A Letter to a Young Emergency Doctor

When I was starting out, I was told there were three types of doctors doing emergency medicine: missionaries, adrenaline junkies, and fools. I was all three. Now that I’m burning out at the other end of my career, I have some tips to share which I hope you will find useful. I did.

  1. All shifts end. No matter how long, how intense, how overwhelming, you will leave the hospital when your shift is over and go back to real life. Let someone else carry the load.
  2. Make sure when your shift does end that you have something to look forward to. It doesn’t matter what it is.
  3. Remember, the patient is the one who is sick. Empathy is good but the suffering belongs to them. Helping our patients is our calling; we must strive to relieve suffering whenever we can. But try not to suffer with them. It will drag you down.
  4. Frustration, disappointment and anger are all normal responses to being a part of a resource-limited health system trying to cope with an overwhelming demand. Feeling those emotions means you care.
  5. When you stop caring you are burning out. You will feel less pain. You will feel less of everything. Talk to someone you trust, there is almost always a way back.
  6. Alcohol is one of the fastest ways to feel better. It will calm you, soothe you, reassure you and destroy you. Use it with caution, if at all. Don’t trust it.
  7. Your ED colleagues get it. No-one else does. Others can imagine, they can listen, they can sympathise, but they don’t get it. Don’t expect them to.
  8. When you feel a failure, when you think you have let someone down, when you think you’re no good and never will be, balance it up. Think of someone you helped, something you did well, a person whose life you touched even briefly and left better off than before they met you. If you’re doing this job right, there are far more of those.
  9. Take breaks. You will think better, work better and be happier. You will make fewer mistakes. You will achieve more work in less time. You will remember important things that need doing but have been drowned out by more recent demands on your attention. No-one who knows anything will resent you taking a break. The smart ones will make sure you do.
  10. Zen. When unwelcome thoughts crowd your mind, when you dwell on what went wrong, when you worry that you won’t make it, do this: Stop, recognise the unwelcome thoughts, and concentrate instead on your breathing. When the thoughts are gone, carry on. It doesn’t take a minute, and you can do it anywhere. Repeat as necessary.

You are in one of the most challenging and rewarding careers on Earth. You will be stretched to and beyond your capacity over and over again. You will do more for your fellow humans in an average week than many people do in their entire lives. You have privilege, power, and pretty good pay. There is a lot to be pleased about.

You strive to be perfect. You fail as all of us do. Know yourself, improve what you can, remember that we are all flawed.  Forgive yourself. Ask yourself this: is the world a better or worse place for having you in it? If better, congratulations. You have the strength to carry on. If worse, you’re in trouble. Speak to someone now. Someone you trust, who gets it. There is a way back from the abyss.

Guest post by Dr Mike Cameron

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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