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Letter to the Editor: A Lifetime Quota of Misery

doi: 10.1097/01.EEM.0000419538.72635.28
Letter to the Editor

Editor:

I have always enjoyed reading EMN more than any other emergency medicine journal out there, hands down. Dr. Edwin Leap's article on post-traumatic stress disorder among emergency physicians really struck a chord. (EMN 2012;34[7]:5; http://bit.ly/NGXEj2.)

I practiced emergency medicine for almost 20 years in Charleston, SC. It was not until I left and went into urgent care practice that I realized that PTSD is essentially a hazard of the trade. I kept a journal, and when I read it again sometime later, it dawned on me just how tough it was being in those trenches. This is the first time I have really heard it addressed in this manner despite the countless boring physician wellness articles I have read over the years.

Dr. Leap has hit the nail on the head. I left the emergency department, not because of physician burnout, but because eventually you have seen so much human misery that you meet your lifetime quota. Fortunately, in our specialty we can go into a practice that for the most part is a happy place. Patients who come to urgent care are glad they don't have to wait seven hours to be seen. The encounter does not usually begin in an adversarial way as it sometimes does in the ED. They usually don't have immediate life-threatening conditions, and are mostly happy when they leave. I have not had a patient confrontation in the past seven or eight years. I have high Press Ganey scores, and the staff is usually happy. Sounds like medical heaven, doesn't it? Well, it is in a way.

My brother on the other hand is a gynecological oncologist, prone to the same rigors and burnout as emergency physicians. Unfortunately for him, there are no oncology urgent care centers at which he can scale down. What that means is that physicians like him who experience patient death and misery on a regular basis end up retiring sooner because of the toll it takes, whether or not they admit it.

The good news for us in emergency medicine is that once we make the transition to urgent care, the scars do heal over time and medicine becomes fun again, believe it or not. It is still hard work, but the human misery factor is not nearly as intense. I am thankful for the many years I spent treating patients in the emergency department and would not trade that experience for the world. It has made me a much better person and physician over the years. I am much more humble, tolerant, compassionate, and empathetic for it. I am also wiser now and appreciate where I am much more for having been there. I try to take extra time with my patients when I am able and address their emotional and spiritual needs more as well.

It is important to recognize this phenomenon that I feel occurs in most emergency physicians and to realize that we have options to lessen the effects in our specialty without leaving the practice of medicine. As the famous George Orwell said, “Time heals all things.” There may be something to that after all. Thanks again to Dr. Leap for the article and his insight.

Michael Lawhead, MD

Chapin, SC

© 2012 Lippincott Williams & Wilkins, Inc.