Coping with tough aspects of EM (advice appreciated)

[emdoc799]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

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[RustedFox]

Have we met?
Are you me?

 

[HoosierdaddyO]

Haha I mean you are literally not alone. Just drove home from my shift… literally reiterating most of not everything you said. It’s tough when all you do is care for the other people, especially when those people seem to give no ****s for caring for themselves. Why are doctors always the villain, why do I have to deal with all of societies woes and issues. Like damn what are the politicians doing about the homeless or the drug issue or healthcare reform. I’m just sitting here getting yelled for nothing

I personally get thru it by looking at it as a job and nothing else. They pay me… and I work!!!

I think I was able to put things in perspective when I took a cross country trip a few months back. There are so many disgruntled and lost people in this world, so many people that work dead end hour jobs… at least I get to do some cool stuff, society kinda likes me, and I make good money. And for those reasons alone I can shut up and carry on. But doesn’t mean I don’t mutter under my breath how stupid people are and can and will continue to be lol!!!

 

[cyanide12345678]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

How busy is the place that you practice at? I personally dislike the silly complaints when it's really busy. At my rural shop where I'm averaging 1 an hour, I'm just much happier, don't mind the easy simple complaints and kind of really enjoy practicing medicine. I feel pretty different at my level 2 shop. some of the sdg set ups I've seen recently have had worse staffing than cmgs.

 

[Rekt]

You're just saying what everyone wants to say. Everything you said is real life emergency medicine. Should be mandatory reading for medical students. Point number three especially. At least where I train this happens all the time due to the regional set up. It's probably the most frustrating patient encounters that I have. I physically get angry in the room and can't stop myself from being mad at them.

A small thing I do is anytime I meet a patient that's even close to normal I try to spend extra time with them, talk about random things, follow up more than once, etc. It's dumb but makes me feel slightly better as I'm seeing 3pph of pure liquid garbage.

One thing I will say is that you don't have a good SDG despite you thinking so. That should never be happening.

 

[oldtown]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

Just let go. Patients are widgets. Just try to move the widgets through the system without killing the widgets. Collect your money for moving the widgets, and find meaning in other aspects of your life.

I think those that are most unhappy in medicine are those that cling to that idealistic version of medicine (all the stuff you said at your med school interview). Reality never lives up to the ideal for the reasons you noted, and the delta between expectations and reality results in unhappiness.

You can work 12 days a month, make $300K+ / year, and do other things. Start figuring out an exit strategy though, because eventually it does crush your soul, bit by bit.

 

[emergentmd]

You have the same issues as most other specialists and people in general. Look around and most work bc its a job that pays the bill.

You make 300K working 12 -14 dys a month. Most make 100K working 20-24 dys a month.

Cut back to 4 dys a month, make 100K, and find something else that you enjoy.

People would kill to make 100K working one day a week. Trust me, grass is not greener.

 

[Apollyon]

If your group would "stop at nothing and completely backstab you and think nothing of it", that's NOT one about which I would say "group is good". Additionally, if you are seeing the therapist for your own good, that is fine. But, is this job the reason you are seeing someone?

 

[Dr Mantis Toboggan]

You have the same issues as most other specialists and people in general. Look around and most work bc its a job that pays the bill.

You make 300K working 12 -14 dys a month. Most make 100K working 20-24 dys a month.

Cut back to 4 dys a month, make 100K, and find something else that you enjoy.

People would kill to make 100K working one day a week. Trust me, grass is not greener.

Yes personally I find that 11 versus 14 shifts a month makes a massive difference. Hoping to get to 7 in the next few years.

 

[WilcoWorld]

@emdoc799 - your situation sounds as terrible as it does familiar.

First, I think @Apollyon raises an important issue - you didn't discuss the backstabbing much at all. I feel as though that warrants more fleshing out.

Second, get ready for a hard eye roll, I'm going to take a very different tack.

When I was close to where you are in my career I was feeling very similarly. I'd embraced the advice to look at EM as "just a job" and was plugging away towards early retirement...and hating every shift. My patients were just obstacles with hidden liability - there was no joy in taking care of them. No wonder I hated my job, how can you enjoy taking care of people that, at best, you're afraid of, at worst, you actively despise? You can't.
I won't claim it was a conscious choice - that's giving free will too much power - but something changed. It probably had something to do with what I was reading at the time (Medicine and Compassion, Welcoming the Unwelcome, to name a couple) but that also isn't the whole story. I don't have a recipe to share, but somehow I started to feel differently and see my job differently by breaking down the wall between me and my patients. I'd built that wall up during and after residency to get through the grind of EM, and I found it was making me hate my job. When I broke the wall down and began to let the experiences and the patients in, began to let it really touch my heart, became forgiving of myself for having a human reaction to all that I was seeing, I was reinvigorated. I began to see the purpose and the benefit of just being someone willing to listen and to try to help those who come to me - be it because they're genuinely sick, or ignorant, or selfish, or misinformed, whatever it was. I just needed to ask myself, "how can I help this person?" Often, the answer is NOT what they want. That's OK - the customer isn't always right.

