Interesting question regarding the stress. I’ll preface my long winded post by saying it probably doesn’t answer either of your questions but hopefully you find it useful some day.
Stress is an ubiquitous component of any emergeny physician’s life. Although its generally ever present, what you’ll find over time is that the things that stress you out tend to change and are directly related to an individuals stage in their career. For instance, in residency, you’ll see roughly 10K patient cases. You’ll need roughly 20-25K to really master the specialty. Prior to 25K, you tend to worry about management centric issues such as accurate diagnosis, accurate management, not killing anyone, procedural competency, really mastering your craft, etc.. Once you’ve surpassed 20-25K, (not based on any science, just my personal opinion) you’ve got a really well formed gestalt based on pattern recognition having seen thousands and thousands of cases and should really know your emergency medicine cold by then. There’s a decreased cognitive load regarding the actual diagnostics and medical management after this point. What I found prior to this level is that there was more of a daily frenetic, sympathetic and adrenergic surge where my physical state was reflected by my emotional/mental stress level. My heart rate was up, my blood pressure was up, I might be sweating a little, etc.. In my personal opinion, that daily physical stress level is what is really bad for your health long term. Anyway, once past 20-25K, it becomes easier to dial that down and reach what I call “zen mode” on a daily level. Always calm, cool, collected and even keeled. Code? Intubation? GSW dropped off at the door? You can more easily reach a point where your heart rate, respiration, blood pressure, stress level are all very relaxed and calm even in the midst of a potentially chaotic situation. After this turning point in your career, you’ll find that other things stress you out just as equally but in different ways. You’ll find yourself thinking more about administrative gauntlet running whether it be metrics, LOS, sepsis bundle compliance, MIPS compliance, etc.. You’ll also find yourself worrying more about litigation and malpractice and might find yourself practicing more defensive medicine.
So, stress by no means goes away, but in my opinion it becomes much more manageable as you go along. For instance, I’ve probably seen about 50K cases plus or minus (and many on here have seen >100K cases or more). It took me a few years to really master that concept of “finding your zen” during a shift. I consciously strive on a daily level when working in the ED to remain calm, cool, collected and focused. I try to objectively pull my “minds eye” back from the magnified distortion of fleeting circumstantial frustrations and choose not to hook into disgruntled patients, angry consultants, etc.. I really think that concept is key to longevity in this field because let’s face it....if you’re running around every day with armpits sweaty, heart racing, adrenaline surging, you’re probably going to “retire early” with a heart attack in your 50s. Anyway, it sounds easy but it was one of the most difficult concepts to wrap my brain around and truly master as an attending but is crucial to controlling your stress in the long term while working in a busy emergency department.
