Another Day in the ED: Empathy vs Desensitization

Patient after patient, emergency medicine physicians experience highs and lows, sometimes minutes apart. "It might be another Tuesday for us, but for the patient in that dramatic life moment on that day, it's everything," says Charissa Pacella, MD, chief of emergency medicine at UPMC Presbyterian in Pittsburgh.

Emergency department (ED) physicians frequently encounter fatal situations, feel frustration when they can't save a person, and constantly see patients in distress. How do physicians weather the emotional storm of life in the ED with both their mental health and empathy intact?

Two ED physicians shared how they stay calm, deal with clinical treatments that may not ultimately save the patient, and create sound emotional boundaries.

Reserve Time for Emotions

Pacella, who has been practicing emergency medicine for 22 years, also serves in a leadership role for Physicians for Physicians, a confidential peer support program at UPMC for doctors struggling with the impact of adverse events and the stress they face. She says it's essential to know how to compartmentalize and focus on the task at hand, but later revisit emotions from a personal perspective.

"We all separate our cognitive and leadership roles from our emotional response in the moment…," she says. "Everybody is just focused on doing the next right thing. And often it's not until sometime later when you sit down or go home or maybe even going in for your next shift that it really hits you in a more emotional way."

If you try to avoid or skip over this part of the process by shoving the emotions down and ignoring them, Pacella says, you leave out a crucial part of the care process. And over the course of a career, you'll risk losing empathy and the human connection that most doctors went into medicine for, she tells Medscape.

Connect With Your Colleagues

Physicians supporting each other is crucial, says Pacella. And luckily, she adds, connection tends to be a strength of the specialty.

"As emergency medicine physicians, we share a lot in common, and part of it is what brought us to choose this specialty in the first place. You picked it because there's something appealing to you about the unknown. It's a unique role, a unique environment, and a unique relationship you have with patients and being able to connect with colleagues," she says.

Lisa Williford, MD, emergency medicine specialist at Texas Health Harris Methodist Hospital in Fort Worth, Texas, says her 14-year career has taught her that no matter how focused a medical professional can stay in the moment, emotions are happening at some level.

"During a level 1 trauma, there are a lot of people in the room — trauma surgeons, residents, nurses, x-ray techs, respiratory therapy, anesthesia — and every one of us is having emotions. It's not realistic to think anyone is avoiding it."

But beyond simply recognizing a shared experience, it's important to talk to each other. It's not just about how you're feeling, but also what you do to help manage that emotional load.

"I'd say that more of us, especially since COVID, are learning that actually getting a therapist is a good thing, having a life coach is a good thing," says Williford. Accepting mental health care and learning how to manage it is also a good thing.

Accept Unpredictability

You may think you know how a difficult situation will affect you, but that assumption can put you in a vulnerable position. Pacella says she's learned that for most physicians, a stress response to a critical incident often has less to do with the type of event and more about who is involved or your past experiences.

"I have reacted in a very emotional way at moments that I would never have expected or predicted," says Pacella. "And it's not always because of some awful event. It's usually because of some emotional connection or trigger embedded in that encounter."

For example, she says, you may have had a past case as an emergency physician where the outcome was not favorable, or the patient involved may remind you of yourself or someone you love.

"It might not necessarily be a horrible thing happening to a young, healthy person that triggers someone; it might be a minor problem involving a patient you, for whatever reason, identify with," she says. "Or you may have had a similar patient where things didn't go well for them. It's just highly variable, even for an individual."

Just as you can't know what medical issues you'll face in a day, you can't predict how you'll react. Approach each scenario with the knowledge that you may veer off emotional course — and prepare accordingly.

Bring Mental Wellness to the Forefront of Training

Williford, who also serves as regional director for ScribeNest, a doctor-operated company that trains medical scribes who are on the path to becoming medical professionals, says she feels strongly about bringing this conversation to the younger generation.

"For me, nobody at the med school level or residency level taught or talked about how to compartmentalize and cope with the traumatic experiences that we saw," she says. "Only in the last decade have we started teaching our residents and medical students about burnout and resilience.

"I say things like, 'Hey, we just witnessed an 18-year-old in cardiac arrest. We did CPR for an hour and didn't get him back. And then you witnessed me tell his mom, who wailed. And then we turned around and treated an ankle sprain. Let's sit down and talk about how jarring that all is and how nobody else experiences these things.'

"We have this expectation that our physicians know how to move on and connect with each new patient with care and empathy, but we have to tell our future doctors the actual steps we take to be able to do that."

Seasoned physicians can lead the way for the next generation and turn the tide toward the normalization of talking about these struggles. By making it part of training, it becomes part of a physician's skill set.

"With a happy, healthy career, we can pay it forward to the next generation and teach them how to be better than we were," says Williford.

Rachel Reiff Ellis is an Atlanta-based freelance writer and editor specializing in health and medicine. She is a regular writer for WebMD and Fortune Well, with additional work appearing in Prevention, Oprah Magazine, Women's Health and others.

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