Resilience in the Life of an Emergency Physician

By Rosanna Sikora, MD, FACEP; Laura McPeake, MD, FACEP; and Arlene Chung, MD, FACEP

Emergency physicians are some of the most amazing and resilient physicians of all specialties. The following is a short example of resilience in a real life scenario. See if you can also find examples in your practice and life of the same sort of resilience. By opening our eyes, we see the beauty of human spirit and reward ourselves with happiness.

Long-time emergency physician, Dr. Silien, is regarded by many of his colleagues as a mentor and example of unfailing grace and humor under pressure. He is well known by all the medical students and residents. We recount a typical Dr. Silien story during sign-out in the emergency department. Dr. Silien begins:

“So this is a 57 year old male with chest pain that seems atypical to me.
Initial work up negative.
Benign EKG, no other risk factors.
So, once his labs come back, discharge him with follow up tomorrow in ASYSTOLE clinic.”

It takes a minute for his joke to set in. We all chuckle and look at each other knowingly.

This case underlines the uncertainty we all live with. It is a lesson in resilience, seeing something alarming and being able to be tougher on the other side of it because you were able to face it. Despite all the blows that time has thrown him, Dr. Silien has weathered every diagnostic dilemma, near miss, and adverse outcome with poise and a little gentle humor. He really cares, and recognizes that won’t always save him or his patients from possible disaster, but most of the time it will see him through. He unconsciously copes by using narrative reflection, atypical humor, and peer discussion. He has the ability to take a hair-raising situation and weave it into a comforting blanket that has us all rolling on the floor laughing.

There are specific strategies to help build resilience in your own practice.

Writing a journal or recording oral narratives. Transforming traumatic experiences into cohesive narratives, such as the many colorful stories shared by Dr. Silien, changes them from potentially damaging emotional memories into opportunities for growth. Observe and note your co-workers and patients for inspiring behavior. This can be done by verbally recording your thoughts onto your cell phone or a hand-held recorder after your shift on the ride home

Peer mentoring. Recently, the field of critical incident management has moved away from the unwieldy Critical Incident Stress Debriefing (CISD) model to focusing on psychological self-assessment and peer mentoring, thereby formalizing something that the more resilient among us have known for years. Discussing stressful events with a supportive and empathic colleague is some of the best medicine that we have, and if our emergency medicine atypical humor is involved, all the better. Humor is a great coping strategy.

Personal Coaching. Develop a mission statement and a career plan. Find a support network to help you to connect to what you value most - both in your career and in your personal life - and to help you achieve your goals.

Focus on empathy. It is the ability to understand and feel another person’s perspective. Multiple resources for building empathy exist, including books, workshops, and podcasts. Connect with your family, friends, and co-workers outside of the fluorescent lights of the emergency department.

Take care of your own needs. It is easier to be resilient with a full night’s rest and a body that’s been fed with proper nutrition. Remember to MOVE your body - a jog a day keeps depression away. Make time for what you enjoy. Place it on your calendar and treat it like a shift

Limit stressful downtime. The old adage, “work hard, play hard,” may actually work against you. When we unwind with horror films, and when our vacations become death-defying adventures, we begin to live in a permanent state of adrenergic arousal, which can cause us to remain detached from our feelings and prevent emotional processing, thereby worsening symptoms of depersonalization.
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