physician burnout, resident physician burnout, dr kristyn smith

LLP128: Truth Is I’m Tired: Burnout During Residency with Dr. Kristyn Smith

 

Let's talk about resident physician burnout…

 

On this week's episode of the Lunch and Learn with Dr. Kristyn Smith an Emergency Medicine resident in Philadelphia to give us some amazing insight on the feeling of burnout at the level of the resident physician. Dr. Smith's current interest include health disparity reduction and cultural & linguistic competence for healthcare providers.

As we have heard already with our two previous podcast episodes (125 & 126) featuring medical students we know the effects physician burnout has at their level but it was great to hear Dr. Smith talk about how being much a resident is affected. She also does a great job providing actionable tips to help residents from all specialities manage burnout during training.

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Download Episode 128 Transcript

[showhide type=””””””””””””””””””””””””””””””””post”””””””””””””””””””””””””””””””” more_text=””””””””””””””””””””””””””””””””Episode 128 Transcript…”””””””””””””””””””””””””””””””” less_text=””””””””””””””””””””””””””””””””Show less…””””””””””””””””””””””””””””””””] Introduction Dr. Berry: Hello everybody and welcome to another episode of the Lunch and Learn with Dr. Berry. I'm your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, affirmation and education. This week we bring you another amazing introduction to the lifestyle of a resident physician talking about burnout. This week we bring you Dr. Kristyn Smith, who is an ER physician. She is in her third year. She's got about a year left before she's out practicing for the world and she is going to be talking to us today how an ER resident is dealing with burnout and stress, a burnout in this day and age. And like I know we've talked especially on the last couple of episodes where we talked to a couple of medical students where we've got their thoughts and their processes and their stresses associated with burnout. So I thought it was very poignant to say, you know what, let me bring someone who is in that mid phase. Someone who's completed the hurdle becoming a medical student, actually is a resident. And let me hear their thoughts on what burnout was. And Dr. Smith does an amazing job just giving us her personal thought process on what she expected at a residency and what actually happened when she got there. And she gave some amazing tips on how to deal with burnout. And I think we both got to the point where we understood that, you know what, burnout is something that's probably gonna happen. And for those who don't know, as an ER physician, if you had to choose a specialty that probably deals with burnout the most is probably gonna be ER physician. In fact, we talked, we even dropped some facts as far as when they did a poll on some ER physicians. Just in their magazine, how many have experienced burnout, at least once. Almost two thirds of ER physicians said, yes, I have experienced burnout. This was in 2013. You best believe it, we did that same type of pool in 2019, that number is gonna be similar. It's not going to be less. So Dr. Smith gives us some great insight on the training as an ER physician and some of the stresses that she has had to deal with and how she helped manage that stress. Remember we don't deal with it, we help manage it. So thank you. Shout out to talk to Nicole from episode 124 to give us, that enlightened in terminology associated with. So again, if you have not had a chance, start over to the series, episode 124 then work your way here or if you would just want to start with Dr. Kristyn Smith. This is a perfect episode to start with because again, I think it will make you want to listen to the past three episodes so you can follow along with a series of physician burnout. And like always, if you had not had a chance, make sure to subscribe to the podcast. Leave us a five star review, especially if you're an Apple podcasts user and let us know how amazing this episode was. Because I think this is something that as a physician, as an attending, as a program director, it's very eye-opening to hear the resident experience when we talk about burnout. So definitely excited for you guys to hear that and like always remember if you're sharing this on social media, whether it be Twitter, whether it be Facebook, LinkedIn, wherever you're sharing it at, I'm likely there as well. Go ahead and throw me to mention or just let me know and how I can drop a comment or like us, my sure appreciation. You guys have a great and blessed day and get ready for another amazing episode here on the Lunch and Learn with Dr. Berry. Episode Dr. Berry: Alright Lunch and Learn community, you just heard another amazing introduction. Again, if you have been following along in this series, Physician Burnout. We've started a trend talking to psychiatrist on the subject. We had a couple of medical students really give their personal opinions and thoughts and feelings on this topic. And this week is no different. We have a physician who's gonna be giving us the inside look of what a burnout consists of, but from the resident physician standpoint. And I think this is something that really doesn't get talked about a lot, really like burnout does. But we're going to hear from a resident Dr. Smith who was about to give her inside a considerations on a such an important topic. And Dr. Smith, thank you for joining the Lunch and Learn podcast. Dr. Kristyn Smith: Well, thank you for having me. Dr. Berry: So Dr. Smith I always start these things out. I read your bio in introduction. I got people who love to skip that bio and go right to the meat of the episode. What would you tell someone who, they're just walking into our conversation and they want to know who is this Dr. Smith that maybe we can’t find in your bio? What's something interesting, important, strange, whatever you want to throw out there? Dr. Kristyn Smith: Well, when people always ask me that, I'm always like, you realize how boring you are, how boring you become you've gotten into