Stressed over the high responsibility

[pennylv]

I’ve been in practice 3 yrs(fam med, urgent care) and i grow more and more stressed over the responsibility of having someone else’s lives in my hands. I knew this going into the profession however feels totally different now that i am practicing. It’s making me reconsider this profession and thinking about leaving medicine. Anyone else feeling the same? Any tips on getting past this?

[Guest UVAPAC]

I always envisioned myself working in Oncology throughout PA school.  I finally got to my Oncology rotation, where I had an amazing preceptor, and got more hands on experience than I did any other rotation (performing bone marrow biopsies, being included in initial consultations, rounding on the Oncology floor on my own, inserting NG tubes, having hospice care talks).  I will never forget watching the MD talk to these families and essentially telling them this is it... he was so skilled in having these conversations, and so good to the families... and then watching the families react... cry, scream, fall onto the ground, console each other was really hard to watch.  I will never forget a young couple that was just about my age came in for test results, the girl (mid-late 20's) had an episode of recurrent breast cancer with mets.  He basically had to explain to them that the cancer was incurable but they would do everything they could to prolong her life.  I watched them cry, and cry, and cry... the MD must have spent 1 hour + with them.  And then I thought to myself... Can I really do this?  Can I be the one to break this news to people?  When people take a turn for the worse, will I ever be able to sleep again?

 

I now work on Occupational Medicine, and also in Urgent Care.  I find myself going home wondering... did I do the right thing?  Did I give the right antibioitic?  Should I have sent that patient to the ED?  Some days I can literally drive myself crazy...

 

I have gotten a lot of positive feedback/recognition from supervising physicians, other PA-C's/APRN's, and medical staff.  I have been practicing 4 years... and always wonder if I will have the courage to step out of my comfort zone and work with sicker patients.  

The thing is... I care a heck of a lot more than other medical providers do.  Anything less than perfect is not acceptable to me.  It sounds like you hold yourself to a high standard which is good, you just can't let it consume you.  With more experience, hopefully you will feel more comfortable (2 years... and even 4 years... we are just beginning in the field)

[pennylv]

On 11/21/2017 at 2:53 AM, UVAPAC said:

I always envisioned myself working in Oncology throughout PA school.  I finally got to my Oncology rotation, where I had an amazing preceptor, and got more hands on experience than I did any other rotation (performing bone marrow biopsies, being included in initial consultations, rounding on the Oncology floor on my own, inserting NG tubes, having hospice care talks).  I will never forget watching the MD talk to these families and essentially telling them this is it... he was so skilled in having these conversations, and so good to the families... and then watching the families react... cry, scream, fall onto the ground, console each other was really hard to watch.  I will never forget a young couple that was just about my age came in for test results, the girl (mid-late 20's) had an episode of recurrent breast cancer with mets.  He basically had to explain to them that the cancer was incurable but they would do everything they could to prolong her life.  I watched them cry, and cry, and cry... the MD must have spent 1 hour + with them.  And then I thought to myself... Can I really do this?  Can I be the one to break this news to people?  When people take a turn for the worse, will I ever be able to sleep again?

 

I now work on Occupational Medicine, and also in Urgent Care.  I find myself going home wondering... did I do the right thing?  Did I give the right antibioitic?  Should I have sent that patient to the ED?  Some days I can literally drive myself crazy...

 

I have gotten a lot of positive feedback/recognition from supervising physicians, other PA-C's/APRN's, and medical staff.  I have been practicing 4 years... and always wonder if I will have the courage to step out of my comfort zone and work with sicker patients.  

The thing is... I care a heck of a lot more than other medical providers do.  Anything less than perfect is not acceptable to me.  It sounds like you hold yourself to a high standard which is good, you just can't let it consume you.  With more experience, hopefully you will feel more comfortable (2 years... and even 4 years... we are just beginning in the field)

You are right about caring, UVAPC. Sometimes I care too much. I’ve thought about leaving urgent care and finding something a bit less stressful but the thought of starting over again at a new job scares me. Im afraid to step out of my comfort zone as well.  I’m a total introvert and don’t do well with change. 

