Controlling What You Can When Things Feel Out of Control
Issue: November/December 2020
Author: Lisa A. Moreno, MD MS MSCR FAAEM FIFEM
Being President of an organization like AAEM has already been a blessing to me in more ways than I can possibly express. One of those ways is the opportunity to form close working relationships with the incredible people who are part of the Academy. Recently, the Wellness Committee has been a special source of inspiration with its focus on mitigating the isolation created by COVID-19, and the Women in EM Section has been equally inspiring with its focus on combating physician suicide. Physician suicide rates are more than twice those of the general population.1 The well-known Maslach Burnout Scale considers emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment to correlate highly with depression and burnout.2 In 2020, emergency physicians are increasingly experiencing these factors. We are seeing needless death in unprecedented numbers. We are discouraged by patients dying alone, and by our inability to touch our patients and our colleagues, to have in-person conferences and meetings, and to gather socially. Our personal impact is diminished by the conditions in which we are working, including the increasing takeovers of our departments by corporate medical groups. Employers, legislators, and insurers purport that the years of extra training and study EPs undertake brings no increased value to our patients and that we are easily replaced by NPs and PAs. A recent study shows that “younger age, surgical specialty, low academic rank, academic main practice, female gender, numerous night shifts, and living alone” most highly correlate with high levels of burnout.3 At home and at work, we are surrounded by people who feel unable to cope. Tempers are flaring. Many people need someone to blame. The slow return to normal is not coming fast enough, and things feel out of our control. Over and over, the wisdom of a children’s film comes to mind: “We’re calling this ‘Controlling what you can when things feel out of control’.”4 And as Olaf pointed out, there is indeed a great deal that we can control.
We Can Protect Our Physical Health
There is no longer any doubt that masks/face covers work. The CDC has shown them to be 97% effective in the prevention of COVID-19 transmission. Beyond this single most important thing that we can do to protect our health, we also need to ensure that no matter how hard and how long we are working, we must take time to eat well, exercise well, and sleep well. Busy people get too much “take out,” depressed people feel like they’ve “earned a treat,” and lots of kindness has been shown to us by local restaurants sending food to the ED. But let’s reframe that: What we sometimes think of as “treating ourselves” with sugar, fat, and processed food is really hurting ourselves. A fresh, natural plant-based diet is the best treat we can give ourselves. With gyms closed, many people are slacking off on exercise. Work outs help both our physical and our mental health. Get a buddy to work out with, and be accountable to each other for healthy eating, working out, and getting enough sleep.
We Can Protect Our Mental Health
“It’s okay to not be okay” is more than just the title of a Korean TV series. This phrase has been reassuring health care professionals that there is no stigma in needing help. The stigma of mental illness is giving way to the image of strength shown by asking for help when we need it. One of the highest compliments we can pay another is to admit our vulnerability and ask them for help. Opening up about our own doubts and emotional exhaustion gives permission to those around us to own theirs. Being human does not equate to being weak. Take time each day to meditate or pray. Connect to the Higher Power who is in control. Write poetry, keep a journal, listen to music (literature shows it is a mood changer!), and follow the advice of the Wellness Committee from the last issue of Common Sense.5
We Can Protect the Health of the People We Love
After we get everyone to mask up and socially distance, be accountable to each other for eating healthy natural food, exercising daily, and sleeping 7-8 hours Q 24, stay connected! We all know that the mind-body connection is powerful, and the literature shows that a purposeful and connected life is more likely to be a long and healthy one.6 Text and call, send cards, drop off food or flowers to neighbors who live alone. Doing this is protecting your own health, since doing good makes us feel good! Many years ago, my husband got me into this habit: Each night before I go to bed, I think of three people who made my day easier, happier, or nicer and I send them a thank you text or email. I’m always pleasantly surprised by how much this means to people.