medicine. I would like people to know about me. I'm originally from Georgia. Currently, I'm up in Philly for residency. I just say that in my free time I enjoy doing very regular activities, whether that be hanging out with friends, visiting some of the local museums, traveling if I can and when I can afford to which is now, not that often. But I enjoy regular activities just anytime outside of my scrubs, outside of the hospital is nice. I do have a previous background in research. Prior to going to medical school, I did a lot of work. In terms of cultural competency and health care disparities in terms of minority populations and disease burden for certain minority population. So that's my research interest and some of my interests in terms of how to improve emergency care for underserved populations. So that's really where I come from in terms of my interests and some of the things I like to do outside of work. Dr. Berry: I love that. And what year resident are you? Dr. Kristyn Smith: I'm a third year, but I am at a four year emergency medicine residency program. So EM programs can be either three years or four years. So I'm at a four year program, some a little bit more than halfway done. Almost halfway through. A little bit more than halfway through the third year now or no, I'm sorry, the first if you want half… Dr. Berry: At first quarter block. Dr. Kristyn Smith: Exactly. Dr. Berry: What made you choose emergency medicine if you might not ask? Dr. Kristyn Smith: I think a lot of people go into emergency medicine for many reasons. But my main reason was because I just loved the emergency departments. When I was on other rotations throughout medical school, I liked small pieces of every specialty that I saw. But when I finally got into the ER, I just noticed how much ER doctors are able to do. You have the acuity, you have variety of diseases, you deal with all types of patient populations. You get to do a lot of procedures, whether it be small procedures like small lock repairs or IMDs, all the way up to bigger procedures. Chest tubes, intubations, and you really get to see a lot. That's what really drew me to emergency medicine. Dr. Berry: And Lunch and Learn community, I will tell you right now, a lot of the reasons that she listed is probably the reasons why I did not go into emergency medicine. I just remember it even when I was a medical student doing my ER rotation, it was such a fast pace, get and go, get and go, get and go. And of course I'm the type I'm trying to ask, what the history and how you doing at home. And I'm like, I'm trying to ask these questions. They're like, no, no, no. Like, is this person stable? Is this good? Do they need to go upstairs? They're trying to get up and move and I'm sitting there trying to ask way too many questions, delving in deep. So I knew right there, I was like, yeah, you know what, medicine might not be for me and that's why I went internal medicine. I like the hospital. I do like the hospital setting. But emergency medicine physicians are a different type of breed when it comes to just being able to go from zero to 100 so quickly. And sometimes doing that for like hours on in. More power to you. Obviously we're going to wish you good luck. Dr. Kristyn Smith: Thank you. We have a lot of rotators who will come through, who are like, I am. And there'll be like, I'll hear, overhear them interviewing the patient, asking like, well, what was your last A1C? And I have never had that before in my life and I probably never will. So it's interesting, but everyone… Dr. Berry: With the topic at hand, especially when we talk about physician burnout, what are some of your thoughts just with the topic at hand? Of course, I think now with the news being the way it is now, where it's becoming such a very popular term to hear, in different variations, as a resident physician, what do you think about it when you hear the term physician burnout? Dr. Kristyn Smith: I think everyone experiences burnout. So whether you're a physician, whether you are a nurse or you're outside of medicine, accountants, every field I would say has some type of stressor and some type of stress that makes you feel like at times you do not want to go back the next day. But I think in medicine we obviously feel it a lot more because of just the nature of the job. I do think it's interesting and I think it's great that you had medical students on this podcast because I remember in medical school, we don't really talk much about physician burnout. We did talk about wellness, but they'd usually be these, once a semester lecture on wellness and what you can do to be well and very generalized. And I think even in residency we do talk a little bit more about physician burnout because we are hearing this buzz word. There's articles everywhere and people are bringing it up more. But we still have, most of our lectures and talks are really around wellness and they're always very counterintuitive. So it'll be a wellness lecture at 7:00 AM and the individual is never a physician. And they're always talking to you about how you can better structure your day so that maybe you can leave work early to go run that air that you wanted to wait until the weekend. But maybe you can get it done during the week and how to make sure you sit in at least a 30 minute workout every day and how to get to bed before 10:00 PM every night so that you can have your eight hours of sleep. And all of those things are really like, they're not relevant for us. Definitely not for residents and often not for most attendings with given the schedule and the workload. So I think that physician burnout is interesting and that I hope, I feel like physician burnout is like the physician actually trying to take control of this wellness talk and to have more saying that, hey, you know, I don't want to hear about wellness from someone who really doesn't know what my work schedule looks like. I want to hear about it from individuals like myself and learn a little bit more about what they're doing to try to make their work life balance better. Dr. Berry: I love that. I really love that. Okay. That's a quotable