Red Shoe Diary

Me and all my friends
We're all misunderstood
They say we stand for nothing and
There's no way we ever could
Now we see everything that's going wrong
With the world and those who lead it
We just feel like we don't have the means
To rise above and beat it

So we keep waiting (waiting)
Waiting on the world to change
We keep on waiting (waiting)
Waiting on the world to change

It's hard to beat the system
When we're standing at a distance
So we keep waiting on (waiting)
Waiting on the world to change

It has been a long time since our department has published a newsletter and needless to say, it has been a crazy, tumultuous couple of years. For those of you who have never seen the newsletter or my editorials, being a musician, I tend to get an idea or a theme from a songhence the John Mayer lyrics at the beginning and end of this article. My hope is to set a tone for the reader with the melody, rhythm and lyrics sort of floating around in your head. (Hopefully it won't create an earworm ala SpongeBob SquarePants.) The increasingly difficult trick is finding a song that residents, junior faculty and we old timers all know! 😉

There have been tremendous changes in our hospitals, our careers and our psyches over the past 3 years. Covid obviously comes immediately to mind, but perhaps in an even more unpredictable, uncontrollable and pernicious way; institutional/administrative changes, both locally and (inter)nationally have been very difficult. Nursing shortages and the lack of in-patient bed availability along with other factors have led to tremendously difficult conditions in our emergency departments which I don't need to list, as you have lived and are living them. Corporate administrative issues, real and perceived only magnify negative emotions and stress among us. It is even affecting the popularity of Emergency Medicine as a career choice. I don't know if our medical students just see and hear about the compounding difficulties in being an Emergency Physician from word of mouth and the media, or if we are also projecting (either directly or by our attitudes) dissatisfaction with our careers; but we are falling from being among the top choices for specialties. Psychiatry is now a more popular choice than Emergency Medicinealthough this nation could certainly use more and better mental health care! (a topic for another time)

 Added to these challenges, there has been a fairly significant turn over in our department's 'old guard'. Most recently Drs. William Berk, Ross Tabbey and although much younger, Crystal Arthur are moving on. It hasn't been that long since Drs. Pam Claps, Pat Sweeny, Chris Heberer and Scott Freemen retired as well. Although most of you reading this didn't know me before I had an intracerebral hemorrhage and only know me as the 'that guy who seems to be from our department but only does observation', for twenty years prior to that, Dr. Alvan Cruz and I held down most of the midnight shifts (usually 12 hour), along with a couple of other hearty (crazy?) souls. Fortunately, the stroke caused no cognitive loss, but rendered my right hand unable to do the procedures necessary for an Emergency Physician. Observation Medicineespecially when our group ran itwas fairly fast-paced with quick turnover that suited my personality and gave me an avenue to continue to practice medicine and to still feel like a part of our department. However, as of this summer I have stepped down from clinical work. I will continue to teach in various capacities in our department and the medical school.

Why do I mention those of us who are joining the retired ranks (Crystal Arthur excepted)? Many of you are probably secretly giving a sigh of relief. "Whew, there are only a couple of Baby Boomers left!"  Or, "Oh boy, if I have to hear one more story about the old days…"   And let it be known in my day, I could trap you in a corner and talk your ear off as much or more than Tabbey! I don't know if I learned it from him or we were both just born this way. No, I am writing this piece to remind you Generation Xers and Millennials that your time has come! (Generation Z students are still in medical school or maybe a few are early in residencies, but they are not yet in leadership positions.) I am not a psychologist, sociologist or an expert in the nuances of the generational differences, but I do know that there is a lot of unproductive chatter that the Baby Boomers are responsible for having messed everything upthe environment, the economy, the world and…the health care system. Many boomers respond by accusing Millennials of being soft or whiny. Well, younger generations, the ball is being passed to you, and we're all 'waiting (and hoping) on the world to change.'

The Baby Boomers and the oldest Gen Xers aren't responsible for all the problems in the world (I hope!), but we are certainly culpable for our share of the troubles we are facing. On the other hand, the older generation deserves credit for a tremendous amount of advances in science and healthcare that we have been a part of and benefitted from over the last 70+ years. What I'm driving at, is that while we enjoy the advances and technological achievements in the world, there are some pretty big problems that need to be exposed, discussed and fixed. Arguably, healthcare is one of the first and foremost. I am not going to debate in this editorial for or against universal health care. That is much too large and emotionally charged issue for this format, but our healthcare is in desperate need of change. Waste, fraud, greed, inefficiency and bloated bureaucracies are damaging what once was and should be the best healthcare system in the world.

Like I wrote above, I am not going to become overly political in this editorial. There is more than one way to improve the system and it will require people smarter than I, lots of thoughtful debate and resources, coupled with compassion. I will express my opinion that a lot of the issues we now face in medicine started when we allowed non-physicians, giant corporations and bureaucracies to enter into the sacred patient-physician relationship. We have become so inundated with documentation requirements, metrics and satisfaction scores that it is too easy to lose sight of why we entered medicine in the first placeto care for our patients.

Well, here's where you (and the song theme) come in. As we Boomers start to ride out into the sunset, it is the younger generations' turn to start assuming the leadership role. Perhaps you've been 'waiting on the world to change' via the elders, but the waiting is over. It is time for the Gen X and Millennial Generations to roll up their sleeves and work with the remaining Baby Boomers to repair our healthcare system. Truthfully, I can't think of a better specialty to lead the charge than Emergency Medicine. We are used to scrapping and fighting for our patients, working in a chaotic environment, overcoming hurdles and having most of the responsibility fall to us anyway. We are tailor made for this role!

And so, I ask you my friends and colleagues, to not get discouraged by the task ahead. Don't lose heart thinking of all the obstacles and problems that need to be addressed to fix healthcare but remember how vitally important it is for our patients and even to our own well-being to do so. We the old guard will still help and support, but increasingly the responsibility will be yours. Learn from our mistakes, because we all make them.

I guess now, I'll be waiting on the world to change, but I am optimistic!

Philip A. Lewalski Editor-in-Chief

It's not that we don't care
We just know that the fight ain't fair
So we keep on waiting (waiting)
Waiting on the world to change

And we're still waiting (waiting)
Waiting on the world to change
We keep on waiting (waiting)
Waiting on the world to change

One day our generation
Is gonna rule the population
So we keep on waiting (waiting)
Waiting on the world to change

Waiting on the World to Change                                                  

                       -John Mayer