[GetMeOuttaThisMess]

There was an article at Medscape within the past year referencing how a not insignificant number of oncology fellows were getting burnt out and they weren't even out of their training yet.

[MikeyBoy]

Medscape just focused on a great study to help prevent burnout on a long term basis- basically by focusing your mindset on the good that happens in the day, not the bad Duke WISER Research. 

 

I work in a MICU, otherwise known colloquially as the graveyard to my colleagues in surgery/IM. I am constantly burnt out. But I love my job and I know I make a difference and take care of myself after I leave work. I could go work at Patient First, make $20k more and have less overall stress, but why would I do that? (no offence to anyone). 

I often think when driving home from work "HOLY HECK. Did I really do that today? Did I just stick a pen-sized catheter in someones neck? Did I really tell that 18yo son that his father is dying?" 

Exercise, debriefing from your day, and staying healthy are my keys to dealing with work stress.

[pennylv]

11 minutes ago, MikeyBoy said:

Medscape just focused on a great study to help prevent burnout on a long term basis- basically by focusing your mindset on the good that happens in the day, not the bad Duke WISER Research. 

 

I work in a MICU, otherwise known colloquially as the graveyard to my colleagues in surgery/IM. I am constantly burnt out. But I love my job and I know I make a difference and take care of myself after I leave work. I could go work at Patient First, make $20k more and have less overall stress, but why would I do that? (no offence to anyone). 

I often think when driving home from work "HOLY HECK. Did I really do that today? Did I just stick a pen-sized catheter in someones neck? Did I really tell that 18yo son that his father is dying?" 

Exercise, debriefing from your day, and staying healthy are my keys to dealing with work stress.

MikeyBoy, thanks for the suggestions. I definitely need to incorporate taking care of myself. I preach exercise to patients but I don’t follow my own advice. I will definitely check out that study. 

[kargiver]

You are in 2 positions that hold a lot of responsibility and front line exposure with them - U/C and Family Medicine.  You carry a lot of mental weight with you in these fields... it is important to have appropriate releases as well.  Exercise helps (my drums take a beating regularly) and art is an amazing outlet for me.  One of the hard parts is that we forget that there is more to life than just medicine... it's ironic - we care for others but the very things we do for them we do not do for ourselves.  There is nothing wrong with caring - it's how you care that matters.  Let it light your flame to be passionate about what you do - but don't let it burn you.  Get out there and do other stuff to balance it all.

Another approach is change fields to what I call a "secondary" field - one that is behind the front lines of medicine.  A lot of fatigue associated with providers is that people just suck, plain and simple, and being the first line provider you have no control over who you see or what you see.  Do something like ENT work (non-emergent) or orthopedics (again, non-emergent) and you know what you are dealing with day in, day out.  Variety is the spice of life for some but not all - and a lot of folks on the front lines of medicine don't realize this until after they have done it for a while. 

Hope this helps,

G

[BruceBanner]

8 hours ago, kargiver said:

Another approach is change fields to what I call a "secondary" field - one that is behind the front lines of medicine.  A lot of fatigue associated with providers is that people just suck, plain and simple, and being the first line provider you have no control over who you see or what you see.  Do something like ENT work (non-emergent) or orthopedics (again, non-emergent) and you know what you are dealing with day in, day out.  Variety is the spice of life for some but not all - and a lot of folks on the front lines of medicine don't realize this until after they have done it for a while. 

Hope this helps,

G

Truer words.

Front line medicine carries a higher degree---or different flavor---of stress than hospital medicine. You just have no control over what gets dropped into your lap, and when it lands it is now YOUR problem. Some of it is appropriate and some of it isnt, but you cant to be the last person to see someone who has a bad outcome.

