WELLNESS COMMITTEE
A Colleague is Making You Unwell: Options? David Hoyer, MD FAAEM
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uffering the slings and arrows of working in our medical-industrial complex takes a significant toll on emergency physicians. Evidence for this toll can be seen in the ongoing drumbeat of our publications showing fatigue, burnout, depression, and suicides. Having suffered some of these wounds myself, here are some tips to my fellow emergency medicine colleagues to hopefully avoid being a casualty. The first step is to take ownership of your wellness, which needs to be tended like a garden throughout your career. Limit alcohol to the CDC’s recommendation of 1-2 drinks per day, avoid other drugs, exercise regularly, meditate, nurture relationships, get 7-8 hours of sleep daily when you are off and learn to say “no.” Once you have established wellness, carefully evaluate jobs. Some shops may look like good places to work until problems arise. Before you sign on the dotted line, read your contract carefully. Find out how patient complaints are handled. Does the medical director make the final call on the validity of a complaint or is it business people? If it is the latter, particularly if you are working as an independent contractor without due process, you are at the mercy of someone who could arbitrarily damage your career and wellness. Of course a trustworthy medical director who is not a spineless bagman for administration can make a big difference to your wellbeing. Avoid shops where there is a cap on the number of complaints acceptable, because you will be “walking on eggshells” or worse if you happen to be on duty when complaint-prone patients seek your care. Finally, avoid those jobs that say they are providing “concierge care” (or a similar term), which is business code for “the patient is always right” and, therefore, the physician is wrong for “allowing” a complaint to occur. Sadly bad business practices continue to corrupt the practice of medicine and subject physicians to moral injury on the job while contributing to the overuse of antibiotics and pain medicines and rising health care costs.1 Let’s say you are working at a job where you suffer some criticism. If you feel it is an unfair criticism it needs to be confronted, in a calm venue where you can effectively defend yourself. Sometimes the tendency is to not “make waves,” but you will feel better about yourself, then and later on, if you stand up to unfair criticism.
affecting patient care, keep records of patients affected. HIPAA generally does not apply here, although you will want to confirm that with your particular board. If a political issue related to medicine makes you unwell, our professional societies can be a significant source of support. While dues to these societies can sometimes seem excessive, you can view the money as an investment in your wellness. Starting with your local county medical society you can submit motions on a policy that can go to the state medical association and on to the AMA if a national policy is involved. A good way to take a break from the rigors and possible unwellness of shift work is by doing telemedicine. Patients may be less sick and, perhaps, less exciting, but you can practice evidence-based medicine at your leisure without Press Ganey and other inventions of the medical-industrial complex hanging over you. Since telemedicine patients are not subject to big bills after seeing you, they tend to be grateful when antibiotics or extensive testing are not indicated. Finally, until we get rid of due process waivers that so many of us must sign to work, we will be at a disadvantage with colleagues who can negatively affect our wellness. Getting the ER Hero and Patient Safety Act (HR 6910) passed into law would make due process waivers illegal and make our workplaces fairer. Some people think HR 6910 has loopholes that should be tweaked before going to a vote.2 If the above options don’t make you well, you may want to consider professional help. I previously published my story in “I Came Back from Depression, and So Can You,” available online and on the AAEM website.3 Be well beloved colleagues.
References 1. Giwa A. et al. Addressing Moral Injury in Emergency Medicine. J Emerg Med. 2021; 61(6):782-8. doi.org/10.1016/j.jemermed.2021.07.066 2. Sullivan W. Making a Stronger Hero (Act). EPMonthly; January 2021:13. 3. Hoyer D. I Came Back from Depression, and So Can You. Emergency Medicine News. 2018;40(9):20. doi: 10.1097/01.EEM.0000546141.79545.c3
If you are being made unwell by a job issue that cannot be remedied by verbal confrontation, you may want to contact your state medical board. For example, if you think that the corporate practice of medicine is
“The first step is to take ownership of your wellness, which needs to be tended like a garden throughout your career.” 28
COMMON SENSE MAY/JUNE 2022
