First Person: 10 Ways to Make EPs More ‘Resilient’ : Emergency Medicine News

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First Person

10 Ways to Make EPs More ‘Resilient’

Duling, Reginald MD

doi: 10.1097/01.EEM.0000855788.18128.8c
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    resilience training, burnout, wellness, humor in medicine
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    I can't be the only emergency physician sick of hearing the term “resilience training.” No one seems to want to put earnest effort into addressing our concerns, so we should learn better coping skills. Great plan!

    What are my two biggest pet peeves, you ask? I know it's a random question, but I'll tell you: wasting my time and insulting my intelligence. Practicing medicine in the 21st century does both. All day. Every day.

    If you're serious about reducing physician burnout, let me point you in the right direction:

    1. Staff the ER appropriately. Health care is the only business in America where people line up day after day willing to pay thousands of dollars for a few hours of service. How do we accommodate them? We don't. We expose them to deadly diseases and anger them as they wait in pain, and then we use their satisfaction scores to label doctors as good or bad.

    2. Jumbo shrimp is an oxymoron. “Epic upgrade” is a term so oxymoronic it should be outlawed by the Geneva Convention. Look, I don't want to go back to paper charts, but failing to make the EHR work for doctors at this point feels willful and malicious. Hard stops are built in overnight, but every time—for more than 10 years—I have entered a diagnosis of bee sting, I have had to click on whether it was intentional self-harm or accidental.

    I've seen a lot of patients with suicidal ideation, but none has mentioned Hymenoptera in his plan. And the first page of discharge instruction selections when I enter a diagnosis of minor head injury involves burr holes or craniectomy. Maybe minor head injuries are managed much differently in other parts of the country?

    But no discharge instructions whatsoever for rash? If I knew what the rash was, I would have entered that as the diagnosis. And that's just discharge instructions, which doesn't even scratch the surface of the countless ways in which the EHR makes practicing medicine grossly inefficient, frustrating, and dangerous to patients. Fix it.

    3. Blow up the current payment system and start from scratch. This is an article, not a white paper, but the current system is insane.

    4. Fix charting, which is probably the single biggest factor in physician burnout and career discontent. I don't have the right to insist the plumber who fixes my leaky toilet write a 1500-word report on it so he can be paid. Here's an idea: Try treating doctors like professionals. Take my word for it if I say I reduced a nursemaid's elbow. It should never take longer to do the chart than fix the problem.

    5. Develop a metric that measures how metrics are destroying medicine. Every patient encounter is another opportunity to fail at something. Explain why taking a patient straight to CT to find a suspected head bleed as quickly as possible is a failure because the glucose wasn't checked, interpreted, and documented with a time stamp inside of 20 minutes. Never mind; you can't because it's not. It's stupid.

    6. Stop running out of stuff. I regret doing so from time to time, but I like getting D-dimers. I often order a side of Omnipaque with my CTs. I prefer 0.5% bupivacaine to lidocaine (why not give longer-lasting analgesia if you're poking someone with something sharp?). I guess I should be grateful I don't need baby formula to treat anyone.

    7. Stop locking up stuff. I'm pretty sure even my most challenged patients can crack the code as I push five buttons in a row across the top of the supply cart. OK, lock the carts in patient rooms, but why lock every cart and cabinet in the ED when everyone who works there has the combination?

    8. Stop pushing “ERs Are for Emergencies” campaigns while making the ED serve every public health function conceivable. EDs are used to clear patients medically for jail, detox, mental health placement, and foster care. We screen for Ebola (still? Really?), depression, human trafficking, domestic violence, and hypertension. I'm not a bad doctor for not telling an 18-year-old with an ankle sprain to follow up with a primary care physician because his blood pressure is 121/80, so stop treating me like it.

    9. Tamp down the sound effects in the ED. I haven't had time to buy an instrument to measure this, but I am fairly confident that the high-pitched tones assigned to everything from monitors and the tube system to a broken negative airflow seal are of sufficient decibel levels to cause permanent hearing loss. No joke.

    10. If you're not going to fix even one of these, you know what you can do with your resilience training. I'll figure it out on my own.

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    Dr. Dulingis an emergency physician in Issaquah, WA, and he recently gave up his amateur status in sarcasm to go pro. He is also the author of ER Doc: Defining Moments of a Career in Emergency Medicine.

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    • wdurkinmdmba11:25:30 PMExcellent article, Dr. Duling. I would also add all of the unnecessary interruptions. Is it really a good idea to rush into the dictation area and disturb our train of thought to ask if a patient can eat? Why not put that in the comments section of the EMR?