that will be quoted sometime this week. So obviously I'm very interested because when we talk about burnout, if someone surveyed medical students, professionals and they say, which is the specialty that's likely to deal with burnout, most of them are gonna say emergency medicine to the point where in 2013, in the analysis of emergency medicine, it talked about how 65%, almost two thirds of ER physicians suffer from some form of burnout. And I know you talked about some of the pros of why you wanted to do emergency medicine. But why do you think just in general a lot of burnout seems to happen to ER docs pretty frequently? Dr. Kristyn Smith: Well, I think it has to do with multiple things. Just to touch on what I spoke about earlier, the reasons why I chose emergency medicine, which was high acuity patients or cases seeing everyone, any patient at any time, and also having a variety of diseases that you'll be treating those things that draw you into emergency medicine or also what probably ends up causing burnout. It can be very stressful at times when everything is always new. You don't know what's going to come into the door. You may already have an intubated patient who's an ICU player boarding in the ED because upstairs at school and you're waiting on a bed. So you have that patient there who needs more frequent check-ins, even though they're technically admitted. You may have another respiratory distress on their way and you just heard it on the haste. Patients with abdominal pain waiting on their cat scan and they're upset with you because it's been two hours and they're still why they haven't gotten their steady. And all these things play into, and you also may have a lack repaired down the hall that you need to tend to, but you kind of let that fall by the wayside because you are dealing with all these other things. But having all of these variety of cases at the same time really does contribute to burn out. And then also, we interplay with a lot of the other specialties in a very unique way, which I think is great because we often have great relationships with all our specialists and we're calling consults. But sometimes you do get the broad of a specialist's anger that day. Of why didn't you do this? Why didn't you think of this? Well, if I come to the ED, I want everything at the bedside and ready to do my procedure. Or, why didn't you order this instead of this. Dr. Berry: Lunch and Learn community I can tell you especially as a resident physician, I remember when we think about the ER, the ER is work. They're not calling to say hi to call and say, hey, I have some work for you. It was a relationship that definitely initially started out as animosity, until one of my attendings schooled me and educated me on the fact that no, like, I, I'm getting the benefit of being a part of someone's care and that's a privilege. And once I really started looking at admissions that way, okay, me and the ER were friends, but I 100% understand what Dr. Smith is saying right now because usually when the ER doc is calling me, he was like, hey, I got some work for you to do. I need you to do some work and I may need you to do it ASAP, not in the morning. No, I need you to wake up at your bed or come from wherever you're standing. I had to come to come see me immediately to do so. Dr. Kristyn Smith: Exactly. And we're very good at knowing what needs to be a call right now versus what can wait until the morning. And I think sometimes when we're speaking to people, they're not aware that we know what we're doing, if you will. Also you have this direct contact with patient’s families. Oftentimes you're sitting at the desk and it's only a few feet away from the patient's room. You may be discussing something about another patient. Obviously trying to remain anonymous and not sharing too much, but a patient may over hear something and think that you're saying something negative about them and then it can become an argument. And then you also have all these patient demands. I've had so many times when patients, they don't want to talk to me. All they want is a blanket and some juice. Or when I get back with the juice, they're like ready to curse me out because they asked for cranberry and I brought apple. There's all these things that are very unique. Dr. Berry: I don't mean to laugh, but it's so funny because I know it was 100% true. I think that's what's so, unfortunately comical about it because I know they're literally doing that to y'all. I'm sorry. Dr. Kristyn Smith: It’s okay. And then you have these patients’ satisfaction scores, which those don't play into, especially the resident, how I practice or anything. But all of these different levels of demands for your time and your attention ultimately can be very draining. And I think also, our schedules and residency, it's a little bit different than as what's different than as an attending. You work more hours, more shifts, but we had a three type schedule, if you will. So we worked three days then we worked three nights and then we're off two and a half to three days depending on how that falls. So it can be tough switching from days to nights and losing sleep on that swing day if you will. Feeling very groggy. And there's just a lot queue the ER that I think as a medical student and when you're on your audition rotations you don't always get to feel or see those little nuance things that can really cause burnout later on. Dr. Berry: What’s interesting especially, I think you touched on it, you definitely hit home. Obviously as a program director, I'm in charge of my internal medicine residents’ schedule. So I'm always very interested in seeing the dynamic of how does a resident, you know, be able to kind of deal with that shift change. I know in medicine, um, you know, our program we don't, we don't, they, they'll have like a week of days, maybe a week of night and then a week of days where they'll have like a one or two day to kind of just kind of adjust unfortunately. And I know it's actually occurs much more frequently, especially in the ER setting where you just kind of this days and nights, days and nights. And