Why Emergency Medicine, #StopTheStigmaEM, and the Future of our Specialty
WELLNESS COMMITTEE
Stephanie Balint, MS2,* Jonathan Warren, MD PGY-3,† Amanda J. Deutsch, MD,‡ Alice Min Simpkins, MD FAAEM,§ and Al’ai Alvarez, MD FAAEM¶
I
recently started rewatching the TV show ER. It’s a great reminder of why I went into emergency medicine (EM). I was struck by the very realistic depiction of many of the conditions and cases they tackled as well as the very unrealistic heroic portrayals of some of their characters—Dr. Greene, Dr. Weaver, and Dr. Ross, among others. There were several inaccuracies though—the county hospital being a stone’s throw away from the Chicago River or the Chicago “L” train stop for the hospital situated within the Loop for example. Clinical scenarios have also evolved—giving “Pavunol and Sux” for every intubation, diagnostic peritoneal lavages during trauma, or even resuscitating without masks and sometimes gloves. And then, there are common threads of vicarious trauma from the perspective of physicians and nurses due to gun violence, intimate partner violence, racism, and discrimination against people with HIV.
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Dr. Bessel van der Kolk, author of “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” talks about emotional and sensory manifestations of trauma that we experience throughout our lives. Because EM physicians see patients at their worst, we’ve mastered compartmentalizing repeated traumatic experiences. Dr. van der Kolk shares that healing comes from addressing these past traumas, which requires personal contemplative training and working with trained experts. Yet, even in 2022, decades after the hit show ER, many of us still do not consider attending to our mental and emotional needs as important as tending to our physical needs. October started the interview season for future EM-bound medical students. As I read through personal statements and met candidates during their interviews, I wondered how much, as a specialty, we’re doing to emphasize the importance of selfcare and boundary-setting.
AS EM PHYSICIANS, WE CANNOT SIMPLY WAIT FOR THE SYSTEM TO CHANGE ITSELF. WE CAN AND MUST BE PART OF THE CHANGE THAT PRIORITIZES OUR OWN WELL-BEING.”
As we forge ahead three years into the pandemic, while many archaic practices are no longer mainstay occurrences, some things are still common: Dr. Weaver getting sick while on shift after chemical exposure and insisting on working, or Dr. Morgenstern suffering an MI while working and trying to convince everyone alternative rationales for his symptoms, or Dr. Greene, having been attacked in the ED bathroom and how this impacted the way he viewed his patients and staff. Just like them, we’re not so great at taking care of ourselves as physicians. These are but three examples of physical trauma that many of us, just like the characters, easily ignore because of our commitment to our work or the misconception that we are less if we take the time to acknowledge our own needs. Another underlying theme is the hidden curriculum of expecting individual physicians to manage our daily work’s emotional and mental impact.
Yes, many would point out that conditions in our work drive the majority of trauma that we experience, and therefore, the institutions should address inefficiencies in practice and create better cultures for wellness. They are not wrong. However, as EM physicians, we cannot simply wait for the system to change itself. We can and must be part of the change that prioritizes our own well-being.
This past October, AAEM joined the Society of Academic Emergency Medicine (SAEM) and other national EM organizations to make October the first ever #StopTheStigmaEM Month. October is an important month to pause and reflect on our purpose in medicine and to prepare us for the busy winter that awaits us. October 9 is Dr. Lorna Breen’s birthday, having died of suicide as a result of the cumulative pressures of the profession and the pandemic. October 10 is World Mental Health Day, aimed to raise awareness of mental health issues worldwide. The #StopTheStigmaEM campaign aims to normalize mental health care among EM physicians like you and me. Each year roughly 300-400 physicians die by suicide, like Dr. Breen, numbers that are higher than the prevalence of suicide rates among US workers in other fields. Before the pandemic, 1 in 15 US physicians had >>
COMMON SENSE NOVEMBER/DECEMBER 2022
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