The Holiday Shift Expectation

Emergency physicians work holidays. It’s just part of the job description. I’ll be in the Emergency Department tomorrow, myself.

Which holidays are typically the lightest – according to this retrospective review from a single pediatric Emergency Department?

  • Probably no different: Washington’s Birthday, Memorial Day, Columbus Day, New Year’s Day
  • Probably lighter: Martin Luther King Day, Labor Day
  • Almost definitely lighter: Thanksgiving Day, Christmas Day

Hopefully we’ll all have good shifts together tomorrow!

“Predicting Flow in the Pediatric Emergency Department: Are Holidays Lighter?”

The Biomarker for Burnout

I’m tired.  You’re tired.  We’re all tired.  Importantly – performance suffers with exhaustion, unhealthy behaviors at work increase, and cognitive errors at work rise.  Burnout.

And now there might be a test for it.

This is a small study of resident trainees in Turkey, correlating the levels of neurotrophic factor S100 calcium binding protein B with symptoms of Burnout Syndrome – emotional exhaustion, depersonalization, and personal accomplishment.  S100B is a marker of glial activation and brain injury, and seems to fluctuate with stress and depression, although the associations have not been shown to be reliable.

Each resident trainee was asked to complete a questionnaire regarding burnout prior to, and following, a night shift, along with concomitant blood draw.  Unfortunately, the results are primarily grim, and not on account of the primary outcome: 37 of 48 participating residents scored in the severe depression category on the burnout questionnaire.  The remaining 11 scored in the moderate range.

Looking at the actual purpose of the study, however, they did find S100B levels were significantly different between severe and moderate depression, even accounting for the small sample.  The pre- and post-night shift levels were not appreciably different.  Overall, S100B seemed to correlate best with the overall burnout score, in particular the subscore for emotional exhaustion.

It’s a little hard to interpret these data, or envision how they might be applied in a real-world situation.  It does seem a reasonable biomarker to pursue as an objective measure of the stresses of training, and, frankly, it may be the on-shift changes were not detected as a result of most residents already exhibiting features of high stress and burnout even before starting their night.  Then, even assuming S100B were proven valid, the “gold standard” in this case – the burnout inventory – is probably less expensive and certainly less invasive to deploy.

I am not certain the way forward for this line of burnout biomarker research, but it is rather interesting.

“Serum S100B as a surrogate biomarker in the diagnoses of burnout and depression in emergency medicine residents.”

Patients Packin’ Heat

Does your Emergency Department have a metal detector?  No?  Then, read on.

These authors describe the installation of a typical arch-style metal detector at a single, Midwest, urban teaching hospital.  Between 2011 and 2013, security personnel screened all walk-in guests during hours of operation, ranging from 8h per day at initiation to 16h by the end of the study period.  In just two years of limited operation, they collected:

  • 268 firearms
  • 4,842 knives
  • 512 chemical sprays
  • 275 other weapons (brass knuckles, stun guns, box cutters)

Hospital maintenance also reported finding additional discarded weapons in the landscaping just outside the Emergency Department after the implementation of screening, while triage personnel also anecdotally noted some potential visitors turned away whence they came upon the security station.

Thus, the authors reasonably speculate their findings are representative – or even under-representative – of the weapons present, and concealed, inside their Emergency Department when security screening was absent.  The authors do not simultaneously evaluate any change in reduction in violent events in the Emergency Department, but it’s a fair conclusion their department is now a much safer workplace.

“Weapons retrieved after the implementation of emergency department metal detection.”

Merry Christmas!

If you truly must read literature on Christmas, then I direct you to thebmj, and a selection of articles from its Christmas issue:

“Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study”

“CARTOONS KILL: casualties in animated recreational theater in an objective observational new study of kids’ introduction to loss of life”

“When somebody loses weight, where does the fat go?”

“Are some diets “mass murder”?”

How Marriage Works in Medicine

…extremely well, in the majority of cases, according to this survey.  55.4% of physician spouses (73.2% female, 27.1% male) responded by saying they were “extremely satisfied” with their relationship, while another 31.4% were “somewhat satisfied”.  Only a tiny 2.1% of spouses said they were “extremely dissatisfied” – and these numbers, as best can be reasonably compared, are very similar to the general population.

Of course, this is a survey of a subset of the Physician Masterfile that even provided an e-mail address for their spouse – so it has all sort of potential for response biases.  Regardless, it’s an interesting glimpse into a few elements that seem to make for healthy relationships:

  • The spouses that saw their partner less than 20 minutes a day were far less likely to be satisfied.
  • Increasing hourly workweeks and nights on-call were negative influences.
  • Spouses employed less than full-time seemed to be less satisfied than unemployed or full-time employed.
  • Fatigue and time commitment were the greatest reported family stressors.

According to these authors, no differences were found between practice type or physician specialty (“data not shown”).  Perhaps they were simply lacking statistical power, because previously published data indicated significant variability in likelihood of divorce between specialties – with psychiatry (50%) and surgery (33%) leading the pack over the base rate of general medical specialties (22-24%).

The Medical Marriage: A National Survey of the Spouses/Partners of US Physicians”