Finding Happiness in the Emergency Department

Finding Happiness in the Emergency Department

by Sam Ko, MD, MBA
CAL/EMRA President, 2010-11

“It’s too busy in the ED these days.” “Another faker.” “Why can’t they go to their primary medical doctor?” Have you ever said these words or overheard them during a shift? It can be disheartening to work a shift and see the patient chart rack mount higher and higher, as you place a central line in the patient with septic shock, then evaluate a patient with chronic low back pain, and then examine the ears of a two-year old whose fever “came right back four hours after Tylenol was given.”

Recently, I’ve discovered the secret of being happy while working in the ED. It’s a simple idea, but has profound implications. The idea stems from Srikumar Rao’s talk, “Plug into your hard-wired happiness.” He states that our mental model of happiness is flawed. Our model is based upon the logic, “I’d be happy if...”

For example, do you remember when you were pre-med college student? You said, “I’ll be happy once I get into medical school.” Then when you were in medical school, you told yourself, “I’ll be happy once I get a high score on the boards.” Then when you were in residency, you said, “Life will be great when I’m an attending.” This mental model is flawed, because it never allows us to be happy in the current moment. Instead, we continually seek the next step to elusive happiness.

Now, can you recall a time when you were truly happy? It may have been while watching a sunset over the ocean, seeing a beautiful rainbow, or welcoming your child into the world. Why were you happy? It was because you accepted everything at that very moment. You didn’t say, “Oh, it’d be more perfect if there were less seagulls flying across the sky.”

The emergency physician’s role is to evaluate everyone who comes into the ED - regardless of how sick or not sick they appear to be - and rule out emergencies. Our realm of practice includes the most bogus visits to the most critical illnesses. The key idea is acceptance of this fact. To accept everything that is happening and every patient who comes in to the ED, no matter what. When I accept the patient with an ingrown toenail, the asymptomatic patient who meticulously measures their blood pressure at home, or the patient in DKA who doesn’t take their diabetic medications, I feel calmer and relaxed. If I don’t want to develop stress-induced hypertension, burst an aneurysm, or start loading up on benzodiazepines prior to work, I choose to accept all aspects of my field.

Every shift, we have the opportunity to relieve pain, alleviate fears, and save lives. It’s a privilege to be an emergency doctor and everything that comes along with it. So here’s the challenge: during your next shift, calmly accept everyone you see in the emergency department.

Reference: Rao, Srikumar. http://www.ted.com/talks/srikumar_rao_plug_into_your_hard_wired_happiness.html Accessed 8.31.10

Originally posted in CAL/ACEP Lifeline October 2010.