Common Sense: From the Editor's Desk

Pilgrimage


Issue: July/August 2018

Author: Andy Mayer, MD FAAEM
Editor-in-Chief, Common Sense

 

A pilgrimage is a journey or search of moral or spiritual significance. Typically, it is a journey to a shrine or other location of importance to a person’s beliefs and faith, although sometimes it can be a metaphorical journey into someone’s own beliefs. (Wikipedia).

I am reflecting on my recent trip to San Diego for AAEM’s Scientific Assembly, and what this gathering means to me. At first glance this might seem a trivial activity, since people usually go to San Diego for sun, sand, food, and fun — and there was plenty of that at the Scientific Assembly. But there was much more. Emergency physicians, from the elders and leaders of our specialty to the wide-eyed medical students who volunteer to be ambassadors for the meeting, come together for this important event. I look back on the many Scientific Assemblies I have attended, and want to share what the Scientific Assembly has meant to me as an individual and as an emergency physician.

Clearly, all emergency physicians have stress and concern about their practice and employment. The stressors are legion, and we must recognize them if we are to have any chance of overcoming them in a healthy way. I find that many emergency physicians feel isolated and alone. My concern is that they think their current issue, which might be anything from the latest sepsis or stroke core measure to another senseless patient complaint, is unique and special to them. They may feel their difficulty dealing with the numerous and oppressive burdens placed on them represents a character flaw or an abnormal inability to cope.

Remember, we emergency physicians have climbed many a mountain and crossed many a raging river to get where we are, usually without a lot of help. The worst thing one could do in my residency was admit weakness. You could stand before the elders and be publicly shamed at a Morbidity and Mortality Conference, but you could not be weak. You were required to suffer any burden in silent resignation and accept all responsibility as a normal part of the medical education and indoctrination process. Does this make us strong, or is it actually making us weak?

This brings me to the real value of the Scientific Assembly. Of course, hearing fantastic lectures from the icons of our specialty can help us learn and grow. I was fascinated by the pain and ketamine lectures of Dr. Reuben Strayer. I don’t think I will be starting Suboxone therapy in my emergency department, but his ideas on opioid naiveté and the use of low dose ketamine for pain caused me to think about changing my practice. The usual star lecturers are always welcome, and hearing a thought-provoking lecture from the coroner of the District of Columbia certainly made me consider the current realities of poverty and violence in America. The small group sessions I attended on epistaxis and vertigo were incredible. This is really a great approach to learning. These are not entry-level talks for physicians from other specialties. They are directed and modeled to help the board certified emergency physician. But enough about the Scientific Assembly as a forum for clinical learning. This isn’t the biggest reason I attend the Scientific Assembly.

The sense of community is why I attend the Assembly. Being with a thousand others who know what it is like to walk in my shoes is what makes the experience important to me. It is a chance to catch up with old friends from residency or practice. Seeing heads shaking in unison in the lecture hall, listening to the problems and issues discussed during lectures, and commiserating over a cup of coffee in the exhibitor hall makes you realize that you are not alone. The problem that seems insurmountable to you has already been faced by others, who are glad to help or at least listen to you vent about whatever protocol or patient satisfaction measure you may be struggling with. Everyone claims their patients are the worst and sickest humans on the face of the Earth, and that their hospital administration is the most unreasonable. The more you learn about other practice environments, the more you realize how similar our issues and frustrations are. Whether you are in a small rural hospital or a large urban trauma center, there really are more similarities than differences in our practices and our problems.

I really go to the Scientific Assembly as a pilgrimage. I personally need to recharge my batteries on multiple levels. Certainly, the medical education portion rekindles my interest in the practice of emergency medicine. Learning a new trick or tip which I can bring home and use reminds me that I need to continuously learn to stay relevant and connected. My biggest recharge though, comes from speaking to my colleagues from across America and learning about their personal, community, and state challenges and how they are responding to those. That makes me feel more like a professional in an ever-expanding specialty, which continues to grow and develop. We need to take pride in emergency medicine and remember that we are special. We are healers, who sacrificed a lot to practice in a specialty where we can and do make a difference in our patients’ lives every day.

I encourage all of you to attend the Scientific Assembly next year and see if it changes your perspective. It is a quick refresher and soul recharging experience. You, as an emergency physician, have much to be proud of and you must remember that even when you feel like a highly paid data-entry clerk. Attend some of the incredible Wellness Committee events, which are designed to help you thrive and grow during your career, especially when that career is at its most difficult and frustrating. You are a real professional and an important specialist, and maybe attending the Scientific Assembly will help you reconnect with that important reality.

 

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