|Image Credit: Common Sense
Author: Nick Pettit, DO PhD
Originally published: Common Sense January/February 2019
Very few jobs, let alone, medical specialties have the potential to encounter death on a daily basis. With this comes responsibility, honor, reward, pride, but also despair, death, and failure. Politics and biases aside, as clinicians, it is engrained early in our training that we are present to aid, cure, educate, and comfort the patient. The patient is the focus of everything, patient satisfaction, outcomes, money, litigation, politics, and this is so true when we as a health care team almost save a life. Imagine Billy, a 12 year old boy riding his bicycle on a sidewalk and is struck by a drunk driver. EMS arrives and finds a child as a GCS 3. Intubated and sent to local ED, where thorough radiographic imaging demonstrates diffuse axonal injury, possible cervical spine injury, bilateral hemopneumothoraces, etc., and clinically has experienced a nonsurvivable event. After being admitted to the pediatric intensive care unit, and after numerous consultations with subspecialists, the parents do the most heroic thing of all and consent to organ donation.
A life almost saved.
In this process of trying to save a life, the family’s life is devastated. As part of the health care team, we need to appreciate that the family are not the only ones impacted by this tragic event. There are:
- Witnesses to the event
- EMT personnel
- All the nursing staff
- The residents and medical students involved in the care
- The recipients of the donated organs
- And most relevant for this article, the doctors taking care of the patient
Burnout and resilience are heavily discussed in residency training and like the prototypical emergency medicine physician we all try to do it all. We cover the extra shifts, we pick up the new patient in bed 10 near the end of our shift, we say yes to that extra endeavor that may be a great boost to the CV, and most importantly we do it with pride. But what happens when we fail? What happens when we almost save a life? Failing and experiencing loss and devastation is something that will occur during our practice and it hurts. No curriculum teaches us how to fail.
How silly would it be to have a lecture named “how to fail.”
As a soon to be graduating resident, I would love that lecture. I have had lectures in every other critical topic in emergency medicine, but nothing has prepared me how to handle an almost saved life, a “honey your schedule is too busy,” or “can you take on this new academic role.” In a little more than two years of training I have experienced the gamut of human experience from best to worst, and like everyone else we move on and see the new patient in bed 10, or push ourselves to pick up that extra shift. For the sake of all physicians, we need to readjust our lens of focus to the patient, to now encompass the patient and the physician. Where does this start? No one knows, but I would advocate for refocusing the lens early in medical training as to make it a priority as we advance the academic totem pole.
In a medicolegal climate where we are as interested in taking care of patients as we are practicing to avoid lawsuits, in an era where corporations and governmental agencies are imposing reimbursements based on satisfaction score, emergency medicine can become the life almost saved. With major corporations running residency programs and being our major employers we need to make sure that we ensure our livelihood and careers are protected. How do we do this? We recognize the need to take care of each other and our specialty. We need mentors to lead the future generation emergency physicians. We need advocacy to continue to pursue legislation that helps protect us as physicians. We need continued wellness initiatives that promote student, resident, and physician self-improvement.
This is asking to create a wave in a well-established paradigm of medical training. Physicians need to be given permission to fail and say no. We are asking to put the physician and the physician’s interest and experiences at the level of the patients’.
Emergency medicine is hard, and is a life we can save with collaboration, teamwork, and communication. Take care of thyself and don’t be afraid to fail. Say no. Debrief with team members and watch out for your peers. Most importantly get help if you need it and recognize we all fail, we just don’t talk about it.