again, Lunch and Learn community members understand that, you know, you're having to do this, but you're still having to be just as sharp in the middle of the day as you are at two o'clock in the morning. So I want you guys to think about how sharp you are at two o'clock in the morning when you were just up the day before. Just to get an idea of the transition that our ER physicians, especially residents have to deal with on a time and this occurs every four weeks. Every four weeks so you're changing or chasing. So it's not like you're even getting time to adjust because after four to five weeks you're in a different whole rotation. Dr. Kristyn Smith: We’re on a block system, so it is four weeks, and it depending on. So we do a lot of, since we're a four year program, we do ED blocks and then we do a lot of ICU time. So most of our ICU blocks are mainly day schedule. Intern year we have some nights and then as for some of our ICU time we have call shifts. But I would say most of our ICU time is mainly more a day schedule. So. Dr. Berry: Especially as a resident, how did you deal with just these competing times and having to be not only physically available but really mentally available during all of these shifting times as a resident? Dr. Kristyn Smith: Well, I'm sort of lucky in a sense that I find it very easy to fall asleep. So it doesn't matter if it's day or night. I can probably fall asleep if I'm allowed to. So for me, that actually helps because I probably adjust a little bit quicker, if you will. I'd say that it can be difficult. I think that everyone does it a little bit different, but I try to stay more on a day schedule, if you will. So our shifts, you'll start out with the three days and then you'll have your swing day where you kind of have 24 hours off. So meaning just for instance, if you got off at 7:00 PM on Monday, you wouldn't go back in until 7:00 PM on Tuesday. So you have a whole 24 hours off. Usually what I would try to do is I fall asleep at a normal time. So whether that be like 10 or 11 at night and then I wake up fairly early, so I'll try to be up by like six because I was going to be up at least by six anyways if I was on day shift. So I'll get up and I'll try to do a little bit of studying, exercise, cooking, cleaning, whatever little errands I need to do. And then I will try to go back to sleep. So by one o'clock I try to go back to sleep to get a few hours of sleep before I have to go in for my night shift. And then after that I'm on a night schedule where I work. We don't work 12 hour shifts, but just for instance, to make it simple, 7:00 PM to 7:00 AM so you get off at 7:00 AM if you have a few notes to finish, you may actually be leaving at eight. You may be home and showered and stuff and had eaten by nine. I usually sleep most of the day and then go back in for nights. So that's how I try to structure it. There's different ways to do it. If you Google online, you can see different people saying how they structure their time. Especially a lot of nurses do this. Days and nights, more frequent shifts and physicians do. So I find that reading some of their blogs and things is helpful in terms of how you can think about what works for you. Another way to do it that some of my colleagues do, co-residents is that they'll stay up super late on that swing day shift. So if they get off at 7:00 PM, they'll stay up super late until 2:00 AM the next day and then they'll just sleep until their night shift. That's another way that you can do it. It just depends whatever works for you. But I think that tweaking it and being willing to change is really what you have to find. Because during first year I was going back and forth. I didn't really know what I wanted to do and I found that when I was talking about the first way helps me better. Dr. Berry: So of course. First of all thank you for that because I think you're definitely right because I can tell you once you’re internal medicine attending, you choose whether you do in days or how you're doing nights. And I know as an actual ER attending, you're still on that schedule, may not be as rigorous as far as you've been treated, but it's still kind of like the flip flopping. Sometimes you work seven in the morning, seven at night. Sometimes you work 10 to 10, sometimes you work 11. So at that those shifts definitely still are there. So the fact that you guys are getting training in that process as a resident I think is very important because unfortunately that's the real life skiing things when you're an attending. Dr. Kristyn Smith: Right. Dr. Berry: So I got to ask obviously the most important question especially when we talk about burnout and we talk about this fluidity of experiencing burnout at different times. Have you ever experienced any periods where if you look back you say, wow, maybe I was feeling burnt out at that moment or at that month or at that week or at that situation? Dr. Kristyn Smith: Every day. No, I'm kidding. But no, no, not every day. I definitely have times where I feel like I'm just to, for me, I know my burnout just feels like even if had my days off, because usually days off are invigorating. Right? You should be able to, we usually spend your time doing what you want to do on days off in my opinion. So whether, especially I'm someone, I'm not married, I don't have kids so I don't have some of those home responsibilities other people have. So I’m more control of my time outside of work. So you should be able to sleep in a little bit longer if that's what you want to do. If you want to get more exercise, whatever you want to do, you should be able to do it. I've noticed that for me, burnout feels, I noticed that I'm burned out when I had those days off, but I'm still really tired. I'm still really drained, still feel very stressed, very wound up and I can't seem to distress because usually after days off I feel a lot less stressed and I'm ready to restart my three-three schedule and go back to work invigorated. And I noticed that I'm burned out when I don't feel that way. Dr. Berry: What do you do when you get, when you get that feeling? Dr. Kristyn Smith: Usually, well, you