I think that's another thing that changed. I realized that, even though there was a pervasive fear among my colleagues about patient satisfaction, I didn't actually have to pander to it. When I stopped caring about PG and just started doing what I thought was right, my care improved and my scores didn't go down. You're the doctor - you know best, be true to yourself.

This is a hard job and people can be rotten, your heart will be hurt. Accept that.
You have the gift of being able to help people of all walks of life. Cherish that.

 

[namethatsmell]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

As I read the 3rd bullet on your list, it brought forth the memories of the hoards of these pts I've seen over the years...and just thinking about them all probably pushed my BP up a few points lol.

Per the bolded, you're clearly burned out. And it's 0% your fault and 100000% the "system's" fault. It's good that you're able to acknowledge the unvarnished truth and the thoughts you're having, as it sounds like they're spurring you to make a much needed change.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

Are you being too idealistic? Hard to say. I think most of us who sacrifice to go into medicine have at least some degree of idealism and then it usually begins to be beat down by the system once residency starts. But I think maintaining some of this idealism is actually beneficial for our happiness and state of mind...without this, we lose the will to keep advocating to make things better for ourselves and patients. And once we stop doing that, we basically allow ourselves to be silently gaslit into the idea that everything in medicine and what admin "provides" is OK.
But the key is to not let these thoughts consume you 24/7 and to check your expectations that this idealism will be embraced by admin or politicians. These guys and the hospital will never love you back. So it's a balance of speaking up for you/your colleagues/your patients vs not letting these thoughts and wishes become a non-stop focus which can spiral out of control quickly.

You do not need to grow a thicker skin. Compared to 99% of society, you already probably have the equivalent of turtle shell covering you body.

Do you need to stop complaining? No. You're a human. Humans complain sometimes. That said, complaining seem to be an itch-scratch circular phenomenon...and I've found that when I focus consciously on complaining less...I can get into a place where I just complain less. Something to consider.

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

As for advice...I used to fall strongly into the camp of "get a few prn or locums gig or go waaaay PT somewhere to have more control over your schedule and work as much or as little as you want." If you can swing it, it's great and I loved it. But with the changes in the EM market, I'm not sure how sustainable that'll be in the coming years.

In your case, since you know your goal already of getting out of EM, I'd start directing focus 100% to what you want to do after EM. You'll probably feel a lot better, and achieve more, by thinking/planning/actualizing your next move vs spinning your wheels about trying to change a field that's already landed you in such a rough spot. As for EM, give it as little of your emotional energy as possible: turn autopilot on when you start a shift and turn it off when you leave.

Nobody can tell you what to do next, but I'll support @WilcoWorld 's experience with my own -- when I was able to connect with patients without worrying as much about the typical BS metrics/med-mal risks/PG scores, I found my own satisfaction at work went up quite a bit. I got past these typical EM hassles by shifting out of the ED and into the outpatient setting. So much better and more sustainable than the ED.

That's not to say you should do the same, but rather support the idea that things can get better if you decide to try another area of clinical medicine. And things can also be great if you go non-clinical. But whatever you do, if you've recognized that EM isn't for you then don't keep looking backwards, you're not going that way.

 

[thegenius]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

I compartmentalize their complaints, find joy in the few patients who use the ER appropriately, and am slowly getting better at politely saying to patients "i'm sorry I can't help you with respect to your symptoms x", or "I'm sorry this is not a service the ER provides." Then I walk away. I don't care what they think of me. I can't help all people with all their problems. It's just that simple.

You know...at the end of the day this bull**** gets to some people more than others. It's just the truth. What can one say? I'm already on my second career so I'm keeping this one as an ER doc. I make good money and live in the Bay Area. So I'm OK in that regard.

And yes...one of the best ways to deal with this stuff is to change your existential approach to the ER. Try not to let things bother you. It's not your fault. You are doing nothing wrong. Some of these dopes really want help actually. They are (somewhat) willing to listen.

You know what...there are few people in society who have jobs that are truly fulfilling. You think the human resources manager at a software middleware company has a fulfilling job? No ... he or she doesn't. It's boring she he/she makes no difference what so ever.

