As Your Career Evolves, So Too Can the Sources of Wellness and Meaning Within the ER

The life cycle in the mind of ER physicians is fascinating. You begin your journey hungry, confident and cocky. You feast on taking care of the sickest of the sick and routinely leave work pumped with adrenaline and satisfaction after a crazy shift. You smile with pride after floating your first transvenous pacemaker and stick your chest out a little more the moment after you do your first cricothyroidotomy.

You think to yourself, “this is what I was meant to do,” and would do it all day if you could. What a blessing that you found a career that is so perfect for you! You stop to reflect and think, “I can’t believe I get paid for this!”

Then, eventually, something changes. I have been a practicing emergency physician for 14 years now. But I noticed something starting to evolve in me somewhere between 5 and 10 years into my own career. For others, it takes longer. Whether it’s after 10, 20, or even 30 years, something isn’t the same anymore.

You still enjoy the occasional trauma resuscitation and running the cardiac arrest code, but you feel it doesn’t get you as amped as it used to. You look at things as “just another case” more than ever before. The conversations that you used to have with your spouse about your crazy day no longer happen. More often, you think that you just want to get home to the normal routine of life, perhaps eased by a glass of wine… or two.

Why does this happen? Do you simply become less compassionate? How can those lifesaving procedures and crazy codes leave you emptier rather than fulfilled? We’ve all seen this phenomenon described in recent years. Hardly a day goes by without a Tweet, a Facebook post or a LinkedIn article talking about physician burnout, and what we can do to make physicians more well.

The solutions to combat burnout are varied: exercise, rest more, meditate, be mindful, go on vacations. These are some of the pieces of advice that we are offered from experts. Cottage industries have formed to help physicians ease this burden of un-wellness. Whether it’s CME trips, online courses or even wellness certifications, there seem to be countless folks trying to capitalize on our misfortune.

There are merits to all of these wellness solutions, and in some cases, they are THE solution.  However, what is not discussed much is the actual work that you do on a day to day basis, and how that work can lead to feelings of dissatisfaction. As we grow and mature, we start to seek something different than the adrenaline high. Perhaps we start to feel unwell because of a growing sense that we are “punching the clock,” rather than curing disease.

We are more consumed by algorithms and placing patients neatly into boxes of “admission” or “discharge” than truly making a difference in the health of populations. This brand of medicine starts to lack meaning. If we are more and more sensitive to the fact that we are not making our patients more well, how then do we ourselves become more well?

One of the most interesting ways that I have learned that ER physicians and providers are getting back this feeling is to have meaningful conversations with patients. Taking time to look at a person’s health from a larger broader perspective can have an unquestionable impact on the patient, and their families.

Personally, I have left shifts with more of a smile after I have been able to have a meaningful discussion with a family about their goals for their elderly father’s third CHF exacerbation in six months, than I have in placing him on Bipap and a nitro drip. I much prefer the cases where I can get a family to realize that they are better served taking their mother home with end-stage cancer with hospice rather than subject her to the dangers and tortures of another hospital admission.

It is a feeling of providing more appropriate care, rather than more care than gives me a tremendous sense of satisfaction. Even more important is the satisfaction from families. It is an amazing thing to see a family come to the realization that their loved one is truly dying, and that they will let them die in peace at home. They are usually thankful for being given the opportunity to spend the last moments with them being comfortable, rather than hooked up to drips and vents. As I have more purposefully sought out these conversations over the years, I have realized that I have never received as many “thank you’s” and positive feedback than in these scenarios.

As I have entered a different phase of my career, I have realized that I would much prefer these cases where I get the feeling of “doing some good,” than the tachycardia-inducing of cases that I used to live for. The feeling that I have added some wellness to a patient, their family and loved ones has helped me to feel more well as well. It has added a much-needed layer of meaning in a field in which it can be a challenge to find. No CME or certification course can take the place of that.