Letter to a young emergency physician

Advice, words of encouragement and ideas for self-care from an experienced emergency physician to the younger generation.

To our newest colleagues...

Advice, words of encouragement and ideas for self-care from an experienced emergency physician to the younger generation are found in this open letter by Nicolas Peschanski, Professor of Emergency Medicine and practitioner at the Renne University Hospital (France). Prof. Peschanski added thoughts and comments to his lose adaptation to a previous letter originally written by physician Dr. Mike Cameron.

Made in cooperation with our partners from esanum.fr

Nicolas Peschanski is a professor of emergency medicine and a hospital practitioner at the University Hospital of Rennes. He has been an active member of the SFMU (Société Française de Médecine d'Urgence, French Society of Emergency Medicine) for many years - with six years spent on the scientific committee - and has been a member of the reference committee since 2020.

Professor Peschanski's international career, particularly in the USA, has enabled him to become a member of the International Commission of the American College of Emergency Physicians as well as the steering committee of the EMCREG-International (Emergency Medicine Cardiac Research and Education Group). He is also a member of the European Society for Emergency Medicine (Eusem) and more particularly of its "Web & social media" committee. Dr. Peschanski is very attached to the FOAMed principle (Free Open Access Meducation). He uses social networks (@DocNikko) for educational purposes and to share knowledge in emergency medicine. We provide our readers with a translated version of his take on Dr. Cameron's message

Our first DESMUs (Diplôme d’études spécialisées de médecine d’urgence, French Diploma Course in Emergency Medicine) are finishing their course and are about to take the plunge. New physicians are preparing to start their training with us. This is an opportunity for me to humbly pass on some advice to each of them, which is not reserved for our young colleagues. I would have liked to have been able to read or hear this advice as I turned to this practice of medicine that is so singular and so modern. For this, I was inspired by Mike Cameron. Before retiring (I'm not, I assure you), this Australian emergency physician spoke to interns who were starting their emergency medicine course:

From A(lcohol) to Z(en)

Every turning point in my career has allowed me to look back at some key periods in my professional life, particularly my early years. When I started my residency in 1995, there were three stereotypes of senior physicians who practised emergency medicine: those who were on a mission to save the world, the adrenaline junkies and those who arrived there by chance. In fact, when you started out, you were often all three at the same time. Has this changed? So, whatever your "profile", here are a few tips that I hope will help you.

1. Every shift ends at some point

No matter how long it lasts, no matter how intense it is. It doesn't matter how much pressure you have been under. You will leave the hospital as soon as your shift is over and you will return to real life, that of a human being living in society.
Before that, always ensure quality handovers. Then let someone else carry the load of what comes next in the emergency room. Do not take it home.

2. Prepare for the after-call

Make sure that when your shift ends you have something planned: sport, cinema, nap, museum, terrace, etc.
Whatever it is, do it!

3. To relieve suffering is not sharing it

A necessary reminder. Empathy is certainly a good thing, but patients' suffering is theirs. It belongs to them and must be respected. Helping our patients is our credo, and we should strive to relieve suffering whenever we can. But don't try to suffer with them; it will drag you down.

4. Frustration, disappointment and anger are part of our job

These emotions are normal responses to doing our job, as we face increasing, sometimes overwhelming, demand in a health system under pressure with limited resources.
Feeling these emotions means that you care about the patients and the conditions of their care. Affect is a good thing, if you can channel it and express it calmly.

5. Are you insensitive? No, you are in burn-out

If you no longer care about your patients in the emergency room or in the ambulances, if you feel their suffering less, it means that you are becoming insensitive to everything. Also to yourself. Don't lie to yourself, you are in burn-out (and/or bore-out). Talk to a colleague you trust; there is almost always a way to prevent this and get back on track.

6. Alcohol and co.

Psychostimulants, psychotropic drugs... Quick ways to feel relaxed after a difficult shift, day or week. Certainly, it will soothe you. Maybe it will make you feel better.
After your job, use them carefully and in moderation. Or not at all. But at work, don't trust any chemical substitute to help you. It will destroy you.

7. Only emergency physicians can understand your work

No other physician does the same job as you. Some may imagine it, may listen to you, may sympathise. But they don't do what you do so well. Don't expect them to be able to do it even if they say they can.

8. A failure? No, a breakthrough

Do you think you have failed? Do you think you have let a patient down? Think you are no good and never will be? Take a step back, look objectively at what made you feel uncomfortable and learn from it. Value your mistake, your shortcoming, your disappointment. Turn it into a strength.

To do this, remember that person you helped, or that other person whose life you saved. Remember that little thing you did a little better, or that difficult thing you did particularly well. Then, focus on yourself and the problem you faced.
This is what moves you forward in your practice. If you are working properly, there is much more to be learned from a mistake or a case that goes wrong than from the routine you have mastered.

9. No efficiency without breaks

Take regular breaks. You will think better and work better - more efficient, faster, fewer mistakes. You will see priorities clearly and not drown in the multiple demands that distract your attention.
No one knows anything about how you feel when you take a break. And it doesn't matter what the sceptics think. Smart ERs will encourage you to take regular breaks.

10. Zen

When unwanted thoughts disturb your mind, when you dwell on what has gone wrong, when you fear you won't make it, do this: Stop everything.
Learn to recognise the unwanted thoughts, and concentrate on your breathing instead. When these unwanted thoughts disappear, go back to your job. It takes less than a minute and you can do it anywhere and almost anytime. Repeat this "exercise" if necessary.

Surpass yourself, forgive yourself, save yourself

You have embarked on one of the most challenging and rewarding careers in medicine.
You have unsuspected resources. You will be thrown far beyond your capacity to think simultaneously about all the cases you will take on, over and over again.

You will do more for your fellow citizens in one week than many do in their entire lives.

You are privileged, you have a lot of power - especially at night and at weekends - which as we know "implies great responsibility". In spite of this, your salary is quite good. In addition, for evenings out with friends, you'll have plenty of stories to laugh about... or cry about.
You will try to be perfect. You will fail as we all have. Get to know yourself so you can improve in whatever way you can. But remember that we are all fallible.

Always learn from your mistakes and forgive yourself regularly.

When you take your watch, ask yourself this: Is the world of emergency medicine a better place than any other? Is it worth being in? If it is, then you belong there, you have the strength to continue. If not, then you are in trouble. Talk to someone you trust without delay.

This person will help you to regain your self-confidence, to get what you want. This person will help you in your practice but also in your professional life. This person will keep you away from the abyss. More than that, this person will allow you to maintain this passion for the other person which animates you.