Editor's Forum

Before the Breaking Point

Jessica Adkins Murphy resized.jpg
During my intern year, I met with a therapist for the first time in my life.

Unhealthy habits I had developed over years had started to catch up with me. When I was overwhelmed by the tragedies and violence I saw at work, I mostly bottled up my emotions. I told myself I was compartmentalizing, but, rather than discussing my painful experiences with my husband or my family at a later time or expressing myself in a constructive manner, instead I attempted to ignore my mounting stress. Of course, this wouldn’t erase my memories of patients’ suffering. It only delayed my response until the tension resurfaced as irritability, less efficiency at work, and a vague sense of disorganization in my life.

These were not debilitating habits in medical school when I was mostly just responsible for myself. But intern year was a wakeup call in which I found myself personally entrusted with patients’ lives. This challenge clarified for me which of my behavior patterns were counterproductive and kept me from rising to the occasion. I was tired of feeling disorganized and falling short of my goals, and I was ready to prioritize my mental health.

That’s when I found my therapist. We met several times over the course of about 6 months, and she helped me identify some ways that I could break my cycles of behavior that weren’t serving me, while also giving myself grace as I grew through the difficult journey of early residency. If I hadn’t made those changes more than a year ago, my life may not have felt manageable enough to take on opportunities like writing for EM Resident. It was a turning point, and I’m glad I made these changes before I would have reached a state of desperation.

Over the next few years, there will probably come a time when you feel you aren’t your best self. Whether you are feeling early symptoms of burnout, are not quite meeting your goals, or suffer from clinical depression, anxiety, substance use, suicidal thoughts, or another severe mental health issue, it’s essential that we have access to professional help and can seek help early.

To our chief residents and to programs’ leadership, you now know the issues of burnout and wellness cannot be solved by an annual yoga outing or another lecture on burnout as an academic concept. Instead, we need real strategies that alleviate stressors at work and reassure us that we are safe to seek professional support. Consider removing your EM residents from an off-service rotation that has little educational value but excessive stress and scutwork. Staff your exceptionally busy shifts with sufficient nurses, techs, students, and scribes, which will allow us to serve patients as efficiently as possible. Secure adequate parental leave and bereavement leave, and offer time that can be used to seek mental health counseling. Residents who are severely burnt out may not need additional wellness activities to add to their list of obligations. They may need a respite.

Now in my third year of residency, I haven’t seen my counselor in several months. But I imagine there may be times in the future I will need support again. If it’s during residency, I’ll be glad my co-residents and program leadership are building a culture that listens and intervenes even before a breaking point is reached. And for my next workplace, I’ll be glad to have federal policy, the Dr. Lorna Breen Health Care Provider Protection Act, incentivizing my hospital to prioritize wellness and security in seeking professional help. Check out the EMRA Wellness Committee’s article in this issue for more on the Dr. Lorna Breen Act, which EMRA members helped bring to fruition.

Now, I want to hear from you. How are you supporting mental health for EM physicians at your program or through EMRA? Connect with me by email or social media, and we may feature your work in the next issue of EM Resident!

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