At the risk of sounding like a slacker I've learned to mitigate my level of responsibility in clinic, and by extension my level of stress. By this I mean I have a low (but not ridiculous) threshold for referral, and I actively avoid complex disasters if I can by saying "this should go to a doc". I also make it public that I'm good at and like to do things like acute injury, procedures, etc so some of those things get funneled to me. And if I even have a whiff of doubt that a patient wont get better with ambulatory treatment or is at risk for a bad outcome, I send them to the ER. No half-day in-house workups, no clinic observation, just send 'em. I also stopped doing obscure and more complex lab workups. No more of that shizz. If I'm not prepared to handle the results I dont order the test.

You can let your responsibility get away from you and your mental health will suffer. Some people really love to take a high degree of ownership in their patient's lives and that's totally ok, just not for me. I'd rather be a technician.

 

[pennylv]

I agree that UC and FP are stressful fields. Any opinions on specializing??? I feel like I would “loose” my general med skills by doing a specialty filed.  However, with the way I’m feeling, I’m starting to see being a PA as more of a job than a career. I just want to get in, do my job, and go home without having to worry and have the fear of when vs if I’m going to get sued. 

[ventana]

no worries

 

you finally know enough to realize you don't know enough....

that is okay

just realize it, learn, read, and ask questions

 

don't be afraid to just "make a decision" and see how it comes out.... that is what doc's do....

[Cideous]

There is a reason why Medical providers have such a high degree of drug abuse, alcoholism, divorce and shortened life span.

Someone needs to do this job.  I'm just not sure how long anyone *should* continue doing it.  In the last few years I have known several providers who have died.  Two were supervising physicians of mine.  Both young.   

[d2305]

After being stuck in the middle of the ocean by myself, acute care/family practice wasn't too bad. There are 3 ERs within 7 miles.

[BruceBanner]

On 1/6/2018 at 0:28 PM, Cideous said:

There is a reason why Medical providers have such a high degree of drug abuse, alcoholism, divorce and shortened life span.

Not sure about the other 3 but I dont think the lifespan thing is validated:

https://www.ncbi.nlm.nih.gov/pubmed/11020591

Definitely agree that the sooner one gets out, the better.

[pennylv]

6 hours ago, BruceBanner said:

Not sure about the other 3 but I dont think the lifespan thing is validated:

https://www.ncbi.nlm.nih.gov/pubmed/11020591

Definitely agree that the sooner one gets out, the better.

Flower shop, Coin-op Laundry mat, professional organizer...just some of the things I've been thinking of doing to get out. Who's with me???

[Guest JMPA]

PM&R or employee health may be a good option for those looking for mundane work

[GetMeOuttaThisMess]

Love me some employee health!!!

[dmdpac]

8 hours ago, BruceBanner said:

Not sure about the other 3 but I dont think the lifespan thing is validated:

https://www.ncbi.nlm.nih.gov/pubmed/11020591

Definitely agree that the sooner one gets out, the better.

 

I don't have any specific stats in front of me at the moment but there has been a push on a number of fronts to address mental health, burnout and suicide in medicine and more specifically emergency medicine.  (At least I see/hear about it more in EM as that's the field in which I work.)  EMRAP has had several segments on EM provider suicide in the last several months.  My hospital recently started a provider well being program.  They've increased the push locally to address provider well being after a recent EM residency graduate was found dead from suicide after not showing up for work.

Anecdote, yes.  But it is getting publicity.

[Cideous]

4 hours ago, dmdpac said:

 

I don't have any specific stats in front of me at the moment but there has been a push on a number of fronts to address mental health, burnout and suicide in medicine and more specifically emergency medicine.  (At least I see/hear about it more in EM as that's the field in which I work.)  EMRAP has had several segments on EM provider suicide in the last several months.  My hospital recently started a provider well being program.  They've increased the push locally to address provider well being after a recent EM residency graduate was found dead from suicide after not showing up for work.

Anecdote, yes.  But it is getting publicity.