still have to go to work, so whether or not you're burned out, it doesn't matter. Dr. Berry: You know I love that you said that because that's something I really try to hit home with a lot of people. Just because physicians they're out here feeling burned out. The reality is, is that you're right, they still got to go to work. There's still a community of people that they have to unfortunately serve. So unfortunately the physician whose personal feelings may be like, yeah, I'm feeling down. I haven't distressed yet. I haven't received, I haven't done something yet to make me want to jump for joy and we run to a car to get to work. I think it's just in our nature, we understand the greater good is I gotta take care of my patients. Because if I don't take care of my patients, I'm not sure who will. We still go and do this. I actually love that you said that because it's 100% true. Dr. Kristyn Smith: Right. Yes. We still have to go to work. Now I do want to say disclaimer, this is my feelings of burnout are different than if you are feeling very depressed or you're having thoughts of self-harm. That's something that I would say is different or to the very extreme of the burnout continuum that you should definitely call out and you should definitely seek help and seek counsel with others and talk to someone. But my burnout is just, I feel like, after the days off, I don't feel quite distressed if you will. But I still have to go to work. So usually I'll go or I always go, but I'm usually, I try to do more small. So usually if I have to work, I have trouble finding a lot of time to do things that I like to do outside of work when I have a work day. Just from finishing up charge for emails or whatever, certain things like that. So when I noticed that I still feel burned out, I try to do, I'll set aside 20 to 30 minutes of my day and make sure that okay, I am not going to feel guilty about not doing my reading or the questions I was supposed to do or what have you and I am going to go for a walk. It doesn't have to be I'm leaning or anything, it's more of a walk to clear my mind or I'm going to call that friend who called me a few days ago, but I was at work site and get to talk to her or him or watch something on TV or do something that may be added the ordinary of what I would do with my normal day. But to try to do something for myself when I feel that I'm more burned out. I also find that talking to your co-residents within your program is really helpful because usually if you talk to someone else in your program, they feel exactly how you do or if they don't feel it right now it's only because they're on a little bit of an easier rotation and they'll feel that way again in a week or so. Everyone has their ebbs and flows to this. And then I'm also talking to, I say you should talk to three to four sets of people, but your co-residents because they likely feel exactly how you feel. And then also sometimes you need to vent about certain situations at your residency or certain people. Dr. Berry: It’s ok. Sometimes you have to talk to Program Director too. Dr. Kristyn Smith: I'm sure no one ever talks bad about you, but those other program directors. So sometimes you do, you need to vent and only people in your program really know what you're going through or really understand what you're talking about. When you talk to your spouse or your best friend. You can try to tell them what's going on, but they never fully get it because they're not working in the same condition that you are. They're not at work with you. I'm also talking to other residents in the same specialty. So I have friends at other EM residency programs and we talk and it's just to compare like, oh, do you feel burned out? What do you do? What does your program maybe do a little bit different that ours doesn't do? And I've noticed also it helps because every single friend of mine that I've talked to, I mean, it's all anecdotal evidence, but every single EEM resident I've spoken to always says that they just want to do EM 50 50. Meaning 50% clinical time and 50% some other magical job that they're still trying to work out in their mind. Whether that be more administrative role, research role, business, what have you. And I think it's interesting because that's a fairly, it's quite a few people who do not want to do 100% clinical time, which I think is interesting to me in terms of with physician shortages. Only estimated to get worse, how will that affect the shortage and things like that? And then also talking to friends in other residencies and other specialties because you'll see that a lot of things are just generally the job of medicine and then also talking to your friends who are outside of medicine because when you talk to them, some people have very similar experiences as well, but they're often coming at it from a little bit different angle. So what are some tools that they use at their workplace or in their free time to reduce their stress levels? I think just try to talk to different people really does help because everyone deals with burnout differently and getting some new ideas for what you can do when you feel burned out is always helpful. Dr. Berry: Thank you for that. I think that's extremely important. I think a lot of times, especially for my thoughts for burnout, I think a lot of times especially as physicians, we internalize so much that we take on such a burden. And because the way we've been taught in, brought up in this process of medicine where we don't let people know when we're not 100%. When we're not killing it. We don't let people know. So we let it eat up inside. So having multiple different people in groups to just say like, hey, this is what's going on in me. Let me just let you know. I think it was extremely important because especially as a resident, but as a physician, and it really just anyway, in general, right? We tell our own patients like, hey, if you're feeling down, if you're not feeling yourself, you should really talk to somebody. But when it comes to physicians, we don't do that. And we let it build, build, build, build until the problems arise of standpoint, which