When I was close to where you are in my career I was feeling very similarly. I'd embraced the advice to look at EM as "just a job" and was plugging away towards early retirement...and hating every shift. My patients were just obstacles with hidden liability - there was no joy in taking care of them. No wonder I hated my job, how can you enjoy taking care of people that, at best, you're afraid of, at worst, you actively despise? You can't.
I won't claim it was a conscious choice - that's giving free will too much power - but something changed. It probably had something to do with what I was reading at the time (Medicine and Compassion, Welcoming the Unwelcome, to name a couple) but that also isn't the whole story. I don't have a recipe to share, but somehow I started to feel differently and see my job differently by breaking down the wall between me and my patients. I'd built that wall up during and after residency to get through the grind of EM, and I found it was making me hate my job. When I broke the wall down and began to let the experiences and the patients in, began to let it really touch my heart, became forgiving of myself for having a human reaction to all that I was seeing, I was reinvigorated. I began to see the purpose and the benefit of just being someone willing to listen and to try to help those who come to me - be it because they're genuinely sick, or ignorant, or selfish, or misinformed, whatever it was. I just needed to ask myself, "how can I help this person?" Often, the answer is NOT what they want. That's OK - the customer isn't always right.

This is a hard job and people can be rotten, your heart will be hurt. Accept that.
You have the gift of being able to help people of all walks of life. Cherish that.

This is what I was trying to write, but @WilcoWorld wrote is so much better than me. And the other thing I do is really try to express my limitations to every patient and I tell them "I'm not sure I can figure this out, but I'm going to try". And of course I can't figure out 80% of what comes, but at least the patient thinks that the doctor tried. Seems to work.

 

[betamale]

We're likely the same age or off by 1 - 2 years. I like my job even with all those mentioned although it took 4 specialty changes to figure it out. I do have a colleague, same age as me and possibly you, though he started med school 2 yrs later than me and he is totally miserable. My group is weird in that 1/3rd of our group is literally my age. I striked up small talk with him to figure out why he looks so miserable EVERYDAY like Eeyore miserable...it's painful to watch. He told me outright that he picked the wrong specialty...he wanted something clinic based but ended up in the ER. So maybe you two have same problem. Maybe try a 9-5 clinic based job with scheduled patients who you get to know, who comes in only for annual physical and with no new complaint, and who you can fire if you don't mesh.

 

[Arcan57]

You're burned out. It's not a personal failing. Unfortunately, it's tough to find effective outside help for burnout. Family and friends often have difficulty understanding the scope of the problem. Burn-out gurus understand the problem, but most of their solutions seems to involve f$@%ing off from their clinical job and giving lectures and taking consulting fees from the institutions helping us burnout faster. At least in my own experience, therapists don't seem to have a handle on the continuous moral injury of modern EM. Recalling particularly egregious examples may help from a venting standpoint but it doesn't stop the pain.

Ultimately you need to find some way to stop the bleeding. Cutting down clinically helps. A new clinical setting may help, but may not since people are people pretty much everywhere. The most lasting solutions are going to be ones that modify your relationship to work. The first time I burned out I realized that I hated every patient I saw and had for months. Looking back, I probably should have felt some guilt or shame about hating them but I was too emotionally depleted to summon those emotions. I decided that I was going to find something positive in every interaction. And it helped. Sometimes it was really damn tough to find, but the conscious decision to look helped.

 

[Tenk]

Ever since covid I have noticed an extreme increase in dissatisfaction not only among people in EM but in other completely unrelated fields (ie non medical) as well. It is my belief that this is due to a combination of prolonged social isolation in addition to the “political” religious level beliefs that people have about covid, vaccine, rights, etc. There is far more hate everywhere than there was 3-4 years ago and it is just feeding itself and getting worse.

We’re heading for something really, really, really bad and it’s made me reconsider a lot of things. So no you’re not alone, you’re actually a part of the majority.

 

[GonnaBeADoc2222]

Let's face it: the work sucks.

The suckage is compounded by gaslighting administration who do everything they can to squeeze more, yet give nothing in return.

As an example, my job would honestly be so much enjoyable if equipment were stocked and patients were gowned. I have asked for these two simple things - that don't cost a dime - so often, that now I don't ask anymore.

I like the advice above to spend more time with normal patients. I do that and it helps a lot. Literally just shoot the **** about whatever: sports, travel, local restaurants, etc. Normal patients are a joy to treat and it keeps me going.

