Dealing with "ER Attending PTSD" and decision anxiety...any tips?

[PASamsOTHERacct]

I'm in Urgent Care, but my prior job, in the ER, was absolutell hell. It was a transitional time in the hospital, and what passed for "training" and "constructive advice" meant being chewed out daily by ER attendings and nitpicked on every single word I uttered and ever letter I typed in my chart, every single day, for months. Being reamed out in front of other staff, for not getting one "crucial" piece of information from the patient, was a weekly occurrence.   Suffice it to say, they took a previously confident PA, tore my soul out, and made me sweat at the thought of talking to an ER attending or even a scribe. It was a toxic place for all involved, and hell for me. The biggest a-holes were the ones who survived there; not softer types like me.

It's been several years since then, but I've never recovered.  I currently work in Urgent Care with a lot of ER attendings who staff it as well.

Now, I have a bit of social anxiety and decision anxiety to start with, and was never the most confident guy in the world. But that job beat me down so hard, that every time I need now to confer with my supervising docs here, I start to sweat, and often can't get my story straight, forget pertinent facts. I hesitate and hesitate, scared  to walk over and open my mouth  Even the realization, during patient interview, that I will have to ask a (probably dumb) question of my attending-type colleagues, makes me forget to ask the right things in the room, and then of course, I ask the dumb thing.  And iffy cases? Decisions? I start to sweat profusely, feeling like, if I wasn't so dumb and meek, I'd have the confidence and knowledge recall to not have to ask the docs my dumb question.  As a result, of course, I come off anxious and uncertain, and the cycle perpetuates as the ER doc colleagues tear me apart with their cold, unforgiving eyes (seems to be a common trait among those types). And it seems like I'm the only one asking the docs questions often...the other PAs seem to know the right thing to do. Every time. Every single time. No fear. No doubts. No recall lapses. No hesitation in their voice. Ever.

Has anyone ever dealt with this sort of PTSD from working in a bad place? How did you beat it?

And how did you get the confidence to make the right decisions autonomously, every time? How did you deal with terrible decision anxiety?

[CAAdmission]

You need help beyond random stranger advice on an internet forum. You should find a life coach or counselor to work with or this will never get better. You need to determine if you are taking good care of patients or not. If you are, then don't give a damn what other people think. Don't wind up on meds because of this, but don't let it go either. 

This is happening to your generation because our society has become is so soft and politically correct. We used to learn to deal with people like these a-holes early in life, but now everyone is sheltered and they never develop that skill. My high school football coach would make your ER doc look like Bambi.

 

[EMEDPA]

I found a better group of folks to work with. I have had several of those jobs over the years. ER docs as a group, tend to be a lot more laid back than surgeons or internal med docs. You just have not found the right job yet. The other thing you could do to boost your confidence would be a residency, where the assumption is that you are there to learn, not to move the meat. 

[EMEDPA]

1 hour ago, CJAdmission said:

 

This is happening to your generation because our society has become is so soft and politically correct. We used to learn to deal with people like these a-holes early in life, but now everyone is sheltered and they never develop that skill. My high school football coach would make your ER doc look like Bambi.

 

 

[thinkertdm]

During my training, I was in a similar situation during my surgery rotation.  Constant put downs and nothing I did was right.

This was constant, and I grew to hate it and the people I was working with.  I left and found the complete opposite with a surgeon who I respected- confidence and knowledge grew.

I learned then that there are two ways to teach.  One is to beat them down, and they will learn, but they will be sullen and only doing it because they have to.  They other way is with respect and happiness and ponies.  That works better.

For you, think of a rat.  In a cage.  You do mean things to that rat, day after day, eventually it will give up and stop fighting and resign itself.

It's not just a matter of not being able to deal with it, because you are essentially trapped in a situation that is new to you, in a volatile environment, and in that situation, even the most grizzled veteran would be hard pressed to deal with it.

You should probably get some counseling, eap, or something along those lines.  

In other news, I do have some social anxiety, but it helps by becoming some one else when I'm at work.  I read all the consults I get back for knowledge.  I constantly review, change, and review again.

[EMEDPA]

11 minutes ago, thinkertdm said:

 

In other news, I do have some social anxiety, but it helps by becoming some one else when I'm at work.  I read all the consults I get back for knowledge.  I constantly review, change, and review again.

This. When I am at work I try to come across as confident and in control, even at the times I am winging it...

