Common Sense


Issue: January/February 2023

Author: Jonathan S. Jones, MD FAAEM

Happy New Year!

As I started writing this column the holiday season was in full swing. While I love the season, activities, fun, food, parties, and family time, it can also be a bit stressful. I am sure many of you feel the same way. That stress immediately melts away when I listened to my daughter discuss her theories on how Santa Claus can actually visit each house and why he only takes one bite of the cookie we left. Watching her school Christmas play and seeing her on Christmas morning made all the stress worth it. Why? Because these experiences brought me joy.

Whether you celebrate Christmas, another event, or no event at all, I hope that something this past month or two brought you joy.

In reviewing the cards that we received this season, there is certainly a trend. Words such as Happy, Joy, Merry, Love, Peace, Celebrate, Good Tidings, and so on appear on nearly every card. And while days, weeks, and years are difficult, and life is full of challenges, it is nice to know that so many people wish us well.

And while I was able to spend Christmas morning with my family, like many of you, I did work the holiday.  As I drove to work for my 7:00pm shift, I am not sure why (maybe I was subconsciously psyching myself up for a busy holiday night shift), but I thought more about all those wonderful cards and specifically about joy.

Life should be joyful. Maybe not all the time, but why not most of the time? However, right at that moment, driving to an ED shift the evening of December 25, I thought to myself that most aspects of my professional life were not joyful. Emergency medicine did not bring me joy. Learning new and interesting discoveries did not bring me joy. Interacting with colleagues did not bring me joy. Even my involvement with AAEM did not bring me joy. (Spoiler alert in case you don’t feel like reading to the end: These things actually do make me happy; I was being a bit hard on myself, but all the aspects of my professional life could bring more joy.)

There are many words to describe how I felt. Burned out, depressed, dejected, angry, morally injured, quiet quitter, or perhaps just joyless. How did I go from having a wonderful day, enjoying my family and thinking about all the well wishes I had received, to thinking that my professional life was miserable? Was it simply that I had to work a holiday or was there something more?

Numerous academicians and researchers have examined causes of physician burn out and depression. While work-life balance is frequently mentioned, the act of working nights, weekends, and holidays rarely comes up. So, clearly, there had to be something more to explain how I felt. It was not the simple fact that it was a holiday.

Well, I arrived at work, walked in, and saw that, surprisingly, it was not bursting at the seams. While I don’t exactly want it to be slow, this was a nice surprise. I also realized that I had left some food in my car. As I’m sure our ED is not unique, the staff had decided to bring food for tonight and I had brought some charcuterie (yes, people made fun of me too; but at the end of the night, there were plenty of left-over cookies, but no charcuterie). Walking back to my car to get it, I realized I was smiling a bit thinking how nice it was that even in an emergency department, we can do some nice things for each other.

I delivered my food to the lounge, grabbed a slice of the Barolo aged salami, some blue cheese, a couple of crackers, and some pomegranate-jalapeño jam to take back to my desk. OK, maybe I didn’t hate every aspect of my professional life.

The first patient I saw had a complaint of “palpitations.” I looked at her EKG prior to entering the room and noted normal sinus with no PVCs, normal QT, and it really was just textbook normal. I checker her rhythm on the monitor which was also completely normal. As we know, dysrhythmias can be transient so I entered the room still highly concerned. The first thing she said was, “Doctor, I feel completely fine now.” Well, that’s good, I thought. Perhaps as she felt fine or maybe she just always liked to talk but she preceded to describe her events in detail. While at times, this can cause a bit of stress as I know there are other patients waiting to be seen, I knew I had a bit of time right now, so I listened. I interjected from time to time to clarify, and I soon realized that I was quite enjoying the conversation. I learned that she had both a history of paroxysmal atrial fibrillation and SVT. She had been feeling fine for most of the day, but then she felt palpitations as well as mild dyspnea and dizziness. She checked her pulse at home and reported that it was 180. Finally, her description of events produced, “So doctor, I know this doesn’t make any sense, but my husband was driving me here and he was going a bit fast and hit a fairly big pothole and I bounced up in my seat.  It’s crazy, but as soon as I did that, I felt better.”

