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First person: 10 ways to make PEs more ‘resilient’ : Emergency Medicine News


resilience training, burnout, well-being, humor in medicine


I can’t be the only ER doctor tired of hearing the term “resilience training”. Nobody seems to want to make serious efforts to address our concerns, so we should learn better coping skills. Great project!

What are my two biggest pet peeves, you ask? I know it’s a random question, but I’ll tell you: wasting my time and insulting my intelligence. Practicing medicine at 21st century does both. All day. Every day.

If you’re serious about reducing physician burnout, let me point you in the right direction:

1. Staff the ER appropriately. Health care is the only business in America where people line up day after day ready to pay thousands of dollars for a few hours of service. How do we welcome them? We don’t. We expose them to deadly diseases and anger them while they wait in pain, and then we use their satisfaction scores to rate doctors as good or bad.

2. The jumbo shrimp is an oxymoron. “Epic upgrade” is such an oxymoron that it should be banned by the Geneva Convention. Listen, I don’t want to go back to paper records, but I can’t get the EHR to work. for doctors at this point feel willful and malicious. Sudden stops are built overnight, but every time – for over 10 years – I entered a bee sting diagnosis, I had to click to find out if it was intentional self-harm or accidental.

I saw many patients with suicidal ideation, but none mentioned Hymenoptera in his project. And the first page of exit instruction selections when I enter a diagnosis of minor head injury involves burr holes or craniectomy. Perhaps minor head injuries are handled very differently in other parts of the country?

But no discharge instructions for rashes? If I had known what the rash was, I would have listed it as a diagnosis. And these are just exit instructions, which don’t even scratch the surface of the myriad ways the EHR makes the practice of medicine extremely inefficient, frustrating, and dangerous for patients. Fix it.

3. Blow up the current payment system and start over. This is an article, not a white paper, but the current system is nonsense.

4. Correct mapping, which is probably the biggest contributor to physician burnout and job dissatisfaction. I have no right to insist that the plumber fixing my leaky toilet write a 1500 word report on it so he can get paid. Here’s an idea: try to treat doctors like professionals. Take my word for it if I say I cut a nanny’s elbow. It should never take longer to make the chart than to solve the problem.

5. Develop a metric that measures how metrics are destroying medicine. Every encounter with a patient is another opportunity to fail at something. Explain why taking a patient straight to the CT to find a suspicious headache as soon as possible is a failure because the glucose was not checked, interpreted, and documented with a timestamp in less than 20 minutes. No matter; you can’t because it’s not. It’s stupid.

6. Stop missing things. I regret doing it once in a while, but I like taking D-dimers. I often order a side of Omnipaque with my CTs. I prefer bupivacaine 0.5% over lidocaine (why not give longer lasting analgesia if you prick someone with something sharp?). I guess I should be grateful that I don’t need formula to heal anyone.

7. Stop locking things up. I’m pretty sure even my pickiest patients can crack the code when I press five buttons in a row at the top of the supply cart. OK, lock the carts in the patient rooms, but why lock every cart and every cabinet in the emergency department when everyone working there has the combination?

8. Stop pushing “Emergencies are for Emergencies” campaigns while making the ER serve every public health function imaginable. Emergency departments are used to medically clear patients for jail, drug rehab, mental health placement, and foster care. We screen for Ebola (again? Really?), depression, human trafficking, domestic violence, and hypertension. I’m not a bad doctor for not telling an 18 year old with a sprained ankle to see a GP because his blood pressure is 121/80 so stop treating me like that.

9. Dim the sound effects in the ED. I haven’t had time to purchase an instrument to measure this, but I’m pretty confident that the high tones attributed to everything from the monitors and tube system to a broken negative airflow seal have some decibel levels sufficient to cause permanent hearing loss. No kidding.

10. If you can’t even solve one of them, you know what you can do with your resilience training. I will find out for myself.

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Dr. Dulingis an ER doctor in Issaquah, WA, and he recently quit his amateur status in sarcasm to turn pro. He is also the author of ER Doc: Defining Moments in a Career in Emergency Medicine.