That (increasingly rare) morning lull before the ward gets busy is a time when emergency physicians can have a moment to think and talk to each other. They might discuss vacation plans, their families, or recent cases. Or they may talk about retirement or complain about hospital administration and drug shortages. They might even joke about their post-traumatic stress disorder or how work is otherwise affecting their mental health.
But are they really jokes? Are EPs immune to the effects of near-constant exposure to the physical and emotional trauma of others? Are our sardonic humor and our talisman of sarcasm enough to ward off the erosion of our physical well-being?
PTSD in EPs is no joke. A Saint Louis University School of Medicine study found that the point prevalence of PTSD in PE was 15.8%, with a history of trauma being the only independent risk factor for reaching the screening threshold for PE. PTSD. (West J Emergency Med. 2019;20:740; https://bit.ly/3zD1qsy.)
It goes without saying that the whole specialty is at risk of developing the disease if more than 15% of PE suffer from PTSD. Researchers collected data from study participants from December 2015 to April 2016; the percentage of EPs affected is probably higher now.
Those of us who don’t have full-blown PTSD are likely experiencing secondary traumatic stress (STS) from caring for trauma victims in our emergency departments. STS is what it sounds like – being negatively affected by hearing about or seeing trauma happen to other people, and it is now a Criterion A stressor in the DSM-5. (Cogn Behav Ther. 2017;46:522.)
The more empathetic we are as PEs, the higher our risk of developing problems related to exposure to stress. The risk is even higher if one has already experienced trauma.
How do we prevent stress and trauma at work from creating dysfunction in our minds and bodies? The first step is to recognize how incredibly high risk we are for STS and PTSD. We will not be prepared to protect ourselves or solve problems if we are not aware of the dangers of our specialty.
EPs act as a filter for the entire hospital; no other doctor can fully understand what we face every day. We code babies. We hollow out the glass and reconstruct the faces. We order a morphine drip for the guy with 80% full-thickness burns as he passes out. We are daily confronted with the most profound human tragedies.
Sights like the abscessed arms of someone with substance use disorder or the ascitic belly of a 40-year-old mother with alcohol use disorder take their toll. EPs from all over the world are doing an amazing job. We keep the health care system afloat in a real way. Now, let’s find out the best ways to feel better so we can continue to push death away.
The usual suggestions for general well-being apply:
- Get the best sleep possible. Get blackout curtains, an eye mask or earplugs and turn down the air conditioning.
- Eat healthy foods; our brain craves it. Go for all those colorful, antioxidant-rich fruits and vegetables and omega-3-rich fish.
- Exercise. Even a little each day will help you maintain your sanity.
- Meditate, pray or keep a journal.
- Live your life outside of ED in a way that connects you with all that is right in the world, spending time with friends, loved ones, and pets.
Also consider these supplements:
- Get a regular massage.
- Spend more time in nature.
- Engage in a hobby.
- Take a sabbatical.
- Limit exposure to traumatic material in the media and verify goodnewsnetwork.org for a happy change of pace.
Pay attention to the warning signs of STS and PTSD:
- Reduced productivity
- Feelings of hopelessness
- Feeling of reliving a traumatic event
- Avoiding people or activities
- Persistent anger and sadness
- Substance use to lessen negative feelings
Have you laughed at this list thinking, “What EP isn’t cynical and testy?” It shows how bad things are. An EP’s crisp personality often belies any trauma she’s been through; it is a scab covering raw wounds to his soul. It’s not his fault that his personality turned that way. This job changes people, sometimes for the worse, but our old selves are still there.
It’s time to act if you’re experiencing more than one of these warning signs. Reducing clinical shifts is a great way to start moving in the right direction. Doubling down on feel-good behaviors can help. Finding a safe space to talk, such as with a therapist or doctor coach, can be a crucial step toward healing from STS. Practicing certain mind-altering thoughts can also be beneficial:
- I’m here to help as many people as possible without stressing myself out.
- I did not cause the disease, trauma, overcrowding or understaffing. I do not control the universe. I just do my best every day, and some days it’s not so good. Its good.
- The work I do is incredibly important, but I am more important than my job.
- I am the kind of doctor that I would like to take care of my family.
- I’m brave to show up every shift.
- All patients are human and have their own story. I am part of their stories.
The reality is that society needs us, and it needs us to stay healthy. We need to put on our own oxygen masks first to help the most people. Let us all remember that healing the needs of our patients begins with our own healing.
Clockwise from top left:Drs. Cazier, Dinsmore, andmorissonare board-certified emergency physicians and life, wellness and mindset coaches. Together they own The Whole Physician, a company dedicated to the well-being of doctors (www.thewholephysician.com). Their podcast, Drive Time Debrief with The Whole Physician, is available on all podcast apps. Follow them on Facebook (https://www.facebook.com/thewholephysician), instagram@thewholephysician, LinkedIn (https://www.linkedin.com/company/the-whole-physician/), and Twitter@WholePhysician. Read their previous columns onhttps://bit.ly/EMN-Wellness911.