I loved my residency experience. I was wide-eyed and optimistic medical student from Los Angeles who evolved over 4 years into a capable, although slightly cynical, Emergency Physician from New York. Smack in the middle of that professional growth was my PGY2 year- the only time my short career when I found myself close to “burning out.”
My PGY2 year was the hardest year of residency. I worked 18- 12 hour shifts a month, with many of those shifts occurring overnight. I was not very good at tying up my loose ends and would frequently stay well past sign out to follow up my patients. I believed that high patient volume would lead to better clinical exposure, which would in turn, develop me as a clinician. I was constantly “pushing through” but after a few months I was really running out of steam. Move fast, think sharply, and see more patients! As much as I wanted to be the best resident I could be, I was clearly falling short, and I need to find out where. I started by logging my day. I was surprised at what I found:
12 hour shift
1 hour wrap-up/sign-out
30 minutes commuting
30 minutes checking/responding to email (or other social media)
30 minutes phone calls to parents/partner/friend
15 minutes shower/getting ready
30 food prep/eating
15 minutes cleaning
30 minutes reading/studying
7 hours sleep
Time Remaining: = 1 hour free time
I was conflicted because although I could feel myself growing as a physician, I also felt like I was on a grind with a cycle of wake-up, get ready, commute, work shift, commute, eat, shower, clean, study, make phone calls, answer emails, and sleep. Those 12-hours of “time-off” really boiled down to 1 scrawny hour of free time.
Most of the research on burnout for emergency physicians suggests that it starts during residency and over the first two years of residency. We are all aware of the amount of kinetic energy that is required to fulfill our duties as hard-working and smart residents. However, few of us are ever truly ready for the costs that come with our profession. It was not even the physical exhaustion that bothered me. It was more so the mental and emotional fatigue I felt at the end of some of my shifts. “Did I discharge a sick patient? …Did I write enough in my note? …Did I forget to give a dose of Aspirin to a chest pain patient? How did I miss that central line!”
So in January of my second year, I decided to make priorities and keep them. Most importantly, I was going to take care of myself first. To facilitate my happiness, I learned to allow myself to say things like, “I deserve this.” It sounded strange at first but I got used to saying it – mostly because it provided me with a bit of validation for all of my hard work. I deserved the extra 30 minutes of sleep, the trip to the movies, and the weekend away with my friends.
I also learned that there is a fine but crucial difference between challenge and exhaustion. I stopped feeling the internal pressure to stay late 2 hours after my shift so that I have no sign-outs. I’m not even sure why I had that pressure on myself to begin with. I had an incredibly supportive residency leadership who valued residency wellness. It certainly wasn’t a departmental or residency cultural pressure. Looking back, I assume I saw another resident doing it and felt that I should follow along. This was a bad idea. Today, I think we should take care of our patients, develop a plan and have fair sign-outs that won’t leave our patients with delayed or unsafe care. After that, time to go home to rest and enjoy life.
Lastly, I now take time while on shift to have bathroom breaks, drink a glass of water, and eat food. These are just natural processes that everyone should be privileged to do. Unless a shift is literally full of nonstop crashing patients, there is always time to sneak away for 3-5 minutes at a time. While I’m on those breaks, I learned to just have some insight into my emotional status and if I’m stressed or tense, I’ve learned breathing exercises from various meditation classes to relax me. Or if I’m anxious maybe I’ll listen to a favorite song while I’m eating food in the break room. Ignoring your emotional state doesn’t make it go away! Be sure to keep your emotions and mind healthy while working.
I could care less about burning through a huge sheet of patients as quickly as possible. Instead I focus more on getting a good history, addressing patients’ needs, and finding a diagnosis. People want to feel better in the emergency department either physically or emotionally. And when I provide that treatment, I feel better about my work. And when I’m at work or home I make sure I’m taking care of myself. That has now become more important than anything. We are in a business to serve others but we must not sacrifice our mental or physical health in the process.
A version of this piece was originally published in the AAWEP Newsletter Fall 2013.