Hey guys, I am looking for some thoughts on this subject. I've been following this forum since I was a pre-med and have learned a lot from you EM vets.
I have thought a lot about wellness and am very passionate about it, but I found myself dumbfounded by the general cultural of medical education and what I perceive as denial about its many problems. I realize this is not just EM, but I am posting this here because I believe we are one of the more progressive specialties less afraid of change and I value the opinions of my EM colleagues.
For background, I am a PGY3. I am a happy person in general. I like to have fun on shift and generally have great rapport with my colleagues and other staff. I am doing fairly well clinically, objectively and subjectively, and am also involved in a fair amount of extra curricular stuff like research. It’s usually hard for me to brag, but I have the cover of anonymity and I really wanted to stress that despite the rant to come, I am not a sadsack or complainer. I am also the only doc in my family so my experience is colored by the fact that the world of medicine was foreign to me before starting this process.
I went to a decent med school and they were pretty innovative and supportive of students. But there was still the usual culture of breaking you down (which I find an interesting contrast to nursing which seems just the opposite). The message always seemed to be “you are so privileged to be here. You are here to become a servant to humanity.” Like most, I was kinda ok with that because of course I just wanted to “help people.” And fortunately, I still do. So I endured the condescension of having to be “taught” empathy. I spent the endless hours studying and standing around on wards with my d@ck in my hand trying not to think about how much I was paying for the “opportunity.” Most people were nice, but of course there was the usual collection of jerks who made my classmates cry, the sexism, the racism, the belittling. But whatever, that’s life. Right? It enraged me to be treated like a child, especially since I had worked my butt off to get there. I had already made sacrifices. I worked in high school and undergrad. I made sure I did well in school so I could reach the next step. But I dealt with the slights because I wanted to be a good doc and I guessed that was how it had to be done. I think that’s why I hated med school despite still being a pretty content, fun-loving person.
Then I became a resident. It was the best thing ever. I love my specialty. I get to be a bada$$ every day. I get to hear the coolest stories, work with the coolest people. My department became my family, kinda dysfunctional, but generally awesome. It was a million times better than med school because I actually got to do stuff. I was finally helping people. There are times when I think about how cool I thought it would be back in med school to actually be an ER doc. Now I am and it’s a surreal feeling- a great one.
But I’m tired. The shift flipping. The night shifts that take me days to recover from. The millions of outside obligations. The f@$%ing kids that decide to die on me and the screams of their parents. The expectation that I will not be hurt by that. The patients that tell me they’ll sue when they don’t get the D. The never-ending emails asking me why I haven’t logged this or that. The consultant making me feel like an idiot even when I gave the right treatment. The surgery residents pushing me aside in a trauma. The nurse second guessing my orders despite me having already discussed with my attending. The guilt for being too tired to study and worrying I won’t be a good doc to my patients. The feeling of failure when I made a mistake, even when no one was hurt.
They taught us how to be compassionate to our patients. But no one taught us to be compassionate to ourselves or each other. They say “you have to be tough” or “have this skin” to do this job. That statement angers me. We are all just humans with different life experiences and vulnerabilities. I am tough. I have been through things way worse than med school or residency as I am sure many others have (though we’d never talk about it). I know I can handle anything. But it doesn’t mean I just float through this stuff unscathed. It affects me like it does everyone else. Our empathy and sensitivities are seen as an achilles heel in this field, but it should be our superpower. It makes us a good. It keeps us human.
A couple times I have asked a colleague if they are ok after a particularly bad case. They always shrug and say “of course, I’m fine.” I’d probably say the same. And in the moment I am fine. I’m a fine-tuned EM machine. I got more patients to see. Just saw a raped teen? No problem. I’m off to joke with some old lady about how I’m a doogie howser.
I’m an expert at telling people their loved one died. No one taught me how to cope with it myself.
I’m great at finding all the things I screwed up. No one taught me that it’s normal to screw up and that everyone else does the same.
I think of all the things I would love to do to change the culture, but I am often met with the same responses.
I propose we get positive feedback (a well known technique for getting happy productive workers in the business world), and they say “oh toughen up.”
I propose we have more sleep friendly schedules, and they say “we had to do q1 call so this is nothing.”
I say we can do better to prevent burnout and make happier docs, and they roll their eyes like I’m confirming the fact that I’m just another spoiled millennial.
The only people that seem to be upset about all this are the grumpy whiners who are never content and no one listens to them. But I am here as a happy person who wants to keep my compassion and enthusiasm. And I am saying WTF? We can do better than this archaic system. We can care about each other like we care about our patients. And if we can’t do that on that principle, then maybe we can do it if we remind ourselves that it will make us better doctors. It’s not easy, but it is simple I think. If we look at what actually improves resident wellness, it’s stuff like sense of control and autonomy, positive feedback, reaching goals, collegiate environment, reducing obligations. But instead we feel out of control, criticized, judged, overburdened. I try to do things for my junior residents to encourage them, but I’m just one person. And I feel like everyone is in denial about what actual wellness is. I feel like if I say something, I’m just a whiner or a pu$$y. And I want to do something in my career to support those that feel burned out or overwhelmed, or even suicidal. But if we don’t acknowledge this, what hope do I have to make a difference?
I try to talk to some of my friends and they act like I’m crazy. Are they just indoctrinated? Can we please acknowledge that this job is like nothing else and it is hard and crazy and sometimes traumatic? Can someone please tell me that they feel the same? And if people do, can we please place the same importance on emotional intelligence that we do on cognitive intelligence?
