ED/EQ: They won’t like you when you get angry

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Invest in your emotional IQ and reap a giant ROI.

If you’ve been following this column you have seen the many ways that using emotional intelligence can make your shifts easier, more enjoyable and less conflicted. Emotional intelligence (or EQ as it is abbreviated) is simply recognizing your feelings and the feelings of others and managing both to achieve the desired outcome. EQ gives us a cognitive framework on which to view past events and guide future encounters.


Since we know this intuitively, it is unfortunate how frequently we eschew using EQ and allow ourselves to react emotionally and create problems. Think about the last time a consultant treated you or your staff poorly—and sadly you may not have to think back very long ago. Here is a story about one of those incidents.

In the middle of the night Dr. Peters, a surgeon, was asked to come to the ED for a bowel obstruction. When Dr. Peters approached the locked ED doors they opened because John, an ED nurse, happened to be walking out the doors at the same time. Seeing no name tag, John asked Dr. Peters who he was as he entered the ED. Dr. Peter’s response was abrupt and dismissive, and the interaction was viewed by another staff member who informed Julie, the charge nurse. As the surgeon was leaving the ED later that night Julie approached him and explained that his hostility towards John undermined the likelihood that John would ask the next person to identify him or herself, thus compromising the security of the ED.

Dr. Peters blew up. His response was such that Julie, who is amazing in any emergency situation, actually cried. Dr. Peter’s next step was to seek out the emergency physician and share that he was going to stop taking calls if the emergency department staff kept harassing him.


On the scale of negative ED consultant interactions, hopefully this ranks pretty far to the extreme for your practice. Emergency physicians have a job description that involves calling other practitioners at inconvenient times and requesting that they come to work at unplanned and inconvenient times. Most of us are well aware of that and preface conversations with phrases like “I’m sorry to wake you up…” or “I know that you’ve had three admissions already…”. Consultant blowups are a factor in EP burnout and in job dissatisfaction. EPs working in small towns are often good friends with their consultants, and while that relationship is helpful, even a good friend can become snappy when they have been pushed too far emotionally or physically.

What is most ironic about these events is that the person who has lost his or her own cool often has their day ruined also. In this instance, Dr. Peters was upset about the interaction the whole day and then stewed about it off and on for the following week. His viewpoint was different from that the staff, not unsurprisingly, and his perception was that he had responded well to the request to identify himself and that he was simply “accosted” by the ED charge nurse. Furthermore, he was tired, on call between OR days, and felt that being on call was a community service and that it didn’t help his practice.

Recognizing that losing one’s temper like this has harmful effects not just on the recipients of the outburst but also the instigator, it begs the question of why do we let ourselves do it?  Do we have little control over our temper?  If we do have control over it, why do we give in to an urge that harms us personally and professionally as well as harming others?  If the cost of letting our temper go is 10,000 times the cost of the energy to control ourselves, why do we do it?

Research suggests that the answer is complex. Anger patterns are laid when we are young by how we experience it in our families, then we build adult interactions that are influenced by our physical and mental well-being, and then stress hormones like epinephrine can make our reactions seemingly uncontrollable.


Self-control is a skill just like any other and has to be practiced. One may have to start small and learn to not get irritated when the dog barks or when some interrupts you for the 10th time or when you encounter one more bad driver on the way to work. There are many techniques to use—counting to 10, taking deep breaths, acknowledging the anger and then releasing it—and like any other behavior, it will become habit such that one day you will wonder “how did I ever let something like that bother me?”  And the beautiful thing is that when you stop being angry at things, not only do you become that doctor that everyone wants to work with, you will also find yourself lighter and happier.

As one’s power of self-control grows, difficult conversations with a spouse or with an angry consultant will make one less likely to react and more likely to be able to use EQ principles to manage the situation. One could decide that something needs to be said or that it should be let go or that it needs reporting to another person in the hierarchy. The important thing is that you will be able to choose your reaction instead of simply reacting.

Even if you have no altruistic impulses, EQ gives you a powerful return on investment. The energy cost to Dr. Peters for the encounter above is so much higher when he allows himself to lose his temper that it just doesn’t make sense to do it. Even if the staff were totally wrong, it was in his own best interest to control his words so that he could have a peaceful day and week. He could have taken one moment to simply show his name badge, not said anything, and then had no negative interactions and no moments of stewing.

When you pass on an abrupt reaction in a moment you always have the opportunity to address it later. But when you blow up, that opportunity is lost forever.


Keri Gardner, MD, MPH, FACEP is an emergency physician and Chief Medical Officer of Alaska Regional Hospital.

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