Life in the emergency room is full of urgent tasks and no time to do them. You’re constantly having to make life-altering choices under immense pressure, which is not always conducive to good decision-making.
Stress is also part of life in the ER. You may have learned in medical school that moderate stress is actually good for you. Newish research even shows acute stress may boost your cognitive function in the short-term.
But over time, acute stress from long hours and overworking wears away at your mind and body, making you less happy, less healthy, and less effective at your job.
You know you’re working too much when you end up learning about family reunions and holiday celebrations for the first time as you gather together pictures of those events to create a slideshow for your mother’s memorial.
“I missed the wedding of my best friend, and I missed countless holidays and special events with my family,” Kevin Pezzi, M.D. writes of becoming a doctor in “Pros and cons of being an ER doctor.”
Time is a big part of what makes the life of an ER doctor stressful. ER doctors often work lots of unpaid overtime doing tasks such as:
- Charting, or proofreading and signing dictated charts
- Attending staff and committee meetings
- Fulfilling continuing medical education requirements
- Filling out insurance forms
- Appearing in court to testify as an expert witness or because you’re being sued
When Dr. Song-Yih (“Sonny”) Tu was a junior assistant attending in emergency medicine at St. Luke’s-Roosevelt Hospital Center (SLRHC) in New York City, he was also responsible for teaching the residents. “So I’m constantly reading medical journals and going over interesting cases for presentations,” Tu told CNN. “Also, I have a responsibility to my patients to keep abreast of new medical developments and treatments. This involves constant recertifications and journal reading.”
The ER will always be a somewhat stressful place. But there are things you can do to reduce unnecessary stress and better deal with the stress you can’t necessarily avoid.
Here are five strategies ER doctors have found useful in the fight against long-term, acute stress. Because the biggest issue is time, the first three strategies you’re offering are all related to this.
1. Take control of your schedule
Taking control of how you use your time is one of the most impactful things you can do for your stress levels. “Most of us experience stress when we feel as though we have a perceived lack of control over the events in our lives,” Psychologist Jeffrey Janata, Ph.D. told ABC News. “Time management—being careful about how we use our time, how we portion our time—can enhance our sense of control.”
As an ER doctor, it’s difficult to feel like you’re in control of how your spend your time. But there are opportunities for you to assert yourself and reclaim your time if you’re willing to look for them.
First, Janata recommends you conduct an assessment of how you’re currently using your time. For example, Vermont ER doctor Joshua L. Harris, M.D. tells Lifehacker that he spends about a third of his time in face-to-face patient encounters. He spends another third reviewing past notes, labs, X-ray, CT, and ultrasound images, and making phone calls to other doctors. The last third is “documentation time.”
Is the same true of you? How many hours per week do you spend on the phone with other doctors? Knowledge is power, and the first step to taking control of your schedule is finding out where your time is going.
The easiest way to keep time is with a free app. Check out “4 Awesome Free Timekeeping Software Options for Lawyers“ for some good options (none of them is legal-specific).
2. Automate routine tasks
Once you know where your time is going, think critically about what tasks you can automate and which ones you should delegate.
For instance, maybe you’re spending a lot of time on documentation. “It takes a large amount of time to document the care I provide,” Harris says. “I document what the patient tells me, their exam, my decision-making process, their labs, X-rays, or results, and their discharge or admission information plus discharge instructions. For more complex cases, I may be documenting procedures, critical care (frequently in the room because someone is very sick), re-examinations, etc.”
Chances are that you can do a lot of that work much more quickly with some new tools and updated processes.
For example, if you’re writing notes by hand when speaking with patients, and then going back and typing up those notes later, think about how much time that’s taking you. How much time would you save by having a computer or tablet nearby for every patient conversation, so you can type your notes instead? Or, what about by cutting out the writing entirely? Almost half of the products in our EHR directory have voice recognition capabilities, so you can speak your notes and the software turns them into text.
3. Delegate what you can
What you can’t automate, delegate.
For example, Harris points out that he spends a lot of time listening to patients telling him what he doesn’t need to hear, but he often has trouble getting the information he does need out of them.
“What I need to hear is a concise, descriptive explanation of why you are in the ER, without tangents,” Harris says. “Telling me that you have abdominal pain and having no other description or history is not helpful. Stating that ‘it should be in my chart’ is also not helpful as it’s not always the most up-to-date or accurate.”
Ideally, Harris says, patients would “bring a list of your medications, allergies, health problems, and prior surgeries,” saying that “ERs need to come with a user manual!”
Unfortunately, they do not, so try working with the check-in staff. They can coach patients and find out this crucial information ahead of time.
4. Take care of your own body
“There is no such thing as a regular schedule in emergency medicine,” Harris says. Long, irregular hours come with the territory.
Tu would get to work at 10 p.m. and wouldn’t leave until after 8 a.m. most days. “It varies significantly week to week,” he says.
