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You Are Not Alone Guest Column: Dr. Edwin Leap

In this column, SCCEP Member and renowned columnist, Dr. Ed Leap, shares with us some heartfelt compassion and insight about being an emergency physician. Next month, SCCEP will award Dr. Ed Leap the Jack H. Warren Award in appreciation for his many years of leadership supporting the goals and missions of SCCEP and ACEP. Thank you Dr. Leap for your lifelong support of emergency clinicians (docs, nurses, techs) everywhere.
Dear emergency medicine physicians, You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them.  Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick and some are injured, and many are addicted and a few are just lonely. They’re inescapable. And nurses. They’re all around also. The ones who carry out your orders, tend to your patients, sometimes ignore what you say and constantly interrupt your train of thought by putting EKGs in your face and shouting ‘Chest pain in room three will you see it!’ Or who constantly ask you ‘is the order in yet?’ You can’t escape them. Even a trip to the restroom will result in a phone call in short order.

Furthermore, there are students and residents to educate, and shape into excellent doctors. (Without killing anyone.) And there are consultants too. The ones who tell you ‘call me when the workup is finished,’ or ‘why didn’t you get the phosphorus level? How can I know what to do without the phosphorus level! Jeez!’ And there are those who refer patients to you. ‘Hey buddy, my patient has pneumonia and needs to be admitted to the hospitalist and has a bed but I need you to check him out first.’ The ones who send you their post-op complication one hour after the surgery.

There are other people all around too. There are administrators and managers, credentialing ladies, people tracking your times and your efficiency and evaluating your patient satisfaction scores. There are medical records people and coders tracking you day in, day out, to keep you on point with the endlessly important charting and billing that are the main purposes of your decades long education. Dear doctor, you aren’t alone. But not because of all of that.

Not because you’re under more scrutiny than at any time in the history of medicine. What I mean is, having traveled this great land of ours doing locums, I assure you that the struggles you face are present everywhere.  Oh, they vary in degrees. Those little oases untouched by the icy hand of EMR can be positively pleasant in their lack of complex charting requirements. And on night shift, in the middle of nowhere, in the mountains, there’s a paucity of people in general. But there will still be complex social situations, still be drug addicts, still be someone who wants to know about your door to needle time. Everywhere you go, there’s ‘that doctor’ who is simply surly and impossible to please when he’s on call.

When I say you aren’t alone, what I mean is that we are a fraternity (or a sorority if you wish). Perhaps better, we are a tribe, a clan, an extended family. Emergency medicine is a small specialty but what we do is so consistent across the country, and around the world, that we can all sit down at conferences or meetings, in airports or over dinner, and share the same stories, the same sorrows, the same laughs over the same archetypes. So when you come home and think that you’re the only one who thinks about quitting, you’re wrong.

We all do it now and then. When you think that maybe you’ve lost your patience with drug seekers, you’re wrong. We all lose it now and then. (I’m not proud…so I won’t go into it.)  If you think that you’re not fit for night shift because you feel terrible after being up, trust me you aren’t alone. Nights make everyone nuts. (As does day shift…and evening shift.) It’s a wonder we don’t all need psychiatric evaluation after long strings of sleeplessness coupled with complex care of the arguably the most demanding people on earth.

Are there days when you just want to go home and cry? Normal. Are there shifts you think you didn’t really know what was going on with anyone? Ditto. (PS, it usually means nothing was going on except drug seeking and the pursuit of work excuses.) Have you wanted to invite your on call specialist to the parking lot for a ‘come to Jesus meeting,’ and you think you have a problem? Nope, I’ve been there. And do you think that you might be the only physician with an EMR ‘inbox’ that’s full to the brim with requests you can barely understand? You aren’t. In fact, I suspect that delinquent charts have exploded in the last few years as charting becomes more and more complex.

Ladies and gentlemen, are there times you think you should have studied harder and tried for that ophthalmology residency? Haven’t we all. You aren’t alone. You aren’t alone in your troubles. But more important, you certainly are not alone in being part of the baddest, toughest, most compassionate and courageous group of physicians in the world.

You’re tough, you’re kind and you’re smart. You endure, no matter how hard or complex the shift, no matter how badly you feel.  You’re weary and irritable and pale. You’re hungry and thirsty and sometimes confused.

But kids, trust me. You’re awesome.

And you aren’t ever alone.
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