It’s almost the end of your sixth shift in a row. You are trying to finish up notes when you hear an overhead page. You find yourself in the middle of a pediatric code that has a poor outcome and you have 5 minutes to spend with the family before being pulled into another patient’s room. You have no time to address the difficult case you just encountered. As an emergency physician, this may happen on a daily basis but some cases hit closer to home. How do you recover after these shifts, and how do you prepare for the next difficult patient encounter? Members of the ALiEM Wellness Think Tank recently spoke with performance psychologist Dr. Jason Brooks about how to mend these wounds and improve performance in the workplace. We provide a summary of our conversation and link to the podcast.

Podcast

Preparing For a High Acuity Situation

Uncertainty in EM is inherent, but preparing in advance for things that you may encounter will help improve your ability to focus. If you are aware of specific situational stressors that raise your anxiety and shift you away from your best performance state, then attempt to mentally work through that scenario with guided imagery beforehand. Guided imagery is much like being in a simulation lab, and rehearsal helps expose you to the stressor in a controlled setting so you can learn how to best respond. This helps improve your focus and confidence when the situation arises. If you utilize guided imagery multiple times (think hundreds), when that true stressor or infrequent procedure arises you’ll be mentally and physically prepared.

Resetting Your Focus

Calibrate your focus and energy when caught off guard and faced with a challenge. Challenges may include a complication, less than optimum outcome, or a disagreement with a coworker. Take a step back and recognize your heightened state of emotion and then reset your focus to the task at hand. Putting distracting thoughts and emotions aside enables you to become more present in the moment, leading to a better outcome.

Difficult Cases and the Importance of Debriefing

You may need to compartmentalize your emotions acutely after a difficult case when the emergency department is busy, but it is vital to revisit the incident. You need to mentally and emotionally process it. Otherwise much like a pressure-cooker, over time you may begin to lose empathy, develop compassion fatigue, and/or burnout.

Even when it is busy, try and spend 10-15 seconds for a micro-debrief with your team. This could be as simple as saying “I appreciate everyone’s efforts” or “let’s honor this person’s’ life.” This is not only beneficial for you, but also for all of your team members who are facing similar emotions. This creates a collective exhale for the time being.

Dealing with Difficult Consultants or Colleagues

When you have a difficult encounter with a colleague, take into consideration whether this behavior is typical or atypical for him or her. If it is atypical, try and understand that he or she may have just had a difficult case or may be having a bad day. You cannot change how people act towards you, but you can change how you react in these situations. Do not let their behavior pull away your energy and focus because it can be used better elsewhere.

Learn as much as you can from your difficult cases. You can take lessons learned and spread this knowledge to others as a mentor or colleague. Embrace difficult experiences as they help you grow as a physician. Remember that you have control over your own headspace. Spend time visualizing difficult situations and your desired response and spend time debriefing your team afterwards.

More from the Wellness Think Tank

Join us for the ALiEM + Essentials of EM Resilience Training for Residents! This exclusive, interactive workshop will help you obtain some of the psychological skills needed for personal and professional resiliency.

• Location: Essentials of EM Conference in Las Vegas
• Date: May 14, 11:00 AM to 3:00 PM
• Cost: Only $249 (includes entry to the entire conference)

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