We are at a crossroads in emergency medicine. We have a lot external pressures to increase speed and see more patients per hour. After a few years in the specialty, I am beginning to see that simply taking histories, performing physicals, writing notes, and calling consults is not enough. The mental and technical challenges of procedures add another level of intellectual and personal reward that can enhance our professional satisfaction, thus reducing our risk of burnout. We can strengthen our bond with our patients and enhance our sense of accomplishment by performing procedures.
I understand that procedures may be a source of anxiety and can even contribute to frustrating shifts and ultimately burnout. Here are a few practical suggestions for improved satisfaction and perhaps even a new sense of excitement for your practice.
- Procedural competency is integral to satisfaction. No one likes being bad at something, especially when that something can contribute to patient pain or, even worse, harm. While we all had to perform a minimum number of procedures for residency graduation, depending on where you work, the acuity and mix of patients may lend itself to varying levels of procedural exposure and competency. Perform a personal evaluation of your procedural skills, starting with listing the emergency medicine procedures that cause you trepidation. Do you feel competent and comfortable? If not, there are a multitude of resources you can access to improve your procedural skills. Many cities will have a simulation center, or you can seek out a conference that offers a procedure lab.
- Ensure your department has the correct kits and tools and that they are well organized. No one likes delays or missing equipment. Does your department have a central line cart with everything in it you need? Do you have a jet ventilation setup and the backup quick setup with a 10 mL syringe and a 7-0 endotracheal (ET) tube connector attached to oxygen tubing? If not, a great way to improve your procedural competency and make better connections with the nursing staff is to better organize the equipment. The nurses and techs don’t enjoy the last-minute running around looking for a key piece of equipment either.
- We can spend more time with our patients during procedures. Our patients crave our time and attention. I have provided parents with in-depth laceration home care instructions while doing the repair. I have had poignant conversations with cirrhotic patients about their struggles with continued drinking and access to care that lead them to the emergency department for their paracenteses. This provides us with more time at the bedside that we can use to connect with our patients and enrich their and our lives.
- Procedural mastery adds to a sense of personal accomplishment, which is one of the known factors that protect us from burnout. Consider that on any ED shift you stand ready and may accomplish a difficult shoulder reduction, intubation, central line insertion, or pediatric lumbar puncture. The breadth of knowledge and procedural expertise that we span on any given day is truly impressive and unique to our specialty.
First, do no harm; that is the oath we all take. Before I do a procedure, I ask myself if I am up to the job. There are times when I readily acknowledge that I’m out of my comfort zone (eg, the horrendously complex facial laceration or the lumbar puncture in the 90-year-old patient with lumbar spinal fusion). In the end, this is still a team sport, and our patients must come first. I believe that maintaining my skills and not punting at every opportunity is part of my duty to be ready for my patients and their needs. At the end of the day, the satisfaction from a well-done procedure can make up for the 20 other patient and consultant interactions that may have been less than satisfying. While I’ll never know the joy of sinking a free throw in the WNBA, I couldn’t gain more satisfaction from sinking the ET tube in a difficult airway.