A veteran ER doctor reveals how she manages stress in a chaotic workplace

"We are supportive of each other, but it’s in more subtle ways."

Dr. Irene Tien smiling while standing in a park on a sunny day
Photo courtesy of Dr. Irene Tien

Dr. Irene Tien is the associate chair of the department of emergency medicine at Newton-Wellesley Hospital, a community teaching hospital outside of Boston. She spends time between the general emergency department and the pediatric emergency department. She has practiced medicine for more than 20 years.

In the following interview, Dr. Tien explains how she and her colleagues manage stress and anxiety in a chaotic workplace.

What is a typical day like for you?

The typical thing about emergency medicine physicians is that there is no typical schedule.

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Every week is different. Most of us rotate through different shifts. Emergency physicians practice primarily at night, mostly to accommodate their personal life.

What are some of the stressors you encounter as an emergency physician?

We gravitate to [ER medicine] because we get to deal with a variety of illnesses, injuries, and complications. We generally are responsible for taking care of very sick people. We’re also comfortable with controlled chaos. We’re also not always provided all of the relevant information we need in the moment, so there’s a lot of investigation and problem solving.

We as a group are generally at ease with those things; but those are also things I think most people would feel very stressed about.

A lot of the stress that emergency physicians experience has to do with disruption to the sleep cycle. I joke with people when they ask me what it’s like to do shift work — I say it’s like having jet lag for 20 years.

There can also be production pressure, and that can be really stressful. Most of us go into medicine because we want to help people, and with the way healthcare is now, there is less time we have available to spend with a patient. That can be challenging.

Are there certain strategies that you employ to keep yourself feeling mentally healthy?

The staff in the emergency department are pretty tight-knit. We are very supportive of each other; we check in on each other. We’re a bit of a “make it work” kind of group because there could be times where we could feel overwhelmed, and other times where we are completely in control. Regardless, we need to work together as a team to address whatever catastrophes happen.

"You don’t want a burned-out person taking care of you.

Support from coworkers is definitely something that keeps stress levels low. Many of us also think a lot about eating healthy, try to sleep well, and have some sort of exercise in our life. Most of my colleagues are pretty fit people because we do work in a physically demanding, active environment.

For me personally, I find that my mind moves around a lot so I try to do about five minutes of meditation every day when I wake up to just sort of quiet my mind and make it calm. That helps me with the rest of the day — I find that having that regular practice helps me focus when I’m interacting with people. I also try to cut back on social media, which also kind of makes my mind go everywhere. I also try to do things like reading a book versus watching a movie, as a way to sort of calm the chaos that is otherwise my life — in terms of work.

Dr. Irene Tien

Photo courtesy of Dr. Irene Tien

Is there a conversation among emergency staff about stress?

I don’t think most people who work in the emergency department — especially doctors — are really great at saying that really stressed me out. Our training is more about making it work, and doing whatever you need to do to take care of the patient.

In the long run, that can be a negative thing. I’ve learned to reach out to my colleagues if I hear they are struggling. We are supportive of each other, but it’s in more subtle ways — like switching shifts if someone asks.

Would you say there’s room for reform when it comes to mental health at hospitals?

Absolutely. Fortunately, our hospital has made that a priority. We just started piloting a peer support program in concert with a local nonprofit organization called the Betsy Lehman Center. The program trains peer supporters on how to reach out to peers who might be struggling. It also teaches about what resources are out there for staff.

The hospital also has many wellness initiatives and a wellness committee. Our hospital, like many, is trying to grapple with burnout. Studies indicate that about 50 percent of physicians are burned out. That’s a problem because you don’t want a burned-out person taking care of you.

Is there anything else that you would like to express to people about the life of a physician?

I think that it is challenging for patients to see their physicians as people. At times, patients think that their physicians don’t have time for them — they aren’t accessible and they don’t want to be accessible.

But I hope that people can understand that those who go into medicine don’t do that because they want to be inaccessible to patients. They go into medicine because they want to help. We encounter many conflicting priorities, but we have as much a desire to be present with you as you do. I would like to hope that people can just be a bit more mindful of that when we are all interacting with each other.

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