[LT_Oneal_PAC]

I started to type a long response about my social anxiety and our generation being viewed as softies, but the basics is this: Don't give a F what people think and cut off people who are a-holes. I had one attending, supposedly from the generation of the tough, who berated me from invading his personal space when I touch him on the shoulder to tell him about a crashing patient. Straight up cut these people out of your life in any way possible. They are toxic and will only lead you to becoming toxic. When they get down on you, ask yourself why you care what an a-hole thinks.

Agree with the pretending above. I often will imagine that I'm doctor green from ER. Calm, cool, collected, until he got a brain tumor at least.

[CAdamsPAC]

2 hours ago, PASamsOTHERacct said:

I'm in Urgent Care, but my prior job, in the ER, was absolutell hell. It was a transitional time in the hospital, and what passed for "training" and "constructive advice" meant being chewed out daily by ER attendings and nitpicked on every single word I uttered and ever letter I typed in my chart, every single day, for months. Being reamed out in front of other staff, for not getting one "crucial" piece of information from the patient, was a weekly occurrence.   Suffice it to say, they took a previously confident PA, tore my soul out, and made me sweat at the thought of talking to an ER attending or even a scribe. It was a toxic place for all involved, and hell for me. The biggest a-holes were the ones who survived there; not softer types like me.

It's been several years since then, but I've never recovered.  I currently work in Urgent Care with a lot of ER attendings who staff it as well.

Now, I have a bit of social anxiety and decision anxiety to start with, and was never the most confident guy in the world. But that job beat me down so hard, that every time I need now to confer with my supervising docs here, I start to sweat, and often can't get my story straight, forget pertinent facts. I hesitate and hesitate, scared  to walk over and open my mouth  Even the realization, during patient interview, that I will have to ask a (probably dumb) question of my attending-type colleagues, makes me forget to ask the right things in the room, and then of course, I ask the dumb thing.  And iffy cases? Decisions? I start to sweat profusely, feeling like, if I wasn't so dumb and meek, I'd have the confidence and knowledge recall to not have to ask the docs my dumb question.  As a result, of course, I come off anxious and uncertain, and the cycle perpetuates as the ER doc colleagues tear me apart with their cold, unforgiving eyes (seems to be a common trait among those types). And it seems like I'm the only one asking the docs questions often...the other PAs seem to know the right thing to do. Every time. Every single time. No fear. No doubts. No recall lapses. No hesitation in their voice. Ever.

Has anyone ever dealt with this sort of PTSD from working in a bad place? How did you beat it?

And how did you get the confidence to make the right decisions autonomously, every time? How did you deal with terrible decision anxiety?

It seems to me these physicians are like predators who sense fear or weakness as a signal to attack. When attacked defend yourself vigorously instead of showing fear and weakness. If you are doing good medicine don't allow yourself to be abused by a-holes of any profession. If these physicians refuse or are incapable of providing the appropriate professional guidance or supervision you need to take them on by demanding you be treated with respect and given proper clinical guidance. Your HR department hearing you utter the phrase "hostile workplace" will be quite interested in the issue along with the Medical Staff Office Executive learning that these physicians are not providing appropriate professional guidance or supervision. Most of all, be ready and willing to fight for yourself without holding back or walk away!

 

[Guest Paula]

The Employee Assistance Program (EAP) is a good place to start.  You have to self refer.  They are obligated to get you an appointment with a counselor and your file is kept private, no notes go into an EHR, and the case can stay open for as long as you need it.   It is free so no deductible needs to be triggered.  I used EAP for a time when I needed it and it was invaluable. 

[Guest ral]

Having read various stories about animals helping some people deal with anxiety,  I asked the clinic manager today if I could bring in an emotional support chicken.  She shot me down.

[thinkertdm]

2 minutes ago, ral said:

Having read various stories about animals helping some people deal with anxiety,  I asked the clinic manager today if I could bring in an emotional support chicken.  She shot me down.

I bring in chicken tenders.  With a dipping sauce.  The other supportive animal is a cow, in a patty form, sandwhiched between two buns with lettuce and tomatoes.  All delicious choices.

vegetables are not emotionally supportive.  As a great man once said- I think it was Homer Simpson- you don't make friends with salad.

[CAdamsPAC]

[sk732]

2 minutes ago, ral said:

Having read various stories about animals helping some people deal with anxiety,  I asked the clinic manager today if I could bring in an emotional support chicken.  She shot me down.

If you haven't, you should read what I thought of doing with a parrot in the "What won't you do?" thread...

