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An Open Letter to My Consultant in the ER

“If you want others to be happy, practice compassion. If you want to be happy, practice compassion.” —Dalai Lama


The emergency department is quite possibly the most exciting place in the hospital, but it can also be the most challenging and chaotic. Patients arrive at all hours of the day, families are scared and frustrated to be there and sometimes we can’t work fast enough to take care of everyone in a timely manner. We are also constantly taking phone calls from other institutions to help decide whether a patient from another hospital needs to come to us, and how (helicopter, fixed wing, or ambulance).

Needless to say, it is a stressful environment. Sometimes stress can make us (any one of us, from a resident, nurse, attending) anxious. Sometimes this anxiety manifests by treating members of our team poorly. When I discussed our shame culture, I talked about this a bit.

I used to get really anxious when the ED got busy, especially if I was fielding lots of phone calls, and felt as though I was being spread too thin.

There is nothing scarier than to think I might miss a diagnosis or not see a physical exam finding because I am too busy. I used to translate that anxiety into barking orders and being impatient with my team, which unfortunately, only increased anxiety!

I have since learned how to improve my interactions and communications with my patients and colleagues. But I know all too well how easy it is to project these feelings onto others, and sometimes it is also hard to recognize we are doing it.

Recently I had a patient that was sent to us for subspecialty care. My senior resident tried to discuss the patient with the consulting physician. Unfortunately, this particular consultant treated the resident with irritation and general nastiness, asking some slightly irrelevant questions she didn’t know the answers to, then shaming her for her lack of knowledge.

He also told her it was ‘inappropriate’ to call him when she was ‘unprepared.’  This kind of interaction (consultants being exasperated with patient consults) is quite common in our field and brings me back to my shame post (which describes in better detail how this manifests). I don’t always have the opportunity to give feedback to the perpetrators of this behavior, partly because I am not always aware it happens, or I get busy with my day, and it gets forgotten.


This blog post is for my angry consultant.

I see you.

For what it’s worth, please know that I recognize we both have really hard jobs.

I know that deep down, under the years of clinical practice, you and I really are the same person, bright-eyed and big hearted, who entered into this magnificent career of medicine with a desire to help others and possibly change the world.

Our jobs turned out to be a lot harder than we pictured they would be in those days. We sacrificed time and relationships, and life moved quicker than we anticipated. The cost to continue in this career has interest, and the rate routinely increases, with no one asking if we have the ability or stamina to pay.

I see you. We are the same.

But for some reason, you have found joy in making others around you squirm. Your ego feeds off of the power this gives you, and it makes you feel entitled to treat others as ‘less than.’ You get frustrated that no one understands the pressure, that every minute of your day is spoken for, and you act on that frustration by being mean.

I promise when you enter my world, there is no judgment. I know you are doing the best you can, and behind the delayed response to your page is a list of patients, a scared parent, and your own family at home. Everyone is asking for a piece of you, but no one is really appreciating the place you are in, the struggles you have.

I promise to see you with the same compassion I see my patients. I promise to thank you for coming by, that I truly appreciate your expertise. I hope that maybe someday you can see me, too. Know that like you, I really try to do the best for my patients every day. I try to only call you when I am worried about a patient, or concerned about the family’s ability to get answers and navigate our difficult health care system.

I see you. I care about you too. Maybe next time you can show me a picture of your dog, or your vacation, or your children, and we can talk about how hard it is to be a doctor, a parent, a friend and how it never feels like enough. How sometimes we give our best self to our job, and how it always feels like someone is getting short-changed.

We can’t forget those people we once were, the bright-eyed ones, that jumped into this crazy field. We are all in this water together, sometimes it actually feels good to help one another swim.

I see you.




Your Friendly ER Doctor