Life of An Emergency Physician

Karunakaran Vetri

Department of Emergency Physician, Kauvery Hospital, Chennai, India

Parental advisory: If you are suffering from anxiety symptoms, and have underlying serious cardiac issues, it is suggested you seek medical attention before proceeding to read this article.

Coming to a screen near you: Doctors who prefer an action-packed film, also involving serious drama and epic decision making, while deftly negotiating the maze and matrix of international guidelines as a part of the job and taking it in your stride, well, you have come to the right place- Welcome to the World of Emergency Medicine (W-WEM! Everything now has an acronym, the more outlandish the better!).

Modern Medicine has been there in this world for ages. History of modern emergency medicine essentially began in the 1960’s during the French Revolution, where a French Military Surgeon inculcated the idea of ambulances to shift wounded soldiers to a nearby hospital for definitive care. It gained some traction during 1960-1970s when other specialty doctors like family physicians, general surgeons and interns were posted in Emergency Room in rotation where they would essentially triage patients and prioritize patient care. However, only by 2009, Emergency medicine was recognized as an independent medical specialty by the Medical Council of India.

Absolute requirements to succeed as an Emergency Physician!

(1). You should work well with others

The ability to work in coordination with the team is one of the hallmark personality traits expected from emergency physicians. As an emergency physician we work as a team. Care starts right from the Emergency Triage Room till the patient is transferred to a definitive care.

When an ambulance crew responds and picks up of the patient, the emergency response team includes the ambulance driver and paramedic as well. The immediate evaluation by paramedic and initial stabilization on site (patient extraction point) play a vital role in improving the outcome for a patient. Even the driving skill and road – handling of an ambulance driver determine the outcome for a critically ill patient.

(2) Multitasking

A busy Emergency department may have more than ten patients at any given time. The emergency physician in charge of the shift needs to figure out a way to prioritize and handle all patients simultaneously.

Always see sick patients first, then discharges, then admissions and then see new patients. In the meantime, if a new sick patient enters the Emergency department, the priority should be the sick patient over others.

Successful emergency physicians often become able medical administrators as they can multitask more effectively.

Fig. 1. shows a communication system to be established by an emergency physician for each and every patient to ensure proper patient care.

(3). Being decisive

“Every second counts” in Emergency Department. There would be instances where we need to act swiftly, be able to evaluate situations and make decisions very rapidly. Prompt decision making will help us multitask better. In order to be decisive we need to have a sound knowledge in the subject without which you would not be a successful emergency physician.

(4). Solving problems

Leveraging a variety of resources to find out what a patient is experiencing is ultimately what emergency medicine is all about! You could literally come to emergency department with mild abdominal pain and you could end up with potentially more than 50 differential diagnoses. As an Emergency Physician we should be able to correlate patient’s complaints with clinical findings. Your thought process and your provisional diagnosis will give a kick start to the thought process of all the other physicians in the hospital

(5). Natural leader

An emergency physician should develop an instinct and talent for command and leadership in the department and should rally the troops (staff, juniors, managers, paramedic, physician assistants) vocally. Your troops would acquire a sense of security and confidence to work under your command. Your leadership defines you in the battlefield (Emergency Department).

(6). Detail oriented

You should give your whole attention to your patient. Take your time while doing your initial assessment and history. Be attentive to every detail of history the patient gives you and observe every sign the patient shows. This is very crucial and would be very useful in designing an appropriate management plan.

(7) Have composure

In the Emergency department you will be dealing with a variety of patients, from a simple one-day fever and to another with poly trauma, and life – threatening pericardial tamponade. As an emergency physician we should be able to rapidly refocus between cases to meet the unique care each and every patient needs.

Maintaining a good bedside manner during these transitions, would help you to control your mindset and conduct. You need to compartmentalize different tasks and information and prioritize accordingly. It does not come naturally. It is an art, and should be worked upon to perfect!

(8) Have a concrete schedule

For many emergency physicians, the unpredictable nature of their work is manageable only by having a concrete schedule. You should have time to relax, time to take a day off, plan your time for hobbies, definitely a fitness activity to keep healthy, strong and energized

It’s a Thankless but Vital job!

