In February, I worked my last shift as an ER doctor. I walked out the front door that morning after an overnight shift and felt nothing. It wasn’t bittersweet. One month later, I feel nothing but relieved. Not even a twinge of regret or nostalgia. How could this be? I spent 12 years and acquired hundreds of thousands in debt to do this thing, and now I’m walking away? When people ask superficially, I offer simple explanations. Too much adrenaline, not a sustainable career. Too much antagonism between departments, the arrogant and egotistical specialists. Too much tragedy, death and dying for one lifetime. If I’m being honest, though, that’s not why I left.
I walked away from emergency medicine because I could no longer accept the reality that I was lying to my patients, day in and day out. Pretending that they were getting the best possible care when I knew otherwise. Presenting a facade of competence. Because ultimately, emergency medicine has one fatal flaw: a jack of all trades is master of none. ER doctors are set up to fail because, by definition, there are no limitations on what we treat. It’s simply not possible for one person to provide excellent medical care across all specialties. In a tertiary care center, where sub-specialists are available day and night to take over complex patients, it can work. But in small community hospitals, there is no backup. Often the on-call list has blank spaces instead of names. When there is a specialist on call, they are usually only available by phone. They are incentivized to avoid coming in to the ER, and to discourage hospital transfers. Rather, they urge us to practice outside of our training. As a result, emergency doctors find themselves with a difficult choice: admit to the patient that they are not the most qualified person to treat this condition and advise them to seek care elsewhere; or save face by presenting the facade of competence and providing inferior care.
People are becoming more aware of the concept of moral injury. This is what occurs when a person must participate in a situation that betrays their deeply held values. As doctors, we swear an oath to “first, do no harm.” But this broken system sets us up to do just that. For the last twelve years, I’ve tried to soldier on, suck it up, be better, learn as much and acquire as many skills as possible to not fail my patients. But ultimately, one person can’t specialize in everything. An ER doctor can’t also be an orthopedist, an obstetrician and a cardiologist. There aren’t enough CME conferences in the world to change this fact. Inevitably, we will fall short. The knowledge or skill gap will be too great, and we will end up causing harm.
That is why I walked away. I couldn’t live with the moral injury of being set up to fail my patients.