I have thought a lot about wellness and am very passionate about it, but I found myself dumbfounded by the general cultural of medical education and what I perceive as denial about its many problems. I realize this is not just EM, but I am posting this here because I believe we are one of the more progressive specialties less afraid of change and I value the opinions of my EM colleagues.
For background, I am a PGY3. I am a happy person in general. I like to have fun on shift and generally have great rapport with my colleagues and other staff. I am doing fairly well clinically, objectively and subjectively, and am also involved in a fair amount of extra curricular stuff like research. It’s usually hard for me to brag, but I have the cover of anonymity and I really wanted to stress that despite the rant to come, I am not a sadsack or complainer. I am also the only doc in my family so my experience is colored by the fact that the world of medicine was foreign to me before starting this process.
I went to a decent med school and they were pretty innovative and supportive of students. But there was still the usual culture of breaking you down (which I find an interesting contrast to nursing which seems just the opposite). The message always seemed to be “you are so privileged to be here. You are here to become a servant to humanity.” Like most, I was kinda ok with that because of course I just wanted to “help people.” And fortunately, I still do. So I endured the condescension of having to be “taught” empathy. I spent the endless hours studying and standing around on wards with my d@ck in my hand trying not to think about how much I was paying for the “opportunity.” Most people were nice, but of course there was the usual collection of jerks who made my classmates cry, the sexism, the racism, the belittling. But whatever, that’s life. Right? It enraged me to be treated like a child, especially since I had worked my butt off to get there. I had already made sacrifices. I worked in high school and undergrad. I made sure I did well in school so I could reach the next step. But I dealt with the slights because I wanted to be a good doc and I guessed that was how it had to be done. I think that’s why I hated med school despite still being a pretty content, fun-loving person.
Then I became a resident. It was the best thing ever. I love my specialty. I get to be a bada$$ every day. I get to hear the coolest stories, work with the coolest people. My department became my family, kinda dysfunctional, but generally awesome. It was a million times better than med school because I actually got to do stuff. I was finally helping people. There are times when I think about how cool I thought it would be back in med school to actually be an ER doc. Now I am and it’s a surreal feeling- a great one.
But I’m tired. The shift flipping. The night shifts that take me days to recover from. The millions of outside obligations. The f@$%ing kids that decide to die on me and the screams of their parents. The expectation that I will not be hurt by that. The patients that tell me they’ll sue when they don’t get the D. The never-ending emails asking me why I haven’t logged this or that. The consultant making me feel like an idiot even when I gave the right treatment. The surgery residents pushing me aside in a trauma. The nurse second guessing my orders despite me having already discussed with my attending. The guilt for being too tired to study and worrying I won’t be a good doc to my patients. The feeling of failure when I made a mistake, even when no one was hurt.
They taught us how to be compassionate to our patients. But no one taught us to be compassionate to ourselves or each other. They say “you have to be tough” or “have this skin” to do this job. That statement angers me. We are all just humans with different life experiences and vulnerabilities. I am tough. I have been through things way worse than med school or residency as I am sure many others have (though we’d never talk about it). I know I can handle anything. But it doesn’t mean I just float through this stuff unscathed. It affects me like it does everyone else. Our empathy and sensitivities are seen as an achilles heel in this field, but it should be our superpower. It makes us a good. It keeps us human.
A couple times I have asked a colleague if they are ok after a particularly bad case. They always shrug and say “of course, I’m fine.” I’d probably say the same. And in the moment I am fine. I’m a fine-tuned EM machine. I got more patients to see. Just saw a raped teen? No problem. I’m off to joke with some old lady about how I’m a doogie howser.
I’m an expert at telling people their loved one died. No one taught me how to cope with it myself.
I’m great at finding all the things I screwed up. No one taught me that it’s normal to screw up and that everyone else does the same.
I think of all the things I would love to do to change the culture, but I am often met with the same responses.
I propose we get positive feedback (a well known technique for getting happy productive workers in the business world), and they say “oh toughen up.”
I propose we have more sleep friendly schedules, and they say “we had to do q1 call so this is nothing.”
I say we can do better to prevent burnout and make happier docs, and they roll their eyes like I’m confirming the fact that I’m just another spoiled millennial.
The only people that seem to be upset about all this are the grumpy whiners who are never content and no one listens to them. But I am here as a happy person who wants to keep my compassion and enthusiasm. And I am saying WTF? We can do better than this archaic system. We can care about each other like we care about our patients. And if we can’t do that on that principle, then maybe we can do it if we remind ourselves that it will make us better doctors. It’s not easy, but it is simple I think. If we look at what actually improves resident wellness, it’s stuff like sense of control and autonomy, positive feedback, reaching goals, collegiate environment, reducing obligations. But instead we feel out of control, criticized, judged, overburdened. I try to do things for my junior residents to encourage them, but I’m just one person. And I feel like everyone is in denial about what actual wellness is. I feel like if I say something, I’m just a whiner or a pu$$y. And I want to do something in my career to support those that feel burned out or overwhelmed, or even suicidal. But if we don’t acknowledge this, what hope do I have to make a difference?
I try to talk to some of my friends and they act like I’m crazy. Are they just indoctrinated? Can we please acknowledge that this job is like nothing else and it is hard and crazy and sometimes traumatic? Can someone please tell me that they feel the same? And if people do, can we please place the same importance on emotional intelligence that we do on cognitive intelligence?
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