I also find it helpful to ignore admin, where possible:

1) I play music at work. It keeps things light and the staff also enjoy it. Admin told me to not play it but I do it anyway because it makes me happy and if a surgeon can listen to music in the OR, why can't I?

2) I don't sign into early ass morning dept meetings - they aren't contractually obligated, and I am not paid for my time - so why would I attend?

3) I never pick up extra shifts. I ignore panicked texts and emails begging for coverage. If you aren't offering me 2x like the nurses get, why would I ever pick up? I never arrive early. I never leave late. I never do charts at home.

Oh and, don't be afraid to call out a few times a year for whatever reason. God knows the nurses do it enough.

If you're going to treat me like a burger flipper, I will behave like a burger flipper.

 

[bravotwozero]

+1 for NOT picking up extra shifts. Since I earn all I need by working the minimum 120 FT hours, there isn’t much incentive to work more and my free time becomes more valuable, in terms of less griping from the wife, more gym time etc.

 

[avatarftw]

Maybe try a 9-5 clinic based job with scheduled patients who you get to know, who comes in only for annual physical and with no new complaint, and who you can fire if you don't mesh.

As a primary care doc I must say that it's not exactly like this. There is no perfect job and some jobs are better in some ways and less pleasant in others.

Some patients come in for a physical, chronic back pain for 20 yrs, handicap parking application, etc for their 20 min visit.

Then drop off disability forms that you had not discussed with the patient in your initial visit. And they'll drop the forms off and ask you to fill them out since the deadline is in a few days.

And you're told to address everything in 20 min while doing preventative health orders such as a pap smear, diabetes screening tests, vaccination updates, etc.

In regards to firing patients there are health care systems where patients almost never get fired.

 

[Franzd'Epinay]

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

I have no idea what the answer is to your specific case of burn out. Maybe you need to take a few months off. Maybe you need to work fewer hours. Maybe you need a different job. Maybe you need to change specialties. Maybe you need to leave medicine. I don't now.

But I do know you need an exit plan from EM, even if you never end up using it. And no, sticking it out for 3,4,5 more years and retiring isn't a realistic exit plan--not in the state you are, at least. You need to think ahead so that you are not starting from scratch when the day comes that you can never set foot in the ED again. Your exit plan probably needs two parts: a stop-gap job to make money, and a more long-term strategy for your career.

Good luck; I hope things start looking up for you.

 

[SeekerOfTheTree]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

This is exactly me...the same amount of time out of residency.

 

[SeekerOfTheTree]

You have the same issues as most other specialists and people in general. Look around and most work bc its a job that pays the bill.

You make 300K working 12 -14 dys a month. Most make 100K working 20-24 dys a month.

Cut back to 4 dys a month, make 100K, and find something else that you enjoy.

People would kill to make 100K working one day a week. Trust me, grass is not greener.

How hard is it to go part-time when one is hospital employed? Have many done this?

 

[e30ftw]

...I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

OP you seem stuck in a negative feedback loop where you get dopamine from hating EM. AKA burnout.

Realism is useful; existential nihilism is generally harmful.

The fact that you don't care about your patients actually may indicate competency; you are no longer intellectually stimulated by 99.99% of your patients.

Now you are free to find a reason to pursue your morally and financially valuable profession beyond intellectual growth for reasons of self-preservation.

Find something you enjoy on-shift and make a conscious effort to appreciate it. It can be something common like a nice, crisp, normal EKG, or less common like a hip reduction.

Lower your expectations for patients. They are often ignorant and confused and lash out unpredictably.

Humor is invaluable.

You have neither the ability nor responsibility to solve systemic problems in healthcare so the COVID patient who demands unnecessary treatment despite refusing the vaccine is quite funny considering the financial implications of their decisions. The ED is one of the best people watching venues in human history and the humor you create with colleagues is one of the best parts of the job.

My expectations for patients are way low. When I intubate or treat a chronic COPDer, the goal of treatment is to allow the patient to smoke another carton of cigarettes prior to ED bounceback, and I have no problem with that as it gives the patient enjoyment and provides me with income. I obviously tell them to stop smoking every time but recognize it's futile.

The last thing I did on-shift tonight was bring a lunch-box to a homeless guy who took a bus from another ER across town because it was cold. His whole face lit up in joy and it was obviously a scam but I didn't care because it felt good inside and he was then discharged.

 

[namethatsmell]

How hard is it to go part-time when one is hospital employed? Have many done this?

Certainly can be done...it just depends on their need. You need to ask as they often won't advertise this as being an option.

If they're desperate, or happen to have a lot of PTers and have found a way to make it work with their schedule then not a problem.