This made me smile again as I explained that this actually could make some physiologic sense. I must admit that I quite enjoyed discussing the theory of pothole dysthymia conversion with her and her husband.

The shift proceeded fairly well from that point. Yes, the volume picked up, but it was never unbearable. I helped some patients. I laughed with a consultant as he told a patient that since the patient was getting admitted, I was no longer his doctor, and when asked for clarification, the consultant stated, “Dr. Jones left to go work on his next movie, you know, Dr. Jones, Dr. Jones.” (The patient mostly just gave a blank stare.) I enjoyed more snacks and also enjoyed watching two nurses argue about whether charcuterie was too fancy or if it didn’t really matter that it was fancy since it tasted good.

As I drove home, my thoughts returned to the same thoughts I had driving into my shift. How could I think that nothing in my professional life brought me joy? I love interacting with patients. They literally trust us with their lives. We shoulder immense responsibility, and truly, I wouldn’t want any job with less. It is a challenge to live up to this responsibility but it is an invigorating and honorable challenge.

And how amazing is the human body and human physiology? I have no idea if hitting the pothole converted my patient, but it seems like a good theory to me. I actually had time later that shift to research this a little and there are several EMS case reports of “pothole conversion.” Science is constantly making new discoveries and it is fascinating to work in a field which still has so many unknowns. I would be bored out of my mind if every single question I had or problem I encountered had one specific and perfect answer.

And my colleagues are great. As much as I love my fellow EM physicians, we do not save and improve lives alone. Nearly every person with which we interact has deliberately chosen a difficult and at times thankless and even dangerous career. This includes other specialists, nurses, technicians, paramedics, and especially environmental services. It is a pleasure to work with dedicated people. Yes, some aren’t ideal, and some are grumpy (some days this describes me), but each one has decided that they want to make someone’s, some patient’s, life better. The vast majority of professionals in this world do not work with people such as we do.

So why had I felt so joyless several hours earlier? Simple, it’s because I really do enjoy my job, but evil people are trying to ruin that. And while this makes me sad, burned out, and maybe even depressed, in a weird way it also energizes me. Stealing a line, “I’m as mad as hell and I’m not going to take this anymore.” And it’s not just me. The entire American Academy of Emergency Medicine is as mad as hell. And we’re not taking it anymore. And we’re finally winning.

Envision’s motions to dismiss our suit failed miserably. We have started the discovery phase and will finally gain access to internal information about their true practices.

Other CMGs are struggling with debt and facing lawsuits for withholding payments to physicians and for putting profits over patients by forcing doctors to work while sick with COVID.

In just the last year, news about our lawsuit as well as other suits against CMGs were mainly only found in hospital specific newsletters or not covered at all.  Now outlets from Becker’s Hospital Review, to NBC News, to NPR are covering these issues.  Many AAEM members are leading the charge to educate the public. And it is working.

The Federal Trade Commission held a listening session several months back specifically to discuss the role of private equity in health care. Several AAEM members contributed. And while the federal government is notoriously slow and secretive, it is now obvious that they did indeed listen at this session. On January 5, the FTC issued a proposed rule to ban non-compete clauses in all contracts. This would apply to physician contracts. The Academy has been fighting non-compete clauses for decades and we may have finally won.

So, while not every interaction I have with the Academy brings me joy, working hard to accomplish great things for our profession sure does.

When I finally got home the morning of December 26, while I hadn’t actually been visited by any ghosts, I did certainly think about old Ebeneezer. Life is wonderful and we are blessed to live a good one and help others do the same. I can ease pain and cure afflictions. And when I can’t, then I can comfort and console. I work with others who strive to do the same. And I get paid to do all of this. And my free time…I spend it with the most passionate and energetic emergency physicians in the world. Sure, we work, we stress, and we argue. But we also affect change and that sure brings joy.

May this new year bring you joy. And while I hope that you get joy from your family and friends, I also hope you obtain it from your patients, your colleagues, and your profession. Maybe AAEM even needs a new vision statement: To ensure that every emergency physician can find joy in their career. (OK, maybe not, but why not?)

As you read this, the holiday season will be behind us, but as I write it, I must end with the simplest sentence Dickens ever wrote: God bless us everyone!

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