that thing is unfortunately sad and I think is definitely aided into it. Again, I'm academic medicine, as a program director and I see the trend. I see it as from an internal medicine standpoint. I see most of my residents wanted to do jobs that don't really require them to be at work 80 hours a week because they know it's crazy. And they were like, no, I'm never gonna do this again. And I sometimes wonder, is our system of training aiding to the fact that people want to do 50 and 50? They want it like, yeah, I want to still do this clinical, keep up my skills but I'm not trying to like go full on clinical where y'all try to run me to the ground. Dr. Kristyn Smith: And I am always interested because when you talk to older physicians who've been practicing for a long time and went to residency when they are no work hour restrictions. No, I say we're soft. You guys are soft. We used to sleep here, we didn't even have apartments. We had the lock here and snow or whatever, whatever they say. And there's this idea that we're soft and things like that. And I'm wondering, some of it is just historical alternate if you will. You forget what it was like when you were there and how bad you really felt. But also now it's more acceptable to say that you feel burned out and things like that. But I do think that things have changed in some senses. There's more protocols. The EMR is there. There's a lot more oversight, I think in medicine. And I think sometimes that makes a lot of people feel somewhat resentful a lot of times because oftentimes the oversight is coming from people who have much less clinical and clinical experience than you and less education. And it can feel that you have spent almost a decade in school, if you say four years medical school, three to four year residency, and then ultimately you're getting emails that, oh, you didn't fill out this subsist bundle correctly and the patient didn't get their antibiotics, which is important for patient health and things like that. And I know studies show that falling these protocols are important, but it also sometimes can be upsetting because you feel like I've spent so much time and even at the end of the day, I don't have the autonomy or the flexibility that I really thought I would or would like. And you're very highly trained. So I think it's interesting. Dr. Berry: Definitely believe it. And it's so funny because I work in a hospital. I've gotten so many of those types of emails. Hey, you didn't order the echo and you didn't add the aspirin within 24 hours and it took you more than 30 minutes to put the admission order in after the ER called you. So I am right there. Dr. Kristyn Smith: And by the way, oh, you had a code at that time. That's why you were delayed with the admission orders. But we don't know that we're just going by the clock. Dr. Berry: Ask a question, as a resident, especially going in. You knew you had an idea. Yes, I want to do emergency medicine and especially as a medical student, why'd I wish you tell, and then before you got into residency and even when you got there first got there, were you prepared to deal with the stressors that and especially being as a third year now that you've faced. Was that something that you hadn't mentally prepared or was it something that the program itself said, hey, hey, this is what you're going to experience as an ER resident. Let me just let you know. And this was some ways that you need to deal with it. Dr. Kristyn Smith: No. Dr. Berry: Were your expectations lower like you thought like, okay, yeah, I know you guys are going to be hard. But then you walk to nail like, whoa, whoa, I didn't realize it was going to be like this hard? Dr. Kristyn Smith: Yes. I think is going to be hard, but I don't think you realize how hard it will be and just all the things that you will see. And I think the program tries to prepare you. They do certain lectures on dealing with a difficult patient or breaking bad news and those are good, but they're always very general. And because I think they're general because they're hard topics. What do you do with unfortunately a patient coded in the ED and you weren't able to bring them back and they pass away and family comes in and they're super upset and no matter what you try, they can't, you're not able to call the family or to calm them down. That happens usually in the difficult patient encounter. That's the scenario. And then give a good speech twice maybe, and then everything's all good. They've calmed down. They’ve quieted down. You’re able to get everyone on the same page and everything. This goes back to normal. But that's not how things happen in real life sometimes. So I think that having simulations and training people on these difficult topics is difficult. But it's something that I think that just in general programs could do better. And I think that my program's pretty good. They try to do different talks on these difficult subjects. But I think it's one of those things, unless you're in that situation or moment, it can be very difficult. Dr. Berry: 100% agree. I can tell you especially as program director, I am constantly trying to find ways to improve a situation that I already know is tough, that I already know is difficult. And figure out ways, because again, I think this is something that as a person who is in academics, understanding that we are playing a role in how our residents deal with just life stressors in and of itself because of the amount of stress we put on them. I'm always listening and thinking about tips and it's really just talking to my residents just to say like, hey, how are you doing? I just wanna know how you're doing. I'm going to care if you don't know how to treat that age right now. Just tell me how you doing just to make sure we were taking care of you as much as we can. I think it's important. Again, I think especially this topic alone and really just talking with everyone we've talked to so far in this series, has definitely been eye opening for me as a program director because I'm sitting there, writing now and I'm taking tips. I'm like, okay, I gotta make sure I got, let me