But for the more sought-after shops that rarely hire or places with no PT folks, it can be tough. For these places, I've seen two strategies work to get PT:
1) offer to work mostly their least-desired shifts (ie swings/weekends/overnights) or
2) start out FT there and prove to everybody how lucky they are to have you and how much you improve morale, and then after a year or two explain that you either need to go PT for [insert your rationale] and explain you'd rather stay PT with them than leave for the competing group in town that'd let you

 

[deleted1114045]

Duty- Remember the Socratic oath. You swore to the people admitting you to medical school and residency that you would use your mental and physical abilities to heal people. Be honorable. Fulfill your oath.

Gratefulness- We live in the most luxurious and abundant age of the entire history of this planet. As an ER doctor, you live in living quarters that are warmer, cleaner, and more comfortable than even kings could hope for or afford 200 years ago. You have a job that is easier physically than 99 percent of jobs out there. 200 years ago, you would have been in a field, hunched over pulling weeds and tending and harvesting crops all day long. There is a good chance that you would have been dead by your age. The amount and variety of our food, clothing, literature, and information at our disposal is extraordinary. We have cleaner water, faster transportation, better medicine, and better communication than ever before. Your problems are first world problems. Suck it up and remember the amazing gifts you’ve been given. This is a special time in the history of the world. Enjoy it. This thanksgiving, enumerate the number of privileges that you enjoy, from having a paying job, to being intelligent enough to get into medical school, to having a childhood that granted you an education that 99.999% of the people who have ever been on the planet were never granted. Write a list of your privileges, pretending that if you don't write it down, you won't wake up with it in the morning. I'm talking pistachio pudding, toilet paper, computers, the internet, shoes, concrete, chlorine, tomatoes, bread, fire, electricity. If you don't end up with a list in the hundreds, you haven't completed the project.

Forgiveness- Now this is a tough one. The patients you describe seem to be on the borderline personality disorder side. Because PCPs often fire borderlines, or at least, tell their staff not to make them available, they go to the ER out of medical necessity, as they require more attention than most sane physicians or midlevels are willing to give them. They are a disproportionate number of our psych patients, as they love overdosing and then sharing it with everyone around them as a form of emotional manipulation. (The worst are the romantic companions who try to break up with borderlines, only to have them attempt suicide. They come to the ER and sit there forlornly knowing they would feel awful if the patient actually killed themselves. The borderline exhudes happiness as their plan worked perfectly in their minds. I'm tempted to whisper... you are a good person... but run!) You’ve got to forgive them for their intractably bad personality. By definition, they’ve been through hell as children. They grew up in chaotic homes that were so abusive that they were never treated like they were worth anything. They were usually sexually abused, and their whole lives revolve around trying to convince people that they are worth listening too and giving compassion to. They spend their whole lives trying to find somebody who will actually treat them with love. They never had an example of compassion or reasonable behavior, so they resort to emotional manipulation, either crying, yelling, or threatening to hurt themselves or other people to get their way. I believe that borderline personality disorder is an epigenetic disease characterized by primal genes that are turned on in youth as a result of warlike conditions (brutality, screaming, rape, etc.) These conditions, in some people, turn on genes that allow people to survive in these conditions by being brutal, screaming, and threatening harm to anybody they are afraid will hurt them. Few of them can change their behaviors or learn to interact meaningfully with society. I grew up with a mother that was borderline personality disorder. I don’t like her. I try to love her. But ultimately, I just don’t go out of my way to interact with her. I try to politely, but firmly establish firm boundaries and not get drawn in to the drama. Borderline people live for the drama, and the way that they can manipulate people through their actions. When they see firm boundaries and a disinterested opponent, they generally go away. Just realize that they fear more than anything, that you will hurt them like they were hurt as children. Quietly reassure them that you will do everything that is medically indicated and in your power to help them. It is fine to be dispassionate, but don’t lose your temper.

Realize that I identify with your struggle more than you can possibly know. I am preaching to myself as much as I am preaching at you.

 

[Apollyon]

"By Apollo, and Hygeia, and Panacea", IIRC.

 

[Birdstrike]

I don’t know how to mentally or emotionally deal with the garbage.

I felt exactly like this, 6 years post residency. It took a long time to finally conclude that it wasn't me that was broken and wasn't my particular job site that was broken. But that EM itself was broken. I concluded that no amount of job switching would be a viable solution, that the only effective solution was going to be a large reduction in shifts. I decided to go for the home run, a reduction of emergency department shifts, to zero. I left EM and 90% of those feelings are gone. I've been consistently much happier and more content since I left EM 10 years ago.