We Can Protect Our Patients
Model the practices of hand sanitizing, social distancing, and masking. Talk about their concerns. Take the couple of extra minutes to answer their questions and be sure you understand what they are really worried about today. And show them love. My colleague, Dr. Heather Murphy, says that before leaving the room, she asks if the patient needs water or a blanket, since caring is part of medical care. Realize that clinics have been cancelled and people have been isolated and ask if they have their medications and follow up appointments taken care of or if you need to help with that. Ask how they are finding a way to combine childcare or eldercare with work now that many schools and day cares are closed. Is there any concern for domestic violence or substance abuse in these days of out of work and stuck at home? We, the emergency physicians, are the nation’s doctors and if we don’t talk about what’s really the problem, no one else will. Remember: Emergency physicians = the brain of a doctor and the heart of a doctor.
We Can Protect Our Colleagues
“Fine” is not an answer to “How ya doing?” Don’t accept that answer. Ask how people are really doing, how they are coping and if there is anything you can do to help. It’s sometimes a shock to realize how little we know about the people we work with every day. Who is a single parent? Whose relative just started chemotherapy? Whose parent was recently diagnosed with Alzheimer’s? Whose partner just lost their job? Notice if someone doesn’t seem at their baseline. And if they insist they’re okay but you don’t think so, kick it up a notch and tell someone else. Create opportunities for social connections through invites to Zoom cocktail parties, chats after meetings or during shifts, and pick one person a week to just call or text for no reason other than to say “I enjoy working with you, and here’s one thing I learned from you that means a lot to me.”
We Can Protect the Future of Our Specialty
The AAEM Board of Directors recently held a highly successful virtual Advocacy Day. We met with Matt Hoekstra, our lobbyist from Williams and Jensen, to discuss the issues of paramount importance to the Academy: due process and balance billing. We celebrated the successful introduction of HR 6910 by Dr. Raul Ruiz and Dr. Roger Marshall, which will bar third party contractors from requiring emergency physicians to waive their due process rights as a condition of employment. Dr. Ruiz, Democratic Congressman from the 36th Congressional District in California brought eight of his Democratic colleagues in Congress who support the bill and emergency physicians to a virtual celebration with us. We also met with other staffers and Members to advocate for physician and patient rights. (See Dr. Kevin Beier’s full report about Advocacy Day in this issue of Common Sense.) AAEM joined with several other EM organizations in a statement that the words “resident, residency, fellow, fellowship” should be restricted to post-graduate medical training and that ED based post-graduate PA and NP training programs should not be initiated without the involvement and consent of EM residency program leadership. Our Scientific Assembly Subcommittee is hard at work against all odds designing an AAEM21 that will uphold our reputation as the best EM conference in the world. The Government and National Affairs Committee is working in Tennessee to eliminate the option of hospitals to require merit badge certifications. The Critical Care Medicine Section has developed a mentorship program to work with residents interested in this specialty. As staff likes to say, “There are over 40 ways to get involved with AAEM.”
When things feel out of control, there really is a lot that we can control. We can, as Gandhi said, “Be the change you want to see in the world,” and as Angela Davis said, “I am no longer accepting the things I cannot change. I am changing the things I cannot accept.” The best way to avoid burnout is to be empowered, and you are empowered as a member of AAEM. We are the Champion of the Emergency Physician. We fight for you, and we also empower you to fight for yourself, your colleagues, your patients, and the future of our specialty.
- Schernhammer, E. S., & Colditz, G. A. (2004). Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). American Journal of Psychiatry AJP, 161(12), 2295-2302. doi:10.1176/appi.ajp.161.12.2295
- Maslach C. Burnout. Hum. Behav. 1976;5:16–22. [Google Scholar]
- Nassar, A. K., Reid, S., Kahnamoui, K., Tuma, F., Waheed, A., & McConnell, M. (2020). Burnout among Academic Clinicians as It Correlates with Workload and Demographic Variables. Behavioral sciences (Basel, Switzerland), 10(6), 94. https://doi.org/10.3390/bs10060094
- Olaf, in Frozen 2
- (Please cite the article from the last issue in the Tales of the COVID section on the Committee Report Wellness)