ask the residents if they are feeling this way too. Because again, it's something that if you never asked, because it's such a conversation, if you never asked, you never know. And if you never know, how can you actually truthfully try to solve a problem. If you act like the problem isn't as big as it really is. And so before I let you go, first of all, I wanna thank you because it's been absolutely amazing discussion. We talked about some of the tips to help just residents in general, ER residents, definitely for sure. Like I said, and I feel for you. I do feel for you because I know and again, Lunch and Learn community, let me just give you an idea. At least in our program, we are at a smaller hospital. I'm not sure how big your hospital. In our program, I know when I talked to my ER physicians, they say they may sometimes see like 50 to 60 people a shift. And I'm like, I'm going crazy guy. I see 30. So imagine you're seeing 50, 60 a shift, three times, multiple days and just on top of that, and it's from kids to adults. It's low acuity, high acuity. That's a different stress level that's bouncing up and down. That’s why I applaud my ER physicians, and so I obviously my ER residents, because I understand I know y'all take a beaten down there. Because y'all don't come with every emission. Y'all only call me for people who need to be admitted. And I don't even include all the people who you saw, you took care of. You're gotta go back to your piece offers or you don't need to be in this hospital. So definitely want to thank you for your work and obviously we wanna make sure we wish you all support, for this next year and three quarters that you got left, that you're attending. And hopefully that it gets better. I'm gonna find out because again, in the end of our series, we're actually gonna be interviewing at ER physician attending. So I'm definitely just, if it gets better right here. Dr. Kristyn Smith: I’ll definitely look, to hear how much better my life will be Dr. Berry: That’s what we're hoping. I know we've talked about making sure you're talking to lots of different people can help having someone to vent out your frustrations or even any frustration, maybe just your concerns or really just about your day. Again, we're one of the few professions that it's sometimes difficult to talk to people about our day because our day, my day may include, I had to send like 200 people to hospice and unfortunately I can't really talk about my day because sometimes I can't give you the details legally. I sometimes can't give you the details. We didn't even talk about the legal, but just the schematic standpoint. Now I may not want to bring that level of stress to you say like, yeah, I had to code three people and two of them didn't make it. And so I understand that. I love the fact that you said, make sure you have a lots of people to talk to. Don't seclude yourself while you're in this training process. You talked about, I know you said sleep. Sleep is a big one for you. When you talk about, just like if you had to give tips to other residents and making sure that they're trying to avoid what sometimes may seem burnout processes. Dr. Kristyn Smith: Definitely sleep. Everyone needs a different amount of sleep as well. So there's some people who are just amazing and they can make it off of four hours a night and I don't understand those people. I'm definitely more towards the eight hour. Need more of that situation. At least six until normal. So listen to your body. If you need sleep then you need to figure out how you can try to schedule some of the time once you get off work in order to get the sleep you need. Because I can really just change everything. Some days if you are sleep deprived, things that usually would not stress you out, stress you out. So I think vast important sleep, making sure, like you said, do not seclude yourself. Talk to someone, talk to everyone. You don't want to obviously get yourself into any legal trouble, but you can often talk about your cases in very general ways or just talk about how you're feeling. Also talking to your attendings or your senior residents if the case doesn't go right. I think that's something that I didn't really touch on. But especially being in the ER and then all fields in all areas of medicine, but especially in the ER with such high acuity, sometimes things don't go right. Sometimes you place the central line and you did everything right and it still didn't go in the right spot. Dr. Berry: Sometimes you started a fluids, you gave the antibiotics, you did everything and the patient still doesn't leave the room. Dr. Kristyn Smith: Exactly and the patient does not get admitted and they don't leave the hospital because they were just at a point that unfortunately you were not able to intervene to improve their health. Not everyone is religious. I understand that. But I am religious and I do believe that a lot of what we do is not finally decided by us because you can see so many patients come in who look fine and then they don't leave. Or so many patients who come in and you're like, they look dead at the door. Not to be too frank or callous, but they did. And then they somehow leave the hospital and they're doing okay or what's okay for them. So I think making sure that you talk to people, especially your senior residents in your attendings if the case doesn't go right, because that can make you feel very guilty and you just need to know that you're not alone. And then also I would say probably two other points. Find something outside of the hospital that you like to do. Not reading, not studying, but something. I'd say really two things. One thing physical, and I’m not an athlete or anything like that by any means, but something physical. Whether it just be like light walks or hikes or whatever. Or just getting outside and sitting outside and relaxing. And then something that is more like purely fun and really not that educational, whether it be watching a silly show on TV or reading romance novels or something of that nature that you like to do that takes you totally outside of medicine and outside of feeling like you