Dealing with stress...

[pas2017]

Hey everyone. New PA-C here in emergency medicine. Been at the job only around 7 months. I was wondering what you guys do to de-stress, especially with those cases you worry about after you get home. I struggle with worrying about almost every single patient even though I staff most of the patients with my attending due to being a new grad and I try to think of the "worst case scenario" with every patient. 

 

Thank you! 

[Boatswain2PA]

Eustress or distress?

Eustress makes you better, makes you staff with the attending, makes you look up things, makes you check up on the patient's outcome.

Distress eats you up.  Don't let that happen.

Ways to handle it: Overtesting.  Overtreating.  OverAdmitting.  Exercise.  Sex.  Rum.  Hobbies.  Watching your bank account grow.

 

[GetMeOuttaThisMess]

Use a test to confirm a diagnosis, not to make one.  Wise words from a wise man (who justifies my taking home a paycheck once a month).

[Boatswain2PA]

5 hours ago, GetMeOuttaThisMess said:

Use a test to confirm a diagnosis, not to make one.  Wise words from a wise man (who justifies my taking home a paycheck once a month).

In a perfect world...yes. 

But the world's not perfect, I am terribly flawed, and there are sharks (lawyers) out there who would LOVE to have what I have earned.

If you THINK about doing the test, then in the ED you should do the test.  The cost of one CT is about $1000.  The cost of NOT doing one CT is easily $1,000,000, and could be much higher.  Want to sleep well at night?  Do the CT.

The ED has the totally undifferentiated patient, whom you have never seen before, who has selected themselves out of the "regular" population by coming to the EMERGENCY department....THEY think THEY are HAVING an EMERGENCY.

If I think about doing a test, then I either do the test, or I carefully explain in my MDM WHY I'm not doing the test, and can usually steer the conversation with the patient to the point where the patient tells me they don't want the test.  Then I write "Offered CT, collaboratively agreed to forego att."

[kargiver]

7 months in as a new EM PA is distressing no matter how you look at it... it is just that simple.  You don't know what you don't know yet, let alone what you do know, and while trying to learn this you are trying to learn how to spin plates, handle flow, manage and lead a team, and somehow expect to maintain a life outside of work.  And that doesn't address student debt, retirement, colleague relations, etc.

We expect a 1-2 year learning curve at this point for anyone relatively new to EM who comes into our group, and that comes with dedicated mentoring, every possible course under the sun, didactic education, and encouragement to get out and de-stress yourself.  EM will eat you up if you let it...

Agree with Boatswain - if you think of it and its relevant - do the test.  A wise person once told me - Internal Medicine docs "play to win," EM docs play "not to lose." You can't afford to lose.  It is what keeps people up at night and haunts you for a career... we are the initiators, the ones that differentiate the "sick or not sick" and that takes a lot of skill, talent and occasionally, luck.

I paint, do photography (both day and night - prefer astrophotography), write, enjoy the occasional good beer or scotch, hanging with a close group of friends, and most importantly - teaching my son what it means to be a good human being (let's hope it sticks!).  And exercise... in whatever manner suits you. But do something.  Find what unwinds you and embrace it as it is the key to doing EM well; when your home/life balance is good, good EM will come with it.  If not, it can get... dicey.

G