I remember coming into the OR my first day on my ortho trauma rotation... after my attending introduced me, this 5'6'" 4th year resident who was acting team lead while the fellow was on leave, looks up his nose at me (I'm 6'2" and change) and says "You can leave - we only use PA students for scut work on the floor".  Being a Senior NCO in the Army,  I bent over, stuck my nose in his face and said "That's not what I'm here for, so I really don't see that happening."   It was a long couple weeks of me having to fight to get on the call rota (imagine that??!!), get a beeper, get involved with fracture /dislocation reductions, etc..all the things I needed to learn, that this hospital was getting paid an awful lot of money for teaching me, but people weren't doing.

The best part of the rotation was the last OR I did before leaving - we were doing a bone graft and I got tasked with the bone marrow harvest, with one of those old school apple corer BM aspiration butterflies...After coring into the pelvis, I was having trouble getting the stylette out so the surgeon freaked out and tried himself - didn't work.  We pulled the thing out and it turns out I bent the thing like 90 degrees.  Attending shows Dr Napoleon "Look what SK did" - dude was Indian and he turned into a Caucasian when he looked at the device and then at me...I had been a hair's width from tossing him from the top floor of the hospital for about 2 weeks and at that point I think he realized I could have snapped him in two.

Be polite, be professional...but always have a plan to kill every person you meet...

SK

[PASamsOTHERacct]

16 hours ago, sk732 said:

Being a Senior NCO in the Army,  I bent over, stuck my nose in his face and said "That's not what I'm here for, so I really don't see that happening."  

 

18 hours ago, CAdamsPAC said:

When attacked defend yourself vigorously instead of showing fear and weakness.

Only in my dreams would either of those happen...not sure whee you worked, but in the places I've been, saying something like that will most likely get you fired on the spot, and they know that there aren't a tons of jobs out there...and not just that, but you can't win. If I prescribe Keflex for a patient, based on attending A's advice, and the next day, do the same thing for another similar patient, Attending B says "hell, keflex is crap, that doesn't work, call the patient back, call the pharmacy, and represcribe them bactrim..." it's an unwinnable situation. As a PA, I am not ALLOWED to practice as I see fit.  That's policy.  The final arbiter are the docs, and if one day, the ER doc totally contradicts yesterday's doc, I have to change my treatment plan (as we all know, get 2 ER docs together and you will have two completely different plans of care).  There's no winning that one with a "vigorous defense". If I say "It's worked in my experience, and this is my usual custom" guess what...you just made an enemy, and my boss will get a phone call that i'm not playing by the rules. And i'll STILL have to change the script.

Just saying....

[CAdamsPAC]

1 hour ago, PASamsOTHERacct said:

 

Only in my dreams would either of those happen...not sure whee you worked, but in the places I've been, saying something like that will most likely get you fired on the spot, and they know that there aren't a tons of jobs out there...and not just that, but you can't win. If I prescribe Keflex for a patient, based on attending A's advice, and the next day, do the same thing for another similar patient, Attending B says "hell, keflex is crap, that doesn't work, call the patient back, call the pharmacy, and represcribe them bactrim..." it's an unwinnable situation. As a PA, I am not ALLOWED to practice as I see fit.  That's policy.  The final arbiter are the docs, and if one day, the ER doc totally contradicts yesterday's doc, I have to change my treatment plan (as we all know, get 2 ER docs together and you will have two completely different plans of care).  There's no winning that one with a "vigorous defense". If I say "It's worked in my experience, and this is my usual custom" guess what...you just made an enemy, and my boss will get a phone call that i'm not playing by the rules. And i'll STILL have to change the script.

Just saying....

Well then.......GTFO!! If you are getting feces on GP it's up to you to stop it or walk away! If you stay and put up with it then you are the problem. You say that you are given contrary direction by attendings, then you need to have THEM hash it out and your boss needs to step up!! Why are yesterdays attendings decisions being acted upon by today's attending?? This is pure BS that you are putting up with games like this!  Is this feces happening to other PAs?Take 2 grams of Growaset daily to achieve the posted results and stand up for yourself if need be go down fighting!!

[MediMike]

I think that guy OD'd on the scrip.

I think you've got three options.

Go seek some professional help in dealing with the anxiety and/or conflict resolution

Change fields or practice locations to a less aggro-toxic, more amenable to your personality

Reevaluate these interactions and try to figure out the underlying cause. Are these individuals really just "cold eyed" monsters or are they frustrated that you're not performing at the level they expect? That's not an excuse for them to act in that manner but maybe confronting them with a "Hey, there seems to be some conflict here, what can we do about it?" would be helpful.

