hour those few days...


Thats the spill I give medical students. There seems to be this HUGE concern about 'burnout' in EM. I think others already made GREAT points in this thread. We, on a daily basis, have to 'deal' with folks that most of us never associate with. I dont 'hang out' with drug dealers, crack ******, psych basketcases, etc...yet everytime I work, I am going to spend some important time with these folks and they can be a pain in my arse. Sure, it has it moments of getting old, but the occasional nice family with a genuine program who are truly grateful for you tending to their loved one... that makes it work it.

Anyways, if you work 6 days a week 12 hour shifts, you WILL get burned out.... and the money of EM make people, I think, get burned out. Often folks get in the rut of well, I could sit at home, or I could be at work bringing in 200/hr... Lets face it, its hard to choose to sit at home.

But, if you can put the money aside.. and think about providing a comfortable, maybe not extravegant, life for your family.. You can literally work a week a month and make a six figure income....


I am FAR from being burned out, but if I ever get the feeling, I'll back of fmy shifts, do what I enjoy.. and still make more money than most any of my other non MD friends working their 8-5 / 5 days a week 'boring jobs'....
 
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EM_Rebuilder said:
I am still very young in all this (3rd year resident in a four year program) and ever since becoming committed to EM and having been attempted to be talked out of it by my medical schools FM program, at the end of the day, there are few specialties where I can literally stop working tomorrow (well, maybe not so much as a resident... but I mean once your through that part) and start working again whenever I want. I can work AS LITTLE or AS MUCH as I want to. Lets face it, 3-4 shifts PER MONTH will make a VERY livable income for a family of four. I think ANYONE can do ANYTHING for 3-4 'days' each month... heck I could watch grass grow if your going to pay me a few hundred an hour those few days...


Thats the spill I give medical students. There seems to be this HUGE concern about 'burnout' in EM. I think others already made GREAT points in this thread. We, on a daily basis, have to 'deal' with folks that most of us never associate with. I dont 'hang out' with drug dealers, crack ******, psych basketcases, etc...yet everytime I work, I am going to spend some important time with these folks and they can be a pain in my arse. Sure, it has it moments of getting old, but the occasional nice family with a genuine program who are truly grateful for you tending to their loved one... that makes it work it.

Anyways, if you work 6 days a week 12 hour shifts, you WILL get burned out.... and the money of EM make people, I think, get burned out. Often folks get in the rut of well, I could sit at home, or I could be at work bringing in 200/hr... Lets face it, its hard to choose to sit at home.

But, if you can put the money aside.. and think about providing a comfortable, maybe not extravegant, life for your family.. You can literally work a week a month and make a six figure income....


I am FAR from being burned out, but if I ever get the feeling, I'll back of fmy shifts, do what I enjoy.. and still make more money than most any of my other non MD friends working their 8-5 / 5 days a week 'boring jobs'....
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:thumbup::thumbup: That was beautiful, man.
 
Burnout is real. I fight it all the time. The soul sucking dementors from Hell are the main thing but the bureaucracy and malpractice and consultants are in there as well. Burn out exists in every specialty. It has more to do with the person than the field.


GeneralVeers said:
Some doctors don't, and to intervene can be harmful. I had an older gentleman come in last night because his blood pressure was "high" at 190/102. His doctor had been tinkering with his doses and it was out of control. He had absolutely no symptoms. I told him to resume his prior dose of blood pressure meds and call his doctor tomorrow. I know some of my colleagues would have checked a creatinine on him (what do you do if it's high?) and given him clonidine.
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Yeah, treating asymptomatic hypertension with clonidine is really big in Vegas. I've had nurses in this festering pit of a town refuse to discharge pateints until I give them "something to get the pressure down." No amount of referencing literature or explaining the chronic nature of htn or questions about what happens in 6 hours when the clonidine wears off will do. They've just gotta record a "normal" BP on the discharge vitals.
 
docB said:
Burnout is real. I fight it all the time. The soul sucking dementors from Hell are the main thing but the bureaucracy and malpractice and consultants are in there as well. Burn out exists in every specialty. It has more to do with the person than the field.



