Emergency patients are finding ERs crowded with everything but doctors - Shilo

The numbers are in. According to a survey conducted by Medscape on thousands of US physicians across more than 25 specialties, almost half of them experience burnout at least some of the time and just less than a quarter of these doctors undergo periods of depression. It would not be unfair to conclude that nowhere is this statistic more evident than in the Emergency Rooms of our hospitals.

What makes ER doctors, or emergency physicians as they prefer to be called, so susceptible to these conditions leading up to burnout and depression? There are quite a number of factors involved here, but the common outcome is that more and more of them are no longer remaining in this specialty. As a result, emergency patients are finding ERs crowded with everything but doctors.

Let’s take a closer look at the modern day ER. What happens when the ER waiting room is devoid of physicians because they have all become so burnt out that they are no longer able to show up for work? Quite frequently, the waiting patients take up the challenge and begin to diagnose each other. “Oh, that’s exactly what happened to my brother-in- law about five years ago except he was playing tennis and not softball and it was his elbow not his groin and he went on a low sodium diet … or was it high magnesium … anyway he’s perfectly fine now except he has to spend a fortune on bladder control pads.”

This conundrum of ER patients helping to diagnose each other may not be such a bad situation, especially if most or all of the waiting room walking wounded are physician burnouts themselves. It is very likely that they are suffering from PTSD which has resulted from the mental, physical, and emotional stress that their workloads have piled on them. It’s no wonder that these missing doctors end up among those patients waiting for treatment instead of the ones who are supposed to be caring for and treating them.

Consequently, with so many MD burnouts missing, the process of triage becomes that much more difficult. It doesn’t take long for the more astute ER patients to come to the realization, whether they are doctors or just ordinary civilians, that they can move up to the front of the triage line if they exercise a little creative exaggeration while describing their symptoms when checking in at the admissions desk. What may have been originally diagnosed as a mild to medium migraine headache can be augmented slightly by reports of flashing red lights, shooting pains up and down the lumbar spine, and voices commanding the suffering patient to destroy any life forms more complex than single cell organisms.

An almost foolproof technique for delaying or stalling the onset of physician or ER burnout is to use procrastination itself to avoid actually having to deal with ER patients. A doctor can buy a huge amount of time by insisting that emergency cases are bottlenecked at the front desk with endless required forms, surveys, and online questionnaires requesting billing, insurance, and a myriad of other bureaucratic information designed to make sure that diagnosis and treatment is put off as long as possible. If these do not delay proceedings enough, you can now add to these formalities even considerably more red tape guaranteed to slow the process down with greater efficiency. These include a list of allergies, previous surgeries, present and past medications, and vital signs which may or may not have any connection with any medical condition ever associated with the human species.

Included in these vital signs and measurements are blood pressure, temperature, heart rate, O2 level, weight (both in pounds and kg), as well as checks for dilated pupils, coughing, lung eficacy, and any other technical procedure that should but usually doesn’t point a clinical finger at the cause of a particular problem. Now throw in a handful of blood samples and chemistry tests designed to gauge a host of markers such as creatinine, HCl, LCl (as if anyone really knew which one was which), and triglycerides, and you are ready to rumble. Well maybe not rumble, but all these setbacks will at least make the waiting time in ER seem to go by more quickly. When all else fails, the emergency physician’s ace in the pocket is to order up a boatload of scans and imaging that will take an eternity to complete (if they ever happen at all). Included among these are ultrasounds, X-rays, CT scans (with or without contrast), MRI’s, Bone scans, and PET scans.Physician burnout can take many forms and its signs can vary from doctor to doctor.

Although it is quite legitimate for the emergency MD to be absent because of health issues or family problems at home, it can become quite suspicious if the attending doctors have locked themselves in the hospital linen closet. Similarly, you may have a problem if the good doctor offers to take two aspirin and call you in the morning. This type of role reversal examination can also lead to you, the patient, being asked to check the doctor’s knee reflex or see what happens when you shine a bright light in her eyes.

A dead giveaway that something out of the ordinary is going on is when you step into the ER only to find the doctor already lying on the examining table. You may have to fight to see who gets more room on the narrow cot, as well as who will win the battle over which one of you will get to use the stethoscope first. Never forget that he who coughs last coughs best. Speaking of the stethoscope, if the metal sensor is merely at room temperature, then the doctor is most certainly on the edge of burnout. Otherwise, they would have remembered to have left the scope (aka instrument of torture) in the freezer prior to bringing it along to work at the ER. If you play your cards right, you could be the first one to ask, “Does it hurt when I do this?”

So the next time you find yourself in medical crisis and in need of ER assistance, don’t forget the lessons learned here. You may be out of sorts and in a bad way, but the attending physician may be suffering from a severe PTSD that dwarfs your particular mild to medium migraine. Be a patient patient. Your emergency physician may need your compassion. It might even be you.