It’s 5:14 AM. I’ve been here since 11 PM. In my younger days (I’m 35) I might still be awake, having drank more beverages than I would recommend my patients drink. But nope, I’m at work.
I’ve just put down an article Emergency Medicine News talking about how bad night shifts are for you. It’s “the equivalent of being legally intoxicated” according to Pat Croskerry, MD, PhD who is a professor in emergency medicine at Dalhousie University in Halifax, Nova Scotia, Canada. It affects relationships, health, mood, reaction time, judgement. Haney Mallemat is quoted as saying “hospitals need to be aware that this is not just a comfort issue but an issue of physician health and patient safety.”
And yet here I am. I’m in my 2nd year out of residency in emergency medicine. This is my second job in 2 years. I hear that’s not abnormal, to have switched jobs within the first few years out of residency. At my previous place of work I would be much more busy than I am right now. I have less than two hours in my shift and I’ve seen 2 patients. I haven’t made much money tonight since we, like many in EM, are RVU based. There’s a night stipend, which helps a little bit. I did get about 30 minutes of sleep so I have that going for me. Helps a little bit since we have a 4 week old at home.
I decided to make this website as an ode to emergency medicine. To discuss the trials and tribulations of the job. To helps us all realize that we’re all thinking the same thing even though it might seem “weak” to say it out loud. I made a mistake. I missed a diagnosis. I caused harm to my patient or delayed their care and now I feel sick to my stomach. There are plenty of websites with much smarter people than I that explain ECGs and procedures and making those difficult diagnoses. This won’t be one of those sites.
Since residency I haven’t been able to shoot the shit as much with people who understand the job. During residence we were all going through the same game. We met regularly at Grand Rounds, Happy Hour, house parties, conferences. As an attending that stuff doesn’t happen anymore. My wife is an architect. She listens to anything and everything I say to her after a long day or night shift but probably doesn’t exactly understand why I’m anxious or discouraged or excited. Recently I’ve joined a Facebook page called EM Docs that has helped because it lets you ask things and vent about things and brag about things related to EM that only EM docs would get. Things like “I just got subpoenaed” and “what’s the highest alcohol level you’ve seen in a ‘walkie talkie’ person?” or “what would you have done in this case?”
The goal of this website is for it to serve as a coach, a counselor, a collection of stories to help us in emergency medicine learn and better understand ourselves, our wins, our losses and all the gray in between. Atul Gawande has been instrumental in breeching the subject of coaching in medicine. Professional athletes, musicians, the POTUS all have coaches in one form or another. Why don’t physicians? Partly because a lot of us have egos. But I think it’s a fantastic idea. Following the ideas of Dr. Anders Ericsson and his idea of Deliberate Practice, the way we truly improve is to practice beyond what we are able to currently do. Here’s the link: http://www.wnyc.org/story/how-become-great-just-about-anything/. It’s great. We have to push the boundary without breaking. Which feels kind of like what we do everyday we go to work. We all make mistakes. Let’s figure out why it happened and figure out how to keep it from happening again. We all go to residency in order to become board certified physicians. We all have great teachers from residency who essentially were our coaches. Now that we’re out on our own do we really not need coaches any more? Can we truly say we’re improving our practice of emergency medicine without constant feedback? I know your director has meetings with you regularly but do they really get specific about how to change for the better? Or more likely, does it go something like this: Hey Rex, you’re doing a pretty good job. The nurses and staff like working with you. Looks like you’re a high CT scan utilizer – maybe you can work on that. Looks like you missed that one MI last month – try not to do that in the future. Your Press Ganey scores are ok – try to please all of your patients. I think that we all come home from a day of work and wonder if something could have been done different, better, more efficiently. I think medical coaching can help explore those thoughts and help us to be better.
Only an hour left of my night shift. Woohooo! Should I have a morning beer when I get home? If only I had some residency buddies to join me…
life limb and sight 