Why are physicians burning out? Too many emotional extremes

Why are physicians burning out? Too many emotional extremes

My patient was brought by EMS after a respiratory, and subsequent cardiac, arrest. She could not be intubated in the field, and I did so on her arrival. We actually restored some circulation, albeit not much. Over the course of an hour, despite our best efforts, she became blue again, with lividity pooling in her flanks. I had spoken with her husband over and over, and he knew that the situation was grim.

It was just after Thanksgiving, and he was wearing Christmas sweatshirt. His family was gathered all around, as families do, especially here in the South.

We decided that it was time to stop. That she had, in essence, already died. That we were only supporting a shell. The family cried as we escorted them to the bedside before we stopped everything.

It was a busy night. All around were university students sleeping off their alcohol, consumed during a football game. There was flu, there were colds, there were ankle sprains.

And it struck me, as I walked from a family’s nightmare to a college girl’s injury, and then to an obnoxious 19-year-old drunk (facing the wrath of his extremely angry mother), that this is a serious emotional roller coaster.

To laugh with one patient, comfort another, save another and lose another, to mourn and to smile all in the span of some 20 minutes is a bumpy ride.

We ask, of burnout, “why is it happening?” We ask why physicians leave the specialty. Is it money? Is it lack of education? Is it insufficient empathy? Is it alcohol or priorities?

I think it may be this. That we see too many extremes in the course of our days, and have to meet each one with appropriate skill and proper emotion. And we have to little time to process any of it.

I used to like roller-coasters. I’m older now, and I can’t handle the twists and turns as well.

Not even in amusement parks.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.

Image credit: Shutterstock.com

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  • http://www.thehappymd.com/ Dike Drummond MD

    The emotional extremes of being an ER doc are not going away. What has changed for you is your ability to recover from the drain they place on your physical, emotional and spiritual energy levels. The feeling that things are getting harder is a sign of stress and if you would describe this as feeling “exhausted” is the first sign of burnout itself.

    The emotional extremes are an unavoidable part of what you do. If you make the choice to continue in the ER … it is a sign to pay some more attention to recharging your energy in all three areas when you are away from work. Fill your tanks so you have some bandwidth to spare for the rough shifts.

    Or … change the way you practice medicine so that you are not the place the buck stops when people are trying to die.

    Your article here is one way to process these emotions as well. Writing about your experiences … especially the challenging ones … is a well researched way to clear the air … even has a name, “Narrative Medicine”.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • glasshospital

    “…lividity pooling in her flanks.”
    nice turn of phrase.

    • Suzi Q 38

      “Love’s life lost.”

  • Rob Burnside

    Here’s an unusual suggestion for ER physician burnout: ride a shift or two with a busy MICU. The pace is somewhat slower- perhaps only 8-10 patients-and you get to see everything in context, rather than in a controlled environment. i.e. Instead of the sudden presentation of a horribly mangled MVA victim, you’re at the accident scene and you gain first-hand knowledge of the “mechanism of injury.” In this way, the worst cases provide a logic of their own, disconcerting though it may be, and once the worst dives are removed from the roller coaster, everything else (the sprained ankle, the drunken college student, etc.) is a cakewalk, perhaps even comic relief.

  • William LeMaire

    I may have avoided “burn out” as a busy academic O&G by retiring early and changing careers. Best decision ever. Never looked back. Ended up writing a free e book about my subsequent experiences, entitled; “CROSSCULTURAL DOCTORING. ON AND OFF THE BEATEN PATH. If you care to read it you can Google it.

    Cheers and happy 2013.

    Wim