Photo Credit: Yacobchuk

Andrea Austin, MD, discusses the risks of compartmentalizing in the emergency department and offers a strategy to help avoid emergency physician burnout.

Clinicians in the emergency department may have to move from one difficult situation to another, with only a brief respite between cases.

In an interview with Physician’s Weekly (PW), emergency physician Andrea Austin, MD, FACEP, CHSE, explains how compartmentalizing in these moments may cause more harm than good. She shares an alternative strategy for clinicians to maintain their well-being.

PW: What are some potential issues with compartmentalizing?

Dr. Austin: I was taught throughout residency that when something happens, you get back on the horse, but there wasn’t much explanation for how you get back on the horse.

We tend to fixate on big moments, like a patient’s death, but even telling somebody that they have diabetes is bad news. It leaves an imprint on us. Actors talk about this. When you have a role and take on that character’s emotional baggage, actors understand that you need a process to emerge from that role.

That isn’t something we’ve talked about in medicine, so many of us learned to compartmentalize. The patient in the next room does not deserve the baggage from the patient before them, so we bottle it up and stuff it down.

What I suggest people do instead is safely contain. This is slightly different from compartmentalizing.

What is “safely containing?”

The concept of safely containing comes from psychology and trauma therapy. When you are talking about traumatic things with a therapist, some will encourage you to develop this idea of a safe container. They say, “We’re going to talk about some hard things today. Outside of this room, if this comes up again, visualize putting this into a safe container.”

For many, this means visualizing yourself putting this difficult situation or memory into an actual safe. What makes it different from compartmentalizing is that when something’s in the safe, you aren’t stuffing it down. You know where it is, and you can go back and retrieve it at the right moment.

The right moment to process is not between patients. It is at the end of our day, on our drive home, or maybe the following morning, when we have time to write, reflect, or think about it over coffee. In your day-to-day practice, you must enter that next room, so you flag hard incidents to come back to and process later.

What’s a longer practice to process what’s in the container?

There are moments throughout our career when a case shakes us to the core. What it takes to process those moments varies.

I encourage people to access a peer-to-peer program. Find a peer that you can talk with. Some of us have developed a network of colleagues or friends that we can call to talk about difficult cases.

Sometimes, you need to see a therapist. If you’re even thinking, “Maybe this is getting into the realm where I should talk to a professional,” you probably should talk to a professional. I’ve gone to therapy and become more comfortable creating processes I can do independently. This might look like journaling or listening to music and thinking about the cases.

There’s literature about matching music to your mood. If you’re feeling sad, listening to sad music can help you process something better than if you listen to something upbeat. Sometimes, during a sad song on the drive home, I cry about some of the patients I’ve lost or sad situations I’ve encountered.

Trauma literature tells us to process difficult things. A lot of us were taught that we just need to talk it out, but we’re learning that somatic processes—listening to music, dancing, making art, writing, anything that involves movement—seem to shorten the amount of time it takes to process trauma. For people who have always said, “Well, I just talk about it,” I would encourage you to reflect on whether you keep talking about the same cases repeatedly. That might be a flag that you should try something else.

Is there anything else you would like to add?

I get it. I am an emergency physician and have some night shifts scheduled this week. In between cases, have your reset.

Many people use hand sanitizer as a quick moment to ground themselves before they walk into a new room. Take a few deep breaths. If you have a little bit longer, you can even do a lap. You can walk outside and look at the horizon. I have a friend who always ensures her tea mug is nice and full because taking a few sips of a warm beverage grounds her.

Make sure you have a fast practice you can do in between patients.