Compassion, Empathy, Respect.

Some of the most difficult lessons in my job are also the most easily forgotten ones.

No matter how much you set out to start your shift with lots of positive energy and compassion, after going through a bunch of patients in a high pressure and time constrained environment, very soon all of that is gone. You become short, blunt, angry, ever more frustrated when you pick up the next chart. It also doesn't help when the next chart you see has a complaint that should have no place being in the ER. Medication requests, chronic pain issues, simple skin infection, a cold.

You look around the waiting room and there are people waiting upwards of 4 hours. There are kids crying 2 hours into their stay. There are people with broken bones, some of them still waiting.

And you have to deal with medication freaken request? (Of course these are triaged lower accordingly, but you would eventually have to see them nonetheless, and that still makes other people who are already waiting wait ever longer...).

How can I possibly not lose my cool in that moment?

I have, of course. I show them a stern face. I lose my usual friendly smile. I deliberately take away my bedside manner. As a form of protest. You should not be here. You are making other people wait. It is unfair to them.

Of course, all that is reasonable in this context. But this is also when things can be missed.

No, nothing bad happened fortunately. I am writing this purely as a reflection after a series of busy shifts and with my patience wearing ever so thin with quite a few of these seemingly "unnecessary Emergency visits". I was growing increasing frustrated. But I also realized I was getting increasingly blunt. And that has to stop.

I have to remember. In the ER we deal with some of the most vulnerable patients out there. And many of them know that they probably shouldn't be there. Many of them, in fact, are quite apologetic, even embarrassed, when they are finally seen. They know the landscape. They know long ER wait time is a wide spread issue.

But, problems big or small, they are probably all there willingly waiting, sometimes upwards of 3-4 hours, for one very simple reason. They are desperate. They are scared. They have one thing on their mind making them tough it out until they see me.

After a few of these busy shift, I have to be honest I felt slightly regretful that I lost my cool a few times. No I didn't act out against the patient. I just lost my empathy towards them. I lost any compassion for the seemingly minor problems they present with. In some cases, I lost respect for them as a person.

And that's a line I should not cross, no matter how tired, how busy, how frustrated I am on shift. But it is not one that is easy to remember in the heat of the moment, for an emotional person such as myself.

Every patient, problems big or small, deserves a certain degree of empathy, compassion, and respect. Even if they honestly have no right being there. Those are their given rights that they shall receive.

After a tough overnight shift I had last week, when I was physically and mentally drained, I had a moment of reflection. Quite often, it is hard for me to offer them everything that they might want on their visit. No, I will not fill that narcotic prescription you are seeking. No, you do not need an urgent CT scan now. No, you do not need to stay in hospital for this, in fact it's better for you to be at home. No, I can't do anything more for you today.

But while those other things have financial and opportunity costs to the patient or the system, giving compassion and respect is free. At the very least, that's what I can offer to them. That's what anyone shall always offer, to be honest.

I'll be be first to admit, and I think any doctor will say the same, that after working in medicine for a while, especially in the high stressed environment that is the ER, you start to lose a bit of humanity. People are simply another chart, another headache, another number. You try to keep your department afloat by being efficient, organized. You focus on flow. As one doctor puts it, you learn how to "move the meat".

When patients are reduced to that singular impression, you lose sight that they are, well, people.

Family medicine taught us well to focus on four factors, called FIFE: Fears, Ideas, Feelings, and Expectations. Those are what we try to flush out during any patient encounter.

When I first started working in the ED, I thought those four mental checklists are extremely applicable and important. But I'll be honest, even only after a few years, I have very often completely forgotten about them.

But no. They are people. They are not meat. Do not lose my humanity in this job.

Before my shift last night, I took a moment and recycled these three words in my head. Compassion, Empathy, Respect. I told myself I will excise all of them on every patient, no matter how busy it is.

Simply an hour into my shift, I already found it difficult to maintain that mindset. But I remembered, and continued to practice it. In the end, I felt good about my shift, and it had nothing to do with the type of cases I had treated.

In medicine we spend hours keeping up with medical knowledge and newest research and advances. Eventually those technical aspects are simply second nature. As we get older and become more seasoned as physicians, I think some of the most difficult lesson has to do with maintaining our humanity. How to not lose our kindness. How to not lose ourselves.

That, perhaps, is the ultimate life long lesson, and one that we need frequent reminders almost every day when we head to work in order to maintain. That, to me, is some of the biggest challenge in medicine.