Not having a regular schedule is incredibly hard on your body. The ER physician’s diet can also wreak havoc. CNN asked Tu what time he usually had lunch and what he usually ate. “Lunch? Who has time for lunch? I live on coffee, Coca-Cola, and Doritos while at work,” he says.
When asked if he had any special techniques or habits for making it through a long day, Harris said, “Other than being well-rested, well-fed, and well-exercised before coming into work, not particularly. It takes an enormous amount of physical and mental energy to make it through a full day. My shifts are only nine hours though, which helps.”
“During the winter, I ski as often as I can,” Tu says. “During the summer, I can most often be found in the Bandshell or on ‘the loop’ in Central Park rollerblading. In general, I just stay active.”
5. Take care of your mind
But it’s not just the body the ER will take its toll on. You must also take care of your mind. In the ER, emotions run high. People are hurt and scared; they’re angry about the long waits; there’s death and gore and trauma.
“It’s high stress; we see disturbing things, and sometimes we make mistakes that can result in harm to patients,” writes one emergency room physician, writing under the name “Shadowfax, M.D.”
Just as staying active keeps your body healthy, there are a few strategies you can explore to keep stress from taking toll on your mental and emotional well-being:
Learn to compartmentalize. Shadowfax recommends ER doctors learn what he calls “professional detachment.” “This is an unnatural skill in which you must suppress your innate sympathy for the suffering experienced by a fellow human being; pain which you may be personally inflicting.”
Label your emotions. Shadowfax also recommends that ER physicians find an outlet for talking about their feelings. Psychologists at UCLA found that when subjects described their emotions and put labels on them, the amygdala and right ventrolateral prefrontal cortex responded to those emotions differently. The theory is that labeling activates the more rational, calm parts of your brain and calms the more upset parts.
Practice meditation and mindfulness. Another great method for staying well is meditation. University of Rochester physician Dr. Michael S. Krasner studied how meditation and mindfulness can help doctors. For one year, 70 physicians took courses where they practiced mindfulness meditation along with writing, discussions, and lectures. The course included instruction on conflict resolution, boundary setting, and self-care. The purpose was to teach doctors how to get and stay “in the zone,” that is, present and aware, without distraction or judgment.
The participating doctors improved their mindfulness, burned out slower than other doctors, and had more emotional energy. Some of these benefits lasted even after the year was up, and new benefits were found. Doctors who participated in mindfulness meditation classes provided more patient-centered care, they showed more empathy, and they cared more about how their patients felt, physically and emotionally.
6. Treat patients’ emotions with care
Patient-centered care is key to providing the best care possible. Not only that, it can also go a long way in avoiding lawsuits and the stress that comes along with them. In “Secrets of the Best-Run Practices,” Judy Capko makes it clear that, before you do anything else, you need to establish a rapport with your patients.
After all, people don’t sue their friends. And, if a patient feels as though you genuinely care about them, they’re not going to be looking as hard for mistakes or interpreting unclear things unfavorably.
Lifehacker asked Harris what the worst part of the job was, and how he dealt with it. “Patient satisfaction,” Harris says. “I would like 100% of my patients to be happy with their care. Nationally, satisfaction of an ER visit is in the 80-85% range.”
“Unfortunately, I feel that most of the time the unhappy 15-20% are unhappy about factors I can’t control,” he says. “Wait times, workup times, and people who want chronic medical problems solved in the ER are top players. Trust me, this is equally frustrating for me too.”
Tu also complains that when he walks around meeting patients during sign-out, they would sometimes yell at him about the long wait.
Even if you can’t do anything about long wait times or solve chronic illnesses in one ER visit, you can make it clear to patients that you care about how they feel. Looking patients in the eye, listening to them when they talk, and taking a genuine interest in their feelings—not just their symptoms—can go a long way.
Stress is, according to Austrian stress research pioneer Hans Selye, highly personal. Two people can have the exact same experience, and one may be stressed by it while the other is unphased. So, the best way to deal with stress also varies from person to person.
At the same time, there are patterns to be found. Try these five strategies that other ER doctors have found useful to see which works best for you.
In the end, even Dr. Pezzi feels more positively about being an ER doctor than you might imagine: “While the job is frequently hellacious,” Pezzi writes, “it can also be far more rewarding than other jobs. What other job gives you the ability to save lives on a regular basis? What other job gives you the chance to forge emotional connections with people who were strangers five minutes ago?”
Tu feels similarly. CNN asked, “When you have one of those days on which you don’t think you can face the job again, what is it that gets you out the door in the morning and off to work?”
Tu responded, “Honestly, I haven’t had one of those days yet. I just really love my job. I guess I’m one of the lucky few who not only loves his job but has also been moderately successful at it as well. Hopefully, I’ll never have a day like that. If I ever did, I know it’d be time for me to leave the field of emergency medicine. When it comes to dealing with people’s lives, if you don’t love what you do, you’d better not be doing it.”
What strategies or tools have you found useful for fighting stress in the ER? Let me know in the comments.And for ways to streamline and automate your processes, check out our EHR, hospital management software, and medical billing software directories.
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