Embracing and Managing Anxiety: Lessons from “Inside Out 2” for Emergency Physicians
ACADEMIC AFFAIRS COMMITTEE
Gabriel Sudario, MD MSEd FAAEM
A
fter a grueling month of difficult clinical shifts and preparing for the graduation of our senior residents, I finally found the respite of a “golden weekend.” Going to the movie theater for the first time since before the COVID pandemic, I decided to take my kids to see “Inside Out 2.” For those unfamiliar with the Inside Out universe, it’s a brilliant animated exploration of human emotions personified within the mind of a young girl named Riley. Emotions like Joy, Sadness, Anger, and others navigate her through life’s complexities. In this sequel, a new character, Anxiety, makes a poignant debut, which hit me with an unexpected gut punch. Our introduction to the character Anxiety starts in an endearing way, as we see her successfully help Riley navigate difficult social situations by constantly anticipating and imagining the “what-ifs.” As Anxiety becomes a more dominant character in Riley’s mind, the cracks in this character’s proactive nature begin to show. In a memorable scene, Anxiety directs a room full of “animators” to project every possible danger and failure Riley might face in her upcoming hockey match, keeping her up through the night in a state of frightened insomnia. The remainder of the film becomes a profound exploration of core identity beliefs and the challenges of managing anxiety when it is at its most overwhelming state.
and equips us to handle the unpredictable nature of our work. However, left unchecked, it can have detrimental effects on our emotional health both inside and outside the ED.
Anxiety sharpens our senses, propels us to think several steps ahead, and equips us to handle the unpredictable nature of our work...
For the next two days, my mind kept coming back to the character of Anxiety, in which her depiction resonated deeply with me. I came to the realization that this emotion that is so vital to my work as an emergency physician could also have been affecting my non-clinical life in negative ways. Recent evidence highlights a concerning trend in the mental health of emergency physicians. Studies show that rates of burnout, depression, and PTSD are significantly higher in our profession compared to others. For instance, a recent study by Shanafelt et al revealed that nearly 65% of emergency physicians experience burnout during their careers.1 A 2016 abstract from Delucia reported that 15% of emergency physicians meet DSM-V criteria for PTSD.2 Anxiety seems to be a common manifestation of mental health difficulties seen in emergency health care workers, with Alharthy et al reporting 52% of emergency healthcare workers in their survey experienced various levels of anxiety.3 While these figures may come as no surprise to us who work in this field, they underscore the urgent need to address mental health within our specialty. The Double-Edged Sword of Anxiety
Anxiety’s character in “Inside Out 2” perfectly embodies its dual role in many of our lives, especially with our work in the emergency department (ED). In the ED, we often thrive on this heightened state of alertness. Anxiety sharpens our senses, propels us to think several steps ahead,
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COMMON SENSE SEPTEMBER/OCTOBER 2024
Anxiety Makes the ED Function
In the chaos of the ED, anxiety can be our ally. It enables us to: y Anticipate Potential Threats: We think multiple steps ahead to identify and mitigate potential life-threatening situations for our patients. This constant vigilance allows us to quickly assess and respond to critically ill patients and is a defining trait of our specialty. y Increase Efficiency: By predicting barriers to patient dispositions, we streamline processes, ensuring timely care. This foresight helps us navigate complex systems and reduce delays, enhancing the overall efficiency of our operations. y Pushing Through Challenges: Anxiety fuels the energy required to navigate administrative and bureaucratic hurdles inherent in our job. This drive enables us to tackle charts, coordinate with consultants, and manage the myriad tasks that endlessly come our way.
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