What’s Your ‘One Thing’?

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Emergency medicine isn’t the most important thing in my life. It’s not even the second on the list. Understanding that has made me a better doctor.

So, a guy walks into a bar with a duck on his head…or was it a burned-out emergency physician with a chip on his shoulder? Regardless, a belated happy Emergency Medicine Wellness Week to you and yours! In an attempt to at least begin to address the high risk for burnout within our specialty, ACEP recently launched a campaign [1] to help support our mental and emotional health. At least someone is thinking of us.

When I was a medical student applying to residency, somewhere I had found the wisdom and the chutzpah to say the following to every program director I met: “If you get me as a resident you need to understand something: if I am doing this thing right, medicine will never be higher than number three on my list of priorities.” I did this for two reasons: 1.) I meant it, and 2.) I was testing them. The responses were predictably of two flavors: either a.) with a puff of smoke coming out of their ears while looking at me like I had four heads or b.) giving me a slight nod and subtle smile. I very quickly discerned from their response where their program would fall on my rank list. I have never once regretted my choice.

In my opinion, medicine in general, and emergency medicine in particular, is a service profession—it demands something of us and we give something of ourselves to it and to our patients.

Don’t misunderstand me, I love my job! I derive great satisfaction and fulfillment from serving my fellow man. And, I love teaching the art of the specialty to my residents—it’s the highlight of my practice. But, at the end of the day, I usually have less than I started with because I have given of myself. I probably haven’t eaten enough, peed enough, spent enough time with my patients, moved fast enough, been kind enough or smart enough. Oh, and when (not if) I make a mistake, my harshest critic is the one in the mirror pointing his finger at me. I need “something else” in life to fill me back up so I can do it all over again tomorrow. You need it, too. Curley in City Slickers referred to it as his “one thing.” What is your “one thing?” For me it can’t be medicine. I have found that if my list of priorities gets out of whack, if medicine starts to creep up my priority list, passing over my faith and my family (in that order), then everything suffers—I’m not a good husband, father, friend, sibling, or son. I’m grouchy, resentful, and bitter with a chip on my shoulder. And I’m not actually a good doctor, either.

This is the place where destructive habits creep in as we try to cope with the rawness of life we are privileged to preside over every day.

Medicine will never have enough of me and it will never have enough of you. As I tell my residents all the time, “you’ll never get to the end of life and wish you had worked more.” Kudos to ACEP for at least starting the ball rolling. But ACEP can’t fix this—it is up to me and it is up to you. I frankly tire of the mantra of balance and wellness, as if we just say the words enough times, do enough trust falls, or talk about it over yogurt and granola during a retreat, it will somehow miraculously happen to us, like winning the lottery. These all have their place but joining Weight Watchers doesn’t actually make you lose weight: it requires significant, perpetual, and usually difficult, life changes—the struggle for balance never goes away. Full disclosure: I will be working on this for the rest of my professional career, if not longer. In no way do I claim to have figured this thing out.

Someday I will stop doing doctor things for good, but I will never cease to be a husband, parent, friend. And, when I take my last breath, I guarantee that I will be grateful that I didn’t go to work more. So will my wife and kids. I bet my patients will be, too.

So, I’m not going in to the office tomorrow—it has seen enough of me this week.

REFERENCE

  1. http://www.forbes.com/sites/robertglatter/2016/01/31/acep-is-first-national-medical-specialty-group-to-launch-wellness-week/#116072fff3df

ABOUT THE AUTHOR

Dr. DeKoning is an assistant professor of emergency medicine and program director at Dartmouth-Hitchcock Medical Center in New Hampshire.

12 Comments

  1. Medication will never have enough of me and it will never have enough of you. As I tell my occupants constantly you’ll never get to the end of life and wish you had worked more Kudos to ACEP for in any event beginning the ball rolling

  2. When I was a medical student applying to residency, somewhere I had found the wisdom and the chutzpah to say the following to every program director I met

  3. Sometimes these judgments are correct and sometimes they’re not—but the experience of being on the receiving end of them is always frustrating for patients. However, given that your doctor has medical training and you don’t, the best you can sensibly hope for are judgments based on sound scientific reasoning rather than unconscious bias. Unfortunately, though, even the minds of the most rational scientists are teeming with unconscious biases. So a more realistic strategy might be to attempt to leverage your doctor’s biases in your favor.

  4. However, given that your doctor has medical training and you don’t, the best you can sensibly hope for are judgments based on sound scientific reasoning rather than unconscious bias. Unfortunately

  5. Don’t misunderstand me, I love my job! I derive great satisfaction and fulfillment from serving my fellow man. And, I love teaching the art of the specialty to my residents—it’s the highlight of my practice.

  6. I usually have less than I started with because I have given of myself. I probably haven’t eaten enough, peed enough, spent enough time with my patients, moved fast enough, been kind enough or smart enough.

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