 

 

They can start by giving MORE PTO and not less, which is the current trend.  Also that study sample was from 1984-1995?  Really?  HMO's really didn't get humming until the early 90's, and it was HMO's that forced providers to see 3x their normal pt loads.  I would like to see a sample from 2000-2015 for example.  Either way, my point remains.  It's a tough field where we as providers have a very hard time finding care for ourselves for a host of reasons.

[PA-C]

19 hours ago, GetMeOuttaThisMess said:

Love me some employee health!!!

What type of duties does employee health entail?? 

[GetMeOuttaThisMess]

Do a search for a job posting I made last fall. Describes our setting. In some settings your PCP/FM equivalent.

[Guest UVAPAC]

6 hours ago, PA-C said:

What type of duties does employee health entail?? 

Pre-Employment physicals on hospital employees.

Checking titres for hospital employees, and vaccinating employees if necessary.

Treating hospital employee injuries.  (Exposures, MSK injuries, Etc.)

[PA-C]

17 hours ago, UVAPAC said:

Pre-Employment physicals on hospital employees.

Checking titres for hospital employees, and vaccinating employees if necessary.

Treating hospital employee injuries.  (Exposures, MSK injuries, Etc.)

Thanks! I was dealing with some car trouble yesterday and for a second I read “checking titres” as “checking tires” lol. Glad that’s not the case!

[GetMeOuttaThisMess]

On 1/10/2018 at 11:38 AM, PA-C said:

Thanks! I was dealing with some car trouble yesterday and for a second I read “checking titres” as “checking tires” lol. Glad that’s not the case!

 

I have them pull around to the back of our clinic during summer downtimes for tire pressure checks. “Come in for your poison ivy and an oil change!”

[mackjacks]

On 1/3/2018 at 4:48 AM, pennylv said:

I just want to get in, do my job, and go home without having to worry and have the fear of when vs if I’m going to get sued. 

I went to a lecture put on by malpractice defense attorneys (had to for a discount) and one of the things they said was that you can do everything exactly right and might still get sued, and it will be a terrible and stressful experience, but that is what you carry insurance for, and you probably won't lose your license and life will go on, and worrying about the possibility now won't do any good. Somehow, thinking about the possibility in that manner helped me with my job related stress.

Why are you so stressed and why do you think it is increasing over time instead of decreasing as you become more experienced and ideally more confident? Do you have supportive coworkers you can run a case by if you are unsure? Is anyone pressuring you to treat things you are uncomfortable with, either long term or by not sending cases to the ER?

Stress/anxiety tips: try to avoid it (consult, send to ER, if you work for some superhero doc who wants to treat everything in-house find a new job), exercise (highly recommend yoga or anything you find calming), no caffeine after noon, keep a regular sleep schedule, talk to your PCP and try Vistaril before bed if you feel like you're going to have poor sleep from worrying about a case, see a counselor to learn CBT for anxiety, take an online course about tactics you can use to lower your chances of being sued

[Cideous]

18 minutes ago, mackjacks said:

I went to a lecture put on by malpractice defense attorneys (had to for a discount) and one of the things they said was that you can do everything exactly right and might still get sued, and it will be a terrible and stressful experience, but that is what you carry insurance for, and you probably won't lose your license and life will go on, and worrying about the possibility now won't do any good. Somehow, thinking about the possibility in that manner helped me with my job related stress.

Why are you so stressed and why do you think it is increasing over time instead of decreasing as you become more experienced and ideally more confident? Do you have supportive coworkers you can run a case by if you are unsure? Is anyone pressuring you to treat things you are uncomfortable with, either long term or by not sending cases to the ER?

Stress/anxiety tips: try to avoid it (consult, send to ER, if you work for some superhero doc who wants to treat everything in-house find a new job), exercise (highly recommend yoga or anything you find calming), no caffeine after noon, keep a regular sleep schedule, talk to your PCP and try Vistaril before bed if you feel like you're going to have poor sleep from worrying about a case, see a counselor to learn CBT for anxiety, take an online course about tactics you can use to lower your chances of being sued

Retire early.