There was a famous quote from John Owen, “God and doctor we alike adore but only when in danger, not before; The danger over, both are alike requited, God is forgotten and the doctor slighted” [1].

This saying goes very well with emergency physicians. We emergency physicians may not be as acquainted with you as your primary physicians but yet, when it comes to giving care to the patients, we never compromise on patient care. We prioritize the sick patient thoughtfully whether we know them or not, and treat them like how we treat our own family members. We keep their bystanders in the loop and keep them well – informed until the patient is shifted to a definitive care after all the life and limb saving interventions are done in the emergency department. On getting discharged from the hospital, patients would remember the primary care physician or a surgeon better and we often recede from their memory. That does not matter; we shall always give our fullest to get you back in shape.

We may or may not be thanked , or even remembered for our deeds; we shall always love what we do; that’s what makes us an emergency physician.

When you come to the Emergency Department, we may not know you personally, we may not know your primary care physician but we shall give you our best learnt skills, following internationally accepted guidelines to bring you back to normalcy. We may not even know your final diagnosis as your illness and recovery evolves while in the hospital, but we were there first, to receive you, care, comfort and reassure you. We would relieve your pain, anxiety and fear. We resuscitate when you are seriously ill; we shall work with a number of provisional diagnoses and ultimately guide your care plan to reach the final diagnosis at the earliest, so that your journey through illness is directed to a safe destination.

Burnout and Work life balance:

Burn out has become an occupational hazard for the bed-side physician all over the world, the rate of which accelerated during the pandemic. It was particularly evident in the community of emergency physicians. Let us take a quick look at the etiology and management

Burnout is a syndrome of depersonalization, emotional exhaustion and a sense of low personal accomplishment. Image 1 highlights the various factors which can cause stress buildup in the medical profession, among various specialties.

Fig. 2. Factors contributing to stress build-up.

In a survey done by Tait D. Shanafelt et al regarding the burnout and satisfaction with work life balance, they have studied the burnout rates of all the medicine specialties in US [2].

Fig. 2. Burnout Rate by Specialty.

From Fig. 2, we can see that emergency medicine tops the chart, with about 65% burnout rate. To ameliorate this, we adopt working in shifts and we schedule day off’s and night offs to help us alleviate these stress factors and maintain a perfect personal and professional balance. Also, we work round the clock as a department, on a shift basis, to give uncompromised patient care ensuring each and every patient receives the best possible care as per international guidelines.

So, it is imperative that we strike a strong work life balance to prevent this burnout rate from affecting our life and work. We should engage in some sport activities, have our own hobbies to work with, have family-oriented goals to get more connected with our family members, get in touch with friends, and eat healthy diet to stay fit. Our specialty demands these aspects to be factored in so that our productivity and the quality of patient care we offer are uncompromised. We get our ultimate job satisfaction when we see our unresponsive patient who came to our department goes out walking out of hospital with a smile. Doctors who achieve higher job satisfaction also achieve higher patient satisfaction.

Conclusion:

Emergency Medicine delivers at the front line of hospital medicine. We have been at the forefront of the battlefield of COVID ever since early 2020. To be an Emergency Physician is a demanding career that demands uncompromising perfection in clinical knowledge and skill, applied with speed and precision. That expectation is non-negotiable. You need to give it all that you have to make you an effective Emergency physician. Once you perfect your skillsets, you would achieve a sense of job satisfaction which no other job in the world can match.

The skill set does not come naturally. It is an art and science, and should be assiduously worked upon to achieve excellence in rendering exceptional patient care under all extenuating circumstances. The journey may mandate you to come out of your comfort zone but the destination you reach will make you say “It’s worth it!!”.

References

[1] https://www.goodreads.com/author/quotes/18457.John_Owen

[2] Shanafelt TD, Boone S, Tan L, et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. American Medical Association. Arch Intern Med. 2012;172(18):1377-85.

[3] Hui-Ching W, Chao-Ming H, Yi-Tien L, et al. Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Med Educ. 2011 Aug;45(8):835-42.

[4] Macik-Frey M, Quick JC. Advances in occupational health: from a stressful beginning to a positive future. J Manage 2007;33: 89-40.

[5] Myers D. The funds, friends, and faith of happy people. Am Psychol 2000;55:56-67.

Life of An Emergency Physician