Dr Daphne Cohen - Reflections on approaching Consultanthood

Dr. Daphne Cohen is an Emergency Medicine doctor who has recently completed her Fellowship examinations. Daphne is the kind of doctor who really sees the person behind the patient, offering care that is both clinically excellent and genuinely compassionate. Daphne has a strong sense of what is right, and always approaches her work with integrity and heart. This shines through in her insightful piece, where she reflects on her experiences as a trainee, and how she hopes to use these lessons to shape her future practice as an Emergency Physician.

---

At PGY10 I have just passed my final Fellowship exam. For the first time since early childhood there is no spectre looming in my future. It should feel good! And it does. But in addition there is a mild sense of terror because, also for the first time since early childhood, the path is no longer laid out before me. The horizon has a distinct ‘cut off’ look to it and I’m aware that at age 36 I’m approaching the end of the conveyer belt I’ve been on since I chose medicine at 15. It feels like a long road, although it’s actually entirely typical - I’ve read that the average age of a new FACEM is 36. All of this has prompted some soul-searching, and my newly won free time (what even is that??) provides ample time for reflecting on who I am, how I got here, and what kind of consultant I want to be.

In my peripatetic career I have worked in two countries, three cities, and six hospitals. In that time I have seen some of the worst examples of bullying and toxic behaviour from all ranks and specialities, but I have also experienced incredible kindness and generosity. When I was an intern a consultant once welcomed me back from a period of sick leave – I was astounded he had even noticed my absence, let alone thought to comment on it! In the very next rotation I was accused of laziness for giving all my theatre time to my surgically-inclined colleague. He chose to stay back unpaid while I took the bulk of ward tasks and still went home on time – an admirable feat, I thought. But because the surgeon was never on the ward, my efforts went entirely unseen. (Kyle, if you’re reading this I hope you made good!) After being gung-ho for ED through most of med school, I almost gave up entirely after a disastrous first rotation which included being shouted at in front of everyone for being so ignorant as to say that the patient’s blood pressure was normal, when in fact they were mildly hypertensive. But my second term, in another hospital and another country, completely restored my faith that the ED and the hospital generally could be a wonderful place. The culture could not have been more different!

All of these experiences, even the ones I no longer remember, have left their indelible mark. Some are scars, but even more are squirreled away - little nuggets of wisdom I have tried to save over the years. The hidden curriculum: be like this consultant, don’t be like that consultant, remember what it was like when you were here, remember how you felt when that happened. The challenge now is two-fold. Firstly, I have to remember them. I know I put them somewhere safe, but where?? The second challenge is even harder – to put them in to practice. To recognise a situation I find myself in but from a different vantage point this time, to do something different (but what?), to balance the often competing needs of multiple people, and to do it all while ensuring patient safety and departmental oversight and efficiency. It’s a daunting task.

The cognitive load in a busy ED (and ICU!) is enormous and the stakes are high. It can be tempting to leave the status quo intact when it benefits the department and yourself, even when it leads to workplace toxicity and perpetuates harm. Maintaining situational awareness is difficult and exhausting, and we all have our low energy days. Our other lives often pull focus, leaving us distracted and scattered at work. Our families and the patients receive the best of our empathy and compassion, as they should, but this can leave only the dregs for our colleagues. Too often we find ourselves pouring from an empty cup, drained by the effort of looking after everyone around us all the time. This is doubly so for women, for whom the expectation of emotional labour and sociability is far higher.

I don’t pretend to have any new answers or solutions for this conundrum. In many ways it’s only a microcosm of the wider society in which we live and over which we have little, if any, direct control. Over the years I have certainly myself contributed, through my action or inaction, to the ongoing harms that the hospital and the institution of medicine have inflicted on the vulnerable. This was despite my best efforts not to, and also in times when I could have tried harder but, for a variety of reasons, did not. And while I will never agree that shouting at the intern in the middle of the ED is acceptable behaviour, I certainly have a new appreciation for just how difficult it can be to respond with your best self while under enormous pressure. All of this is to say – be kind to yourself, and be kind to others. It may sound trite and cliché, but sometimes there is precious little else that we can do to change things. To paraphrase a great Rabbi: the day is short, the work is hard, the reward is great and the master of the house is insistent. It is not your duty to finish the work, but neither are you at liberty to neglect it.

Take heart and do your best, and never forget what it was like when you were a trainee!