Yeah, treating asymptomatic hypertension with clonidine is really big in Vegas. I've had nurses in this festering pit of a town refuse to discharge pateints until I give them "something to get the pressure down." No amount of referencing literature or explaining the chronic nature of htn or questions about what happens in 6 hours when the clonidine wears off will do. They've just gotta record a "normal" BP on the discharge vitals.
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The nurses here at St. Elsewhere are very reasonable. They often bring to attention a patient's blood pressure, but then I educate them about acute lowering of blood pressure leading to stroke, and more often than not they thank me for the education and discharge the patient.

I go to great lengths to explain to nurses my rationale for doing things, and educate them about the disease processes. Most of them are very receptive and want to learn. I think they also respect you more if they know you have a solid reason for doing what you are doing. It also makes them feel like they are part of the "team". Occasionally I will show them interesting X-rays or CT scans on their patients.
 
Hah, hah! Dementors. Such an appropriate reference. (I've read all those books about 4 times each.)
 
Jarabacoa said:
Our job is a pain sometimes, but what job isn't?


I repeat, with emphasis...ALL JOBS SUCK. THEY ARE WORK!

(At least, until we are completely socialized, and we can join the masses of the proudly mediocre Europeans, where nobody works hard, and nobody gets paid good.)
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As an MS4, I found myself in the past months searching for the "perfect field" of medicine. The fact is, it doesn't exist. Work is called work for a reason. After doing my rotation in EM I have found that there are some things that are probably "soul-sucking" as you attendings call it ("my body aches all over...and this guy was a classic drug seeker), but there are some very rewarding things as well. For me, treating "normal" people with very valid complaints/problems that you or I could have just lifts my spirits like you couldn't believe. The problem is that those "normal" patients stand out like a sore thumb and are definitely the exception rather than the rule.
 
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Yeah, I hear you on that one. When I did my fourth-year rotations it seemed like "every patient was a problem patient"; whether they were junkies in need of a fix, or a homeless guy in want of a turkey sandwich, or had some bogus complaint like "left knee pain x 9 years", and expected us to fix it right then and there.

The part that burns me the most is that none of these people will ever pay a dime for their care, so they don't think twice about just coming back on in for any old non-emergent complaint. Furthermore, the good taxpayer foots the bill, so in effect - I'm paying for the "privilege" of treating bogus complaints. Meanwhile, millions of good, hardworking, wage-earning people can't afford health insurance, or get their claims denied by those new robber-barons *the insurance companies*.

I'm not sure why I worked so hard to achieve all that which I have, if I can have everything handed to me just by being a complete zero.
 
This could work out well then... I put up with these kind of crazies the last few years of my life. Only difference was I got paid less than a McDonald's manager to do it!
 
RustedFox said:
I'm not sure why I worked so hard to achieve all that which I have, if I can have everything handed to me just by being a complete zero.
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We already have that. It's called socialism. We have that in welfare, medicare, medicaid, and social security.

It's human nature. If something is given to you for free, why would you value it, or work for it? If you go into a restaurant and some big company is footing the bill do you think twice about ordering the filet and lobster?

I'd rather see a few non-paying chronic patients, than have an entire government run system.

Under a government system EVERYONE will be eating for free, so why bother making an appointment with your PMD, when you can get it done "drive-thru" style at the local ER?
 
GeneralVeers said:
Under a government system EVERYONE will be eating for free, so why bother making an appointment with your PMD, when you can get it done "drive-thru" style at the local ER?
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Er, you might be a little ahead of your time. I just got an e-mail from ACEP the other day that a certain hospital's ED wanted to experiment with having an actual 'drive-thru' ER!
 
bravotwozero said:
Er, you might be a little ahead of your time. I just got an e-mail from ACEP the other day that a certain hospital's ED wanted to experiment with having an actual 'drive-thru' ER!
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Hmmm, wonder if there will be a coin operated gate to get to the drive through?

