I vividly remember one of my first experiences at the beginning of my intern year. I had arrived at the emergency department for my night shift, and an emergency medicine attending said a surgical resident was looking for me. A few minutes later, that resident confidently strutted up to me and berated me loudly about a patient I had admitted the day before.
My face burned from embarrassment as I attempted to shrink into nothing. As quickly as he struck, he turned on his heel and walked out of the department. Against every shred of my free will, I began to cry. The attending grabbed my arm, wrestled me into the hallway, and declared, “Never in front of the ED staff.”
The message was blaringly clear: Consultants are allowed, even expected, to put emergency physicians in their place. This situation was repeated throughout my training—for EM residents and attendings alike. As a senior resident, I watched my attending hold a phone 10 inches from her ear because the physician on the other end was screaming. I swore no consultant would ever treat me that way after residency.
Fast forward to my first year out. A patient arrived with a clear-cut STEMI and symptoms to match. I activated a Code STEMI. After discussing it with the cardiology fellow, the patient ultimately declined cath lab intervention. In an apparent act of misdirected frustration, the cardiology attending sauntered over to my workstation, picked up the obvious STEMI ECG, and said disdainfully, “This is not a STEMI. Perhaps you need more ECG education during your conferences.” He dropped the ECG and strutted away.
Never mind the initial troponin of 14 ng/mL. I emailed the ED administrator the details of the experience, expecting him to admonish the unprofessional behavior. Unfortunately, I was advised to contact cardiology if there were any borderline ECGs, completely dismissing this physician's totally inappropriate behavior. Once again, everyone seemed to agree: Emergency physicians are the idiots in the basement and deserve to be treated as such.
Sadly, my experience is not unique. A recent letter in the Annals of Emergency Medicine reported that 88 percent of 225 emergency physicians surveyed reported abuse from consultants, and 85 percent believed it contributed to burnout. (2020;76:686; http://bit.ly/385i058.) Another study of 1774 EM residents found that 98 percent of them experienced abuse, but only 3.2 percent filed a complaint. (Acad Emerg Med. 1995;2:293; https://bit.ly/2WnrQtQ.) This is consistent with a culture of normalization of abuse of emergency physicians, to our detriment.
When the SARS-CoV-2 virus exploded onto the scene, the medical community melted down. The media reported waves of sick patients overwhelming hospital systems, and emergency physicians went from zero to hero seemingly overnight. Patients were thanking me, my friends were thanking me, consultants were thanking me, and all I could think was, “I'm doing the same thing I've done for years.”
Would you believe the chair of ENT brought doughnuts to the emergency department at 7 a.m. on a Saturday? Suddenly, the value of emergency physicians was universally acknowledged. Or so I thought.
As the first wave of COVID-19 in the big cities subsided, I accepted a facility medical director position in a small, community emergency department closer to my original home, a place yet to experience many COVID-19 cases. I suddenly found myself again in a system peppered with consultants who felt empowered to mistreat emergency physicians. This time things were different. My experiences in the pandemic reaffirmed my role (and that of all emergency physicians), not only in patient care but also in the refusal to accept toxic abuse from supposed peers.
I raised concerns about unprofessional behavior from consultants to administration twice in my first eight weeks on the job. Despite my initial hesitation, these were met with support from the hospital and dealt with in a professional manner appropriate to the complaint.
COVID-19 is reshaping the house of medicine. Physicians of all specialties are retiring at unprecedented rates due to burnout, changes in patient volume, and financial hardship. Young physicians are being forged in the fire of the most stressful time in modern medicine. Now, more than ever, it is critical that we redefine the expectations around our specialty.
What can we do to advocate for ourselves? If you work in a community ED and often interact with consultants at outside institutions, those phone calls are typically recorded. A polite reminder in the moment will frequently curtail abusive behavior. Consider reaching out to the department director. Abuse of emergency physicians may be a manifestation of burnout, requiring intervention. If you practice at a larger center and are working with consultants in house, find a champion in your department. If your department chair or director isn't enthusiastic, search for another outlet. Consider reaching out to your wellness committee. If you witness a consultant trainee abusing an EM resident, intervene immediately and explain the behavioral expectations in the ED.
We have too long quietly handled whatever situation we faced, but now it's time to speak up. Emergency medicine brings value to the patients we serve and the medical community. It is time that we are treated with professional courtesy and respect.
Dr. Holladayis the medical director of emergency medicine at Samaritan Albany General Hospital. Follow her on Twitter@Dallas_Holladay.