always have to think. And then lastly, going back to that, there's a saying, comparison is the thief of joy. I may not have said that exactly right. I think that you have to be very careful when you compare yourself to others, whether it be, you're scrolling Instagram and you see these medical blogs are like really hot topics and people are doing all this medical blogging, which is awesome because they make medicine look so fun. But you don't see, no one's posting when they lose a patient. No one's posting when they left the hospital four hours after their shift because they had a code come in right at the end of their shifts and they were working on that patient for two hours and couldn't get the patient back. And then they had to call family, do all these things and they left four hours later than they should of. No one posts the negatives. And I think you always have to keep that in the back of your mind because you can start to feel like, oh, I feel like I worked so hard. I feel like I'm always burned out. What are other people doing that I'm not doing? And oftentimes it's not that they're doing anything different or they feel anything. Anything different from how you feel it's that what they're choosing to show you are the highlights and the happy times. And you have to realize that obviously just in general in life there's good and bad. And especially with the residency, there's good and bad and you're going to have some bad days, bad weeks even. And those are those times when you really have to make sure that you're staying up on your sleep, staying up on doing activities outside the hospital and keeping up with friends and family because at the end of the day residency is temporary. It's a temporary amount of time. I know when you were in medical school you thought medical school and it ended and you know you may have had some bad times in medical school but you got through them. In residency, I try to remind myself its temporary and I may have bad times, bad days, things that don't go well but at the end of the day it's a finite amount of time that you need to get through. So those are kind of my takeaways. Dr. Berry: I love it. Especially at one point because honestly and I've said this before, I've said it publicly. I think the older physicians who are always like oh you guys are soft and dah, dah, dah because I'm young too. I've been out like five years, but I got residence older than me. And it's a crazy, crazy dynamic. But when I hear from older attendings, I always tell them, I'm like, well, you know what, maybe if y'all told us how crazy it is over here, maybe we would have been prepared too. I think they're the biggest culprit at not saying really how bad stuff is. Just having us walk into it and are now getting upset because we were calling it out. I always have my day attending colleagues that, because I say, oh, you know, y'all would've told us how bad this was. Maybe I should've had work hours back then, but y'all were so scared that we gotta deal with. Dr. Kristyn Smith: But they needed more people to replace them. So if you tell all the bad things, then you have no one who will be there. (You're right). We are privileged to do what we do. Dr. Berry: Once my attending, he educated me and say, you know what, it's a privilege right to take care of patients. Is a privilege to be a part of someone's care. That's when my ER and I am animosity pretty much disappeared. And I'm like, oh you know, you're right. You're right. Why I tripping for, like I'm good. Because it's not difficult. I don't get my ear doc, I'm, I make sure not to get my ER docs to hold a hard time. And so, okay. Alright. So what are we doing? What do you want to do? What are you thinking? I'll take care of it that way. Because I already understand that I'm probably going to be one at a 10 because they got to make that hour. I'm probably going to be the nicest person that they have to deal with. As you know the ortho guys don't want to come down and general surgery really wants to know that they really have to come up. But I already understand that. That's definitely something I'm very aware of. I love my ER docs. I know how hard y'all work because I know I would never do it. I never do it. I get nervous when I walked down. Let me just get my admission so I could walk out this because just being in a vibe of an emergency room and I'm gonna turn this. I work in a hospital and I'm like I got to get out of here. It just feels like too much works down here for me. Dr. Kristyn Smith: We often like talking to you all because it's like, oh honestly I didn't think of that. I'll go ahead and add that test on or oh you know, that is a good point. Or you may have taken more time to look through the chart and see that they have an old echo and this was very yes then. And this is it now. So I think, we don't work in silos, we work as teams. So it is very appreciated. Dr. Berry: Before we let you go, where can others, I'll always starts, I love the fact that especially in this day and age, social media is a locked into medicine, right? And just our mind is in training. Where can others find you? They want to say, you know what, I love hearing Dr. Smith's voice. I want to follow her journey when she finally becomes an ER attending and life is so much greater for her. Where can I follow you? Let them know. Dr. Kristyn Smith: In a fantasy land. I know it will get better. They can find me on Instagram. My Instagram is dr.kjsmith. So Instagram is one way to find me. You can also find me on Twitter, although I don't post that much on Twitter, but it's Kristen J. Smith DO. And then, if anyone has any questions or wants to connect, you can always DM me on Instagram. That's probably the easiest way. Dr. Berry: I love it. And again, thank you again. We always appreciate when our physicians and colleagues, whoever, whatever our guess come in and take the time to really help educate the Lunch and Learn communities. Always appreciative. And thank you for taking the time to join us this week. Dr. Kristyn Smith: Thank you so much. I appreciate it. [/showhide]

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