I’m an ER doctor who can’t wait to quit my job, and I’m certainly not alone.
If you’re not an ER provider, maybe this essay will bore you. Or maybe it’ll be a little dark. But myself and many of my ER friends are suffering burnout and I think it’s important to shine a light on the issues that weigh on me and my colleagues.
Why write this essay? Why am I venting to you? Certainly, it’s partially a form of therapy to get these things off my chest. And constructively, I’m writing it for myself in the hopes that by organizing my feelings I can find solutions.
I remember being in high school watching the TV show “ER” and knowing that I wanted that job when I grew up. Action, excitement, drama, and morning drinking — these were career characteristics I could look forward to!
In my ER Residency, life was almost as entertaining as the TV show, even if we were less handsome than Clooney and Wyle. There was life and death drama. Puddles of blood. A baby delivered in a car. Hastily scribbled charts as patients were rushed to the OR. The shifts were hard work but left time to play hard. I was getting paid and I wasn’t carrying a pager, so life was good.
It took about 10 years to start feeling differently about my career. I started to get exhausted and frustrated after shifts. Sure, I was still saving patients’ lives, but I started to recognize some of the same patients that needed saving over and over again. Paperwork started to take up more time, pulling me away from the bedside. Next, computerized records were mandated. I was doctoring less and typing more.
Now I am 13 years in, and I’m ready to be done. It’s not just me: 60% of ER Doctors suffer from burnout. The 40% still feeling good are likely the ones who have been in the game for less than 10 years.
The danger of burnout is a real problem in Emergency Medicine. High rates of substance abuse plague the specialty. Depression and suicide affect some. Caregiver fatigue makes many of us — at times — substandard parents.
The causes of burnout vary from provider to provider, but they start to take their toll after a decade of practice. Different challenges affect each of us differently, but here is my list of triggers, starting with the worst:
Factor 1: The Electronic Health Record. This was a very well-intentioned tech revolution, that deployed disastrously and worsens year after year. (I’m looking at you, Cerner EHR.)
In 2019, I spend my shifts clicking through irrelevant alert after alert. The algorithms get things wrong, flagging my panic attack patient as having SIRS, and my alert fatigue worsens. Important lab results appear at the top of one chart, and then are randomly buried at the bottom for other patients. Just when I think I’ve had enough, the safety checklist for CT Scans reminds me to check a pregnancy test, even though my patient is a 7 year old boy.
The patients don’t see behind the veil to witness this comedy of errors. I can ask Ms. Smith about her medications and she will answer, “Oh, it’s all in my records, Doctor.” This is worse than nails on a chalkboard for me. “Which records Mrs Smith? The ones in Cerner? Or Epic? Or Meditech? Maybe somewhere else?” It’s not Mrs. Smith’s fault: she very reasonably assumed that all the EHRs integrate, but they don’t. Integration might cut into their slice of market share, so the EHR vendors are not interested in fixing this problem.
Studies show that physicians spend more time charting on computers than on direct patient care. That’s half of my workday spent in suffering. I should just resign myself to the inane mess, but I keep picking at the wound because the idealist in my can’t bring myself to give up hope for a better EHR. It has to come someday, right? Maybe the next release, just around the corner, will actually work?
Factor 2: Frequent Flyers. These are the patients that I recognize in the grocery store, the names every local doctor knows. If I — who is terrible with names and faces — knows your name or face it means you’ve been in the ER too many times this year and this makes me tired and sad. More professionally phrased, I have compassion fatigue. I am exhausted from caring for patients who can’t or won’t care for themselves.
Frequent visits may be good for the hospital’s financial bottom line, but all these visits indicate a system or societal failure on some level. Is the patient seeking an escape from abuse at home? Perhaps they cannot afford needed medications. Do socioeconomic pressures force them to prioritize daily survival over preventative care? In some cases, healthcare cannot encircle them with adequate resources. Many have anxiety or depression, or some other mental disorder driving their visits. Maybe there is some secondary gain from their visits that we are too harried to uncover?
Whatever the reason or reasons, these are sad cases. They reflect poorly on us as a society, they take away from time I could be spending with more acutely sick patients, and frankly, they exhaust me.
Factor 3:Patients “seeking.” Maybe they seek a narcotic prescription. Or crave free turkey sandwiches. Or attention on a lonely night. Maybe “chest pain” is just an inmate seeking a night away from prison. We all have needs, but too many people lean on the ER for these things.
“Do you feed the bears?” a new nurse recently asked me. If you give a homeless patient a turkey sandwich because you’re a compassionate human being, does that increase the chances of her making up a complaint to justify returning on another night? When someone is in severe pain from narcotic withdrawal, do you let them suffer towards sobriety (whether or not this is their goal), or do you offer them an opiate to ease the pain?
I struggle with these decisions. I don’t have a best answer, and my answer is sometimes inconsistent from day to day. My lack of conviction coupled with the onslaught of patients all seeking or needing something takes its toll.
Factor 4: Professional isolation and heavy workload. Most of the places I have worked in these last few years have been single provider EDs. During my shift, there is no second doctor to bounce ideas off of. No one to commiserate with or gripe with. And more than just once in a while, it would be nice to have a functional human being to chat with.
When it gets busy, there is no relief valve. You have no choice but to see every patient walking in through the ER doors. When the ED gets swamped, it’s hard not to resent the patients who are there for minor ailments, because each patient means another chart to write. Resenting your customers? That’s a sure way to feel burnt out.
“Doctor, heal thyself.” In medicine, diagnosing the ailment is the first step to prescribing a cure. I know that these four factors are taking their toll on the health of my career. I’ve identified them, so now I’m going to get to work finding some solutions.