I still take care of patients. So, I still have frustrations with how people are, how much of their misfortune is brought upon themselves, how little so many do to help themselves. I think all doctors in all specialties feel some amount of emotional exhaustion. But I cannot underestimate how much those feelings of dehumanization, dissolution and general dysphoria are magnified by the chronic circadian rhythm effects, that are so severe in EM. Having normal sleep, all the time, goes a long, long way.

About six weeks after my last (ever) EM shift, my wife said, "You're personality has changed." She noticed that I wasn't so negative, sarcastic, disgruntled and in a bad mood all the time. My general outlook on life, everything about life, became much more positive. The surprise isn't that I was happier, but that it took SIX FRICKIN' WEEKS for the circadian rhythm dysphoria to wash out of my system. It's downright physiologic, not just emotional.

I still had PTSD from my EM experiences for about 2-3 years. That's why I wrote all of those vivid stories here on SDN EM, EP Monthly/White Coats Call Room, that many of you read. But once I spit those experiences out, that had been rattling around in my head out onto the screen in words, and experienced them again through other people's reactions, they were gone. I had finally made the mental, emotional and spiritual break from EM, to lock those years away in a tiny box, far back in my brain, and throw away the key for good.

I'm proud that I did the work for over a decade (if you include residency). I was good at what I did. But I didn't have it in me to do it for 30 years. Some people have a 40 year EM fuse. I had a 10 year fuse. And that's okay.

Also, be aware there's a tremendous amount of dishonesty in EM culture. A culture of brainwashing that EM is great in so many ways it's not and that it's flaws are actually flaws in you. It's all lies. The very survival of EM depends on a culture of gaslighting the entire workforce into believing that the flaws in the system, in EM itself, are flaws in you. That if you just flip a certain switch in yourself, or view things differently, or make a minor adjustment you didn’t think to make, EM will be what they told you it was. Look up the definition of “toxic positivity.” It’s used with reckless abandon in EM culture.

You'll find your way through this, @emdoc799 . But it's going to take some hard work. And you're going to have to be 100% honest with yourself. But it will be worth it.

 

[BoardingDoc]

"By Apollo, and Hygeia, and Panacea", IIRC.

Wouldn't know. My med school gave us all white coats when we first started. Our white coat ceremony involved giving it back to them so that they could formally present it to us. I thought that was rather idiotic and so I didn't go. Turns out that was also the day my class all took the Hippocratic oath. Whoops?

As to OPs issue: work less. Spend lots of time with normal nice patients, spend as little time as possible with the annoying ones. Spend time talking with your colleagues about random interesting things.

 

[Apollyon]

Wouldn't know. My med school gave us all white coats when we first started. Our white coat ceremony involved giving it back to them so that they could formally present it to us. I thought that was rather idiotic and so I didn't go. Turns out that was also the day my class all took the Hippocratic oath. Whoops?

As to OPs issue: work less. Spend lots of time with normal nice patients, spend as little time as possible with the annoying ones. Spend time talking with your colleagues about random interesting things.

Dude, I was just being snooty. In any case, I forgot Asclepius, and spelled Hygieia wrong!

 

[dchristismi]

You're totally normal, your skin is perfectly thick, and finding just a teensy bit of good in the tidal wave of bad does help tremendously.

In fact, one bit of good does a lot to negate the bad. But yeah, you're among friends, vent away, and you do sound utterly burned out, which is a system problem, and not sometime you can inherently fix with yoga, meditation or vacations. (Because lord knows, that's been tried.)

I don't have thick skin. I left EM but have some pretty deep scars from those days and Birdstrike is absolutely right about how the EM culture gaslights us into thinking that we are the problem. It's exhausting.

FWIW, I now have a different kind of emotional drain but it's because of my patient population... and helping them deal with some pretty heavy stuff. The fact that "existential suffering" is something I actually get to manage now leads to different challenges. Deeper ones. But I still have crispy days. Weeks even. Because sometimes people just suck.

 

[dadaddadaBATMAN]

Duty- Remember the Socratic oath. You swore to the people admitting you to medical school and residency that you would use your mental and physical abilities to heal people. Be honorable. Fulfill your oath.