Take care,
Jeff
 
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Burn out is very real. For anyone, in any field.

The key is to recognize it when it starts to happen and intervene to avoid it. And once you recognize that burn out can happen, take steps to keep those things from happening again.

http://www.mayoclinic.com/health/burnout/WL00062
 
em_rebuilder said:
i am still very young in all this (3rd year resident in a four year program) and ever since becoming committed to em and having been attempted to be talked out of it by my medical schools fm program, at the end of the day, there are few specialties where i can literally stop working tomorrow (well, maybe not so much as a resident... But i mean once your through that part) and start working again whenever i want. I can work as little or as much as i want to. lets face it, 3-4 shifts per month will make a very livable income for a family of four. i think anyone can do anything for 3-4 'days' each month... Heck i could watch grass grow if your going to pay me a few hundred an hour those few days...
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oh my god is this really possible!!! If it is, this makes EM better than Der... ALL
 
Birdstrike said:
(I've posted this before, so if you've already read this, I apologize. I thought it would be best to move it here to the stickies)

.If you haven't read Dr. Greg Henry's article about EM physician longevity this month in EP Monthly, its a must read:

http://www.epmonthly.com/columns/oh-...ishing-strong/

Here is my response:


..The Emergency Physician Bill of Rights and Responsibilities to Him/Herself.

..
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:thumbup: Thanks so much for sharing!
 
Birdstrike said:
Thanks for reading. :thumbup:

Live life to its fullest. Do not be held back by anything. Make life your adventure. Do something different and exciting. Try something new and if you don't like it, try something else. Ignore the naysayers. Live your dream. Godspeed to you.
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Very eloquent. Thanks
 
FunnyCurrent said:
oh my god is this really possible!!! If it is, this makes EM better than Der... ALL
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Yes. Totally.. You can find a job that pays $200 / hour. Work 40 hours and thats 8000 per month or 96k per yr. The math is that simple. Thats twice what an average person makes.

It depends on your student loans, spouse, and what you like to do for fun.
 
It definitely exists, and for Emergency Medicine It is fundamentally different than other professions. In my experience lack of skill can hasten burnout. If you strive to be average in this field, you will make mistakes, mistakes that cost lives. The title of Doctor confers an expert status to you, if you do not or are not wiling to embrace that then you will be unable to avoid burnout.

I've worked there for about two years and I know that I have a personality and self-care repertoire that would allow me to work successfully in the field if I chose it for a specialty. But, I know that it isn't what I really want to do and that would eventually hasten my burnout. My interest lies with neuroscience.

I think my ER experience has given me an invaluable ability to prioritize and appreciate the diversity of humanity, an experience that will prove invaluable in the precision based worked of neuroscience.

More to the point, I definitely echo the physician responsibilities list posted above. If you want to avoid burnout you have to be able to acknowledge that a 12 hour shift takes more than 12 hour of free time to recover from.

I work with several providers who have been in the field for more than 25 years. They are driven to help others, and as long as they know they have done everything they can do to to help the patient, then they have done their job well. Like I said above, that means being an expert in your field. Being an expert means acknowledging that your medical education and residency are just the tip of the iceberg. You have to continue your education far beyond CME requirements to be a true expert.
 
Here's an interesting article that's gone completely viral in the past few days, not so much on EM burnout, but physician burnout in general. I think it's interesting, not so much from the facts stated, but for the question, "How do we fix our profession?"

The amount of anti-physician bitterness in the comments is notable, and there's quite a bit of frustration voiced in the article itself.

I personally think we have great power to right the ship, but not without significant risk in the process.

http://www.thedailybeast.com/articl...tor-became-the-most-miserable-profession.html



(Edit: I just realized that in her article, in paragraph 10, she actually links to my article I first posted here. LOL. That's cool, though.

"It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim."

Also, note the old prolific anti-doctor troll "Johnathan Blaze" shows up again in the comments. Don't remember Johnathan Blaze? I do. He's the troll that prompted me to write this post [first posted here on SDN], even quoting him in the opening quote. Interesting times we live in.)
 
