Emergency medicine is stressful. There are charged moments of powerful highs and lows. In one shift, you may achieve return of spontaneous circulation in a college student with a massive pulmonary embolism, who will survive neurologically intact. The next shift you may feel inadequate as you realize the antibiotics you prescribe will never be picked up by your patient. You may alleviate pain and anxiety for a dying great-grandfather and his family or listen to an underserved veteran recount their service and struggles. You may ponder your life decisions and over a decade of specialized education, while a patient calls you slurs and hurls a turkey sandwich at your face.
Explore This IssueACEP Now: Vol 42 – No 08 – August 2023
The emotions and thoughts associated with our work are one of the reasons that burnout rates and levels of mental illness are high in emergency medicine.1-3 Also, on shift, time is short. Emergency physicians spend only 5 to 10 percent of their time for personal activities on shift.4-5 That amounts to as little as 24 minutes on an eight-hour shift to include going to the bathroom and eating. While there has been ample discussion of “the practice of mindfulness” in health care workers that improves mental well-being, when do we have this time?6
What’s Your Pre-Shift Ritual?
We can leverage pre-shift rituals that many of us do already to exercise mindfulness. Some of us bike to work or chat with colleagues just before shift. While the activity is different for everyone, these rituals are primed for stress-reducing mindfulness because they are routines we already use to prepare for stressful shifts.
Mindfulness involves being present—experiencing the moment you’re in—and being an accepting observer of those experiences, thoughts, and emotions. For example, my pre-shift ritual is a cup of hot, black coffee that I either buy or brew myself. I am being present as I smell and taste its sour and sweet parts, like an orange. I feel warmth as I drink and often feel content to enjoy the taste of the coffee. I’m observing the moment, accepting whatever feelings or experiences are occurring.
However, it’s natural for our mind to wander from the present or to experience negative emotions. When we do this, we may experience reflective thoughts like, “I must’ve burnt the grounds … again” or future thoughts like, “I should really go to a coffee shop next time.” That’s okay. We should decenter our viewpoint, shifting our perspective from internal to external, to that of a listening friend, observing our own thoughts and emotions. It helps one to realize that many thoughts and emotions, whether good or bad, are only transient. Future worries or past ruminations are natural, but the stress attached to them is fleeting.