Gratefulness- We live in the most luxurious and abundant age of the entire history of this planet. As an ER doctor, you live in living quarters that are warmer, cleaner, and more comfortable than even kings could hope for or afford 200 years ago. You have a job that is easier physically than 99 percent of jobs out there. 200 years ago, you would have been in a field, hunched over pulling weeds and tending and harvesting crops all day long. There is a good chance that you would have been dead by your age. The amount and variety of our food, clothing, literature, and information at our disposal is extraordinary. We have cleaner water, faster transportation, better medicine, and better communication than ever before. Your problems are first world problems. Suck it up and remember the amazing gifts you’ve been given. This is a special time in the history of the world. Enjoy it. This thanksgiving, enumerate the number of privileges that you enjoy, from having a paying job, to being intelligent enough to get into medical school, to having a childhood that granted you an education that 99.999% of the people who have ever been on the planet were never granted. Write a list of your privileges, pretending that if you don't write it down, you won't wake up with it in the morning. I'm talking pistachio pudding, toilet paper, computers, the internet, shoes, concrete, chlorine, tomatoes, bread, fire, electricity. If you don't end up with a list in the hundreds, you haven't completed the project.

Forgiveness- Now this is a tough one. The patients you describe seem to be on the borderline personality disorder side. Because PCPs often fire borderlines, or at least, tell their staff not to make them available, they go to the ER out of medical necessity, as they require more attention than most sane physicians or midlevels are willing to give them. They are a disproportionate number of our psych patients, as they love overdosing and then sharing it with everyone around them as a form of emotional manipulation. (The worst are the romantic companions who try to break up with borderlines, only to have them attempt suicide. They come to the ER and sit there forlornly knowing they would feel awful if the patient actually killed themselves. The borderline exhudes happiness as their plan worked perfectly in their minds. I'm tempted to whisper... you are a good person... but run!) You’ve got to forgive them for their intractably bad personality. By definition, they’ve been through hell as children. They grew up in chaotic homes that were so abusive that they were never treated like they were worth anything. They were usually sexually abused, and their whole lives revolve around trying to convince people that they are worth listening too and giving compassion to. They spend their whole lives trying to find somebody who will actually treat them with love. They never had an example of compassion or reasonable behavior, so they resort to emotional manipulation, either crying, yelling, or threatening to hurt themselves or other people to get their way. I believe that borderline personality disorder is an epigenetic disease characterized by primal genes that are turned on in youth as a result of warlike conditions (brutality, screaming, rape, etc.) These conditions, in some people, turn on genes that allow people to survive in these conditions by being brutal, screaming, and threatening harm to anybody they are afraid will hurt them. Few of them can change their behaviors or learn to interact meaningfully with society. I grew up with a mother that was borderline personality disorder. I don’t like her. I try to love her. But ultimately, I just don’t go out of my way to interact with her. I try to politely, but firmly establish firm boundaries and not get drawn in to the drama. Borderline people live for the drama, and the way that they can manipulate people through their actions. When they see firm boundaries and a disinterested opponent, they generally go away. Just realize that they fear more than anything, that you will hurt them like they were hurt as children. Quietly reassure them that you will do everything that is medically indicated and in your power to help them. It is fine to be dispassionate, but don’t lose your temper.

Realize that I identify with your struggle more than you can possibly know. I am preaching to myself as much as I am preaching at you.

@Birdstrike taught me a wonderful new term today:

Per google: Toxic positivity involves dismissing negative emotions and responding to distress with false reassurances rather than empathy.

I was trying to succinctly write what was rustlin’ my jimmys about this post, and that’s it.

“Don’t try to walk out of the fire, be grateful the coorperate overlords placed you in it! Never have the flames of industry burned so bright!”

Ronweasley7 you seem like you’re trying to do some good work, and forgiveness is a great thing to work towards, especially towards someone who hurt you like that. Gratitude is a useful tool, but if it is used to blind yourself it can be harmful too.

However, if you’re talking more for yourself than the op I wonder if it really is helpful for him to process the self-flagellation you’re experiencing.

I think compassion/empathy is more helpful here.

For the op, I find hating people exhausting. I briefly hated my patients intern year and 2nd year when I was very burned out.

I am now very neutral towards the vast majority. Hate takes an awful lot of energy.

I *nothing* the high energy patients like borderlines and screamers. It’s like putting them in the vacuum of space, it’s incredibly effective. When it doesn’t work I escalate to ejection/escort out or chemical restraints quickly and unemotionally after giving 1/2 solid but very very brief verbal de-escalations. The nurses will love you for being “calm.” This makes people happy you’re there, and makes work better.

and when I find a kind or thoughtful person I spend additional time making sure they are emotionally taken care of. This gives me back as much as it gives them.

But considering I’m hitting the eject button as well maybe I’m not the best to ask

 

[emdoc799]

Wow, I truly appreciate the responses and honestly just the time people took to read. It felt good to rant and I don’t regret it. It means a lot to me not only because of the content of your responses but even more so because I’ve never had this meaningful of dialogue with actual peers. And I don’t know any of you personally (I think). Validation can be very empowering. So thank you. I think some of the wisdom you all shared will probably help extend my clinical career.