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JB the troll is obviously bitter. My guess, a guy who couldnt get into med school and is now ranting. He says that 300k in debt is nothing if you are guaranteed 250k. Thats even worse as a percentage than most undergrads. Thats a debt to income ratio of over 100%. The dude either doesnt understand the concept of interest or is just a basic troll. Ill go with #2.
 
Speaking of burnout, I'm paying the piper right now for my New Mexico trip. I've worked 13 shifts in 18 days... and I'm pretty toasted. Fatigue up, compassion down, diet in the toilet, no real 'exercise'.

Its mentioned here and other places on this forum, but it bears repeating:

Psst... its the number of shifts.
 
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AmoryBlaine said:
I'm not that far into residency but I can already see junior residents "burning out" in their own way. It's usually easy to spot these unfortunate people -- they hate every rotation and are always stressed, they often fail to get along with colleagues.

I think that one of the unique problems of EM is its relative sexiness and its perception as being a real lifestyle field attracts students who are not really well suited to the MEDICINE.
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I have the same perception among my fellow residents. EM was so competitive this last year, and I look around and see a lot of my fellow classmates who I don't think are cut out for the field. They are certainly intelligent enough (most are smarter than me), but I feel that EM takes a certain personality, and many don't have it, but they enter the field anyways.
 
HooliganSnail said:
I have the same perception among my fellow residents. EM was so competitive this last year, and I look around and see a lot of my fellow classmates who I don't think are cut out for the field. They are certainly intelligent enough (most are smarter than me), but I feel that EM takes a certain personality, and many don't have it, but they enter the field anyways.
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What personality are you referring to?
 
GTP said:
What personality are you referring to?
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EM personality ( in my humble opinion)

1) MUST be able to multi-task. More so than any other field. Much of what is required about this field is to "clear the pipes and keep the sludge moving through". This requires not only juggling, but to be able to prioritize tasks accordingly.

2) MUST be personable. EM sees a lot of patients every day. You know none of them, and they are often from a different walk of life from you.

3) MUST be a great communicator. You have very limited time with patients, and being able to competently explain to them what you are doing and why, at their level of understanding, is critical. It is also very important to be able to communicate effectively with your nursing staff, consultants, EMS, etc...

4) MUST be decisive. EM does not afford you the luxury of time to discuss treatments plans with teams of other physicians on rounds, all of whom have a complete and accurate medical history of the patient. You have to make the best decision with limited information available.

5) MUST be willing to accept the fact that everyone else will constantly question everything that you do. PCPs, consultants, lawyers, nurses, and administrators.

I am just saying that I look around and see a lot of my graduating class who are quiet, indecisive, and overwhelmed by having several different things to do at once. I feel that many of them are going into the wrong field by choosing EM. I feel that many of these people are at increased risk for burnout.
 
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RustedFox said:
Speaking of burnout, I'm paying the piper right now for my New Mexico trip. I've worked 13 shifts in 18 days... and I'm pretty toasted. Fatigue up, compassion down, diet in the toilet, no real 'exercise'.

Its mentioned here and other places on this forum, but it bears repeating:

Psst... its the number of shifts.
Click to expand...
This. This is at LEAST 85% of the cause of burnout (for me)
 
EvoDevo said:
This. This is at LEAST 85% of the cause of burnout (for me)
Click to expand...

There's one more layer of it (for me)... watching society go down the toilet for that many shifts.... THAT'S the real drag. If I dont have to shake my head after each patient because of their obvious social/addiction/secondary gain issues... shifts become infinitely easier to grind out.
 
Birdstrike said:
Here's an interesting article that's gone completely viral in the past few days, not so much on EM burnout, but physician burnout in general. I think it's interesting, not so much from the facts stated, but for the question, "How do we fix our profession?"

The amount of anti-physician bitterness in the comments is notable, and there's quite a bit of frustration voiced in the article itself.

I personally think we have great power to right the ship, but not without significant risk in the process.

http://www.thedailybeast.com/articl...tor-became-the-most-miserable-profession.html



(Edit: I just realized that in her article, in paragraph 10, she actually links to my article I first posted here. LOL. That's cool, though.

