Dr. Birnbaumer Balances Realism and Optimism in her Closing Keynote
"Shore up your foundation," she advises.
During ACEP22’s Closing General Session, keynote speaker Diane Birnbaumer, MD, FACEP, did not sugarcoat her thoughts.
“I’m not here to blow smoke. I am not here to pretend,” she told the audience. Her session title, “Why We Matter and Where Do We Go From Here?” demonstrates the real problem, she said. “There is something extraordinarily wrong in how we feel about what we do.”
Dr. Birnbaumer got right to the heart of the burnout problem facing many emergency physicians. It’s not that you can’t make a list about why you matter, she said. “The real problem is that your heart doesn’t believe it anymore,” she said. “…We need to fix that connection.”
She explained that emergency medicine is such a young specialty, but the cool thing is that the specialty got to invent itself. “We got to say up front: we're the white hat specialty. And honestly, I think it's why a lot of us chose it, right?” Dr. Birnbaumer said. “We love being the place where people come when they need us… We basically kicked our doors open and said, ‘Here we are.’”
“What we do is extraordinary,” she said. “What we do is absolutely awesome, except what we did 50 years ago is we crawled into a pot, and underneath the pot the burner got started. And what's happening now is we are the frogs in the pot that is now at a rolling boil.”
She listed off the many factors that are boiling the water: overcrowding, reimbursement struggles, EMRs, malpractice threats, Press Ganey scores and more. And all of this was already a big issue before the pandemic, she reminded the audience.
Dr. Birnbaumer disagrees with those who paint the future as irreparable situation. “I don’t think it’s a dumpster fire,” she said. “…I think of it more as a Jenga tower. What we do in medicine is we put all kinds of blocks in our Jenga tower, and over time you can poke them out or pull them out... there is no reason to believe we can't put them back in again.”
After looking at the current state of the specialty, she turned her focus to the individual emergency physician. Dr. Birnbaumer talked about how attendees can return to their medicine origin stories – from their toy doctor sets to med school applications and Match Day and everything in between – to remember what drew them to this specialty in the first place.
She pulled up her own college application essays to remember what she wrote back at the very beginning of her physician journey. “I remember that young woman. She was passionate, she was smart, she was ambitious. Really idealistic. Very altruistic. And she lives in me now,” Dr. Birnbaumer said.
Dr. Birnbaumer told the audience that person who was driven to get the grades and go through the difficult steps necessary to become an emergency physician – with all of the enthusiasm and energy that entails – still lives in them.
But for those who are feeling exhausted or burned out right now, what are some practical solutions?
Dr. Birnbaumer focused on two key steps. First, she told to the audience to grieve for what they’ve been through recently, to shed tears of frustration and disappointment for the burden of a broken system exacerbated by a historic pandemic. She encouraged them to let it all out.
And then, she said to go back to basics: “Shore up your foundation.” The hierarchy of needs is real, Dr. Birnbaumer said, and everyone needs sleep, security and meaningful relationships. After firming up the foundation, it’s time to make a build a path forward.
For Dr. Birnbaumer, it was a colleague who introduced her to the Japanese concept of Ikigai that really changed her perspective. Ikigai is roughly translated into “reason for being.” The simplest summary is to examine the intersection of four key parts of life: 1) What you love; 2) What you’re good at; 3) What you can be paid for; 4) What the world needs.
Dr. Birnbaumer said that going through the exercise of writing down lists for each category and looking at where they overlap really opened her eyes to things that were missing.
What she loves about this Ikigai list process is that it’s not a one-time thing. Every time life feels off-balance, upsetting or unfulfilling, the Ikigai charts can be analyzed again to identify new gaps and opportunities.
Dr. Birnbaumer’s hobby is pottery, an art form where a beautiful vessel can fall and crack into many broken pieces. When that happens, there are different ways to handle it. The pieces can be thrown away. They can be glued together with transparent glue, hoping to make it look like they were never broken. Or those broken pieces can be glued together artfully, like Kintsugi pottery, using glue dusted with shimmering gold to highlight the beauty of the cracks.
“If you are feeling cracked and broken, please fill your cracks with gold,” she said. “Take your mark of the healer, which is what you have, and wear it proudly because you have earned that.”
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