The truth is though that I either did not pick the right specialty or that it just isn’t a good fit for my personality anymore. When I leave I will carry valuable lessons with me to whatever comes next.

Please keep the conversation going. Not necessarily here but with your colleagues or otherwise. This thread proves others feel similarly and people might not be comfortable initiating the conversation with others.

 

[betamale]

I tried a couple of telehealth services recently as a patient for prescriptions, tests...and they were awesome. As a doc, you get to screen the consults and pick up whatever you want to respond to. As a matter of fact, looks like Push Health is free app and founded by an EM doc (I might actually sign up myself 🤔). Try it, good luck 🙂

 

[robellis]

Looking for genuine thoughts and advice from seasoned EM docs. I’m truly at a crossroad in my career and every day am on the verge of resigning, and not because of the reasons frequently discussed such as CMGs, metrics, admin, etc.

I don’t know how to mentally or emotionally deal with the garbage. Yes I see a therapist and they are helpful but since I’m not in a position to talk about this to others in my group, I am interested in the opinions that all of you can offer., since you live it every day. My group (an SDG) has some good people but others will stop at nothing to completely backstab you and think nothing of it. Because of this, I can't reveal to them what they would consider a significant weakness. Overall the group is good, and is not the reason I will leave EM.

I think it’s been highlighted by the pandemic, and how it brings out the stupidity in people, but I have found increasingly often that I hate my patients. Every single one of them. I honestly don’t care if they live or die. I don’t care about their complaints, their health, their pathology, their living situation, or anything else about them.

I don’t know how to reconcile these situations in my mind (we have all been here):

• The person who waits 6 hours in the waiting room for a cold/runny nose/musculoskeletal pain/chronic pain/asinine complaint then is pissed you can’t instantly fix them
• The covid patient who has an insane amount of scrutiny for the vaccine but somehow zero for the “infusion”, because they look at it as a quick fix
• The patient who had a major procedure/complications at another hospital who shows up to my (a different system) ED expecting me to be able to offer them all of the resources they need, have all of their records from the other hospital, and produce a specialist who can/is willing to deal with their complications
• The patient who comes in for an idiotic complaint requiring no workup but demanding all kinds of stuff, then 5 minutes later asks how long it will be until they can leave
• People who want things to be wrong with them

Obviously these might be minor annoyances to some, and I probably let a lot of this get under my skin when I shouldn’t, but as hard as I try, I cannot get past some of these things and the absolute lack of accountability, logic, and thought process. Furthermore, I feel like I never actually help anyone, and don’t know if I even want to anymore. Yes status epilepticus is cool, but then I remind myself its from their chronic alcoholism, and I go back to hating the patient and blaming them. As horrible as it sounds, I do not care about and have exactly zero sympathy for people with covid, people with addiction, chronic pain, anyone with COPD, any intoxicated person, anyone with an injury related to doing something dumb, or anything related to a bad habit. Even as I type this, and look at what I'm writing, I feel like I should not be practicing medicine.

I'm not looking for "get more hobbies". I have plenty that make me very happy and feel fulfilled, and take my mind off of work. As said above I also see a therapist regarding some of these issues and do occasionally find mindfulness helpful. Am I being too idealistic, and just need to get thicker skin and stop complaining?

I appreciate the time of anyone who read my rant and has some genuine non-sarcastic advice. I am relatively early in my career (6 years post residency) and want to get a few more years in for financial reasons only, and am trying to do whatever I can to let myself stand it for that long before I get out.

Find a different career if that’s financially possible asap

 

[Dr Meow]

Yes. Lots of people are stupid, short sighted, uncaring, brutish, ignorant, arrogant, entitled, etc.

There's possibly another way to think about this:
And that is to have No Opinion of them.

Don't judge them as good or bad. Just think nothing of them. Do your work as just work (which is what this is anyways). Work is work. Keep your personal thoughts out of it.

Don't let them change you. And you don't try to change them. You're not their savior. You have only legal responsibilities to them.

In all relationships, both work and family, it's good to keep some personal distance (and obviously with work, you keep a HUGE personal distance) or else you will be BURNED, MANIPULATED, DEMOTED, and SCREWED hard.

 

[xaelia]

In all relationships, both work and family, it's good to keep some personal distance (and obviously with work, you keep a HUGE personal distance) or else you will be BURNED, MANIPULATED, DEMOTED, and SCREWED hard.

🥶