"It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim."

Also, note the old prolific anti-doctor troll "Johnathan Blaze" shows up again in the comments. Don't remember Johnathan Blaze? I do. He's the troll that prompted me to write this post [first posted here on SDN], even quoting him in the opening quote. Interesting times we live in.)
Click to expand...

Johnny Blaze:
johnathanblaze2 days ago




Don't pity doctors. They make insane amounts of money for relatively little work. The only hard work a doctor does is to get into medical school. Once they are in, they are guaranteed a 6-figure salary for the rest of their lives with minimal effort. No one else in America has it as good as the doctors.


Who cares if a few of these spoiled idiots are killing themselves? There will always be people who don't realize how good they have it.
Click to expand...

Most doctors are divorced because they are rich and were able to find a younger hotter woman. A lot of the times they run off with their nurses.

So don't pity the doctors...chances are they wanted the divorce.
Click to expand...


He's a bitter fellow.
 
"minimal effort". Riiiiiiiiiiiiight. Because it's so cush to be up all night when everybody else is sleeping constantly saying "no" to the dregs of society that threaten to off themselves if you don't refill their narcs for their chronic abdominal pain and cyclic vomiting syndrome. Also don't forget the glamour of getting pulmonary edema froth all over your face during a crash intubation. Or when an old lady with a kidney stone barfs all over your shoulder. And it totally takes no skill or effort whatsoever to just pop that hip back into place, especially for a 5'1" lady doctor. Nosiree.

No job is more like being a prostitute than being an ED doc. Body fluids, transmissible diseases, unpleasantly unhygienic clientele, being awake at 3:30 am, going home smelling like latex, and your only company on the slow nights is a bored cop who keeps threatening to taze people. At least prostitutes get to wear fabulous shoes and if Pretty Woman is anything to judge by, they do pretty well for themselves on an hourly rate. Plus they have the luxury of saying "no".

#preachingtothechoir
 
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RustedFox said:
There's one more layer of it (for me)... watching society go down the toilet for that many shifts.... THAT'S the real drag. If I dont have to shake my head after each patient because of their obvious social/addiction/secondary gain issues... shifts become infinitely easier to grind out.
Click to expand...
Yeah man. Addiction is a real thing out here. It is out of control
 
pagemmapants said:
No job is more like being a prostitute than being an ED doc. Body fluids, transmissible diseases, unpleasantly unhygienic clientele, being awake at 3:30 am, going home smelling like latex, and your only company on the slow nights is a bored cop who keeps threatening to taze people. At least prostitutes get to wear fabulous shoes and if Pretty Woman is anything to judge by, they do pretty well for themselves on an hourly rate. Plus they have the luxury of saying "no".

#preachingtothechoir
Click to expand...

I may have found a new signature, lol.
 
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pagemmapants said:
"minimal effort". Riiiiiiiiiiiiight. Because it's so cush to be up all night when everybody else is sleeping constantly saying "no" to the dregs of society that threaten to off themselves if you don't refill their narcs for their chronic abdominal pain and cyclic vomiting syndrome. Also don't forget the glamour of getting pulmonary edema froth all over your face during a crash intubation. Or when an old lady with a kidney stone barfs all over your shoulder. And it totally takes no skill or effort whatsoever to just pop that hip back into place, especially for a 5'1" lady doctor. Nosiree.

No job is more like being a prostitute than being an ED doc. Body fluids, transmissible diseases, unpleasantly unhygienic clientele, being awake at 3:30 am, going home smelling like latex, and your only company on the slow nights is a bored cop who keeps threatening to taze people. At least prostitutes get to wear fabulous shoes and if Pretty Woman is anything to judge by, they do pretty well for themselves on an hourly rate. Plus they have the luxury of saying "no".

#preachingtothechoir
Click to expand...


I can handle almost any bodily fluid, but respiratory secretions are by far the nastiest thing in medicine.
 
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