I've been in your shoes, remember about 2wks in to my first job in a quaternary academic medical center's CCU calling a CT surg consult and just getting reamed repeatedly. Again. And again. And again. 

Then I realized one day that I could just meet this guy outside the hospital and break his fingers thereby ruining his career and I felt better. (Kidding. Kind of.) 

Only you can figure out what's best for you, I do wish you luck!

[d-wade]

Honestly I agree with Lt Oneal up there. You need to re-establish your confidence, and if you have to channel the energy of someone you look up to... or a fictional character i.e Dr. Green... etc then do that. Basically start acting. I think if you can put yourself into the proper mindset you will stop second guessing yourself, and you will be surprised at how competent you really are when you're not having mental blocks secondary to what seems like extreme anxiety due to past experiences and maybe a little bit of your natural disposition. Additionally, it's OK to ask questions, and when you do so, do it with confidence; square up your shoulders, don't hunch, stand straight up, make good eye contact and be deliberate. It's okay to seek therapy for your issues as well; you aren't unique; plenty of people have gone through this.


 

[Marinejiujitsu]

I think an SSRI might do some good for you. Seems like you just need to treat performance anxiety. No 5th a big deal. I used to take cymbalta early in my career for the same reason.

Sent from my SM-N950U using Tapatalk

[sk732]

Sorry took awhile to get back - was rewriting this a bit.

I worked with an ER doc that used to abuse the RN's, other docs and me...I finally had it one night.  I went home and then went back to work and asked to speak to them in private and then lit them up...they tried to tell me they were teaching...I told them they were a horrible teacher and that people don't learn anything like that...and then I told them I wasn't even allowed to talk to my soldiers the way they talked to me and I also mentioned that when I was in school, when people started doing the education through embarrassment thing, I called them on it.  I finished by saying I was no longer a student and had been practicing for several years.

If you're gong to call someone out, do it in private if possible - keeps people from getting their backs up in public and keeps potential disciplinary action to a minimum for the same reason.  Only time I actually lost it at someone in public was for actual insubordination in public and for safety issues. 

I was working on a longer bit of prose, but, if you don't like John Matthis" "Be polite, be professional, but always have a plan...", go with this one "Do not strike others and do not allow others to strike you.  The goal is peace without incident"  (Chojun Miyagi, founder of Goju Ruy Karate).  All I'm saying is having a plan one way or other gives you a psychological boost going into something like this...knowing you're walking into a potential kill zone but have a counter ambush immediate action to get you out with an ultimate final conclusion is much like imagining people naked when doing public speaking - puts the audience at a disadvantage because they're naked and vulnerable.  Be a hard target - bullies don't pick on them. 

MM

 

 

 

[sas5814]

On 3/26/2019 at 8:57 PM, ral said:

Having read various stories about animals helping some people deal with anxiety,  I asked the clinic manager today if I could bring in an emotional support chicken.  She shot me down.

If you had...what fun when you slaughtered it and fried it while at work. "That chicken wasn't working out."

[ArmyVetDude]

This is why we need to be LEGALLY UN-LINKED from docs and keep pushing for OTP.  If they are a part of the team, they should lead. Otherwise, if the practice wants to only hire PA's they should not be hired for MANDATORY COLLABORATION

They feel like they can control us.  they should not have the entitlement to bully us. Our license and livelihood should not depend on their willingness to SUPERVISE or "COLLABORATE" 

WRONG! 

 

[sas5814]

I don't know if un-linking will stop asses form acting like asses. Supervision or not has never stopped me from counter punching. I gobsmacked a surgeon once by suggesting he had confused me with his wife and I wouldn't be talked to that way. He was outraged that I mentioned his wife! My reply was simple...that's how people all around you feel every day because of the way you treat them. He didn't turn into a saint overnight but he did improve.

[ArmyVetDude]

Go read SDN. You will see what most attendings, esp ER ones feel about PA's. Think of us as dispensable meat movers. They feel like they have power over us. They always talk about how if we are slow movers  our ropes need to be let go. Our livelihood and the ability to practice should not depend on them.  Our relationship with docs should be how Optometrist and opthamlogists or podiatrist and ortho should be like. Both doctors - not physicians - and complement the practice not one rules over the other