EM Collective Wisdom: Shahina Braganza
Author: Shahina Braganza, MBBS, FACEM (@shahinabraganza, Senior Emergency Physician, Queensland, Australia) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)
1) Why still Emergency Medicine?
Because within a single discipline of Medicine, there is so much diversity. We are jacks of all trades and masters of some. We are the frontline for care delivery. We are, in essence, the face of our respective health services. We can make a big impact to people in a short time.
2) Most impactful case.
“Emily” was a patient I wrote about in https://www.goldcoast.health.qld.gov.au/about-us/news/when-humanity-all-we-have-offer
The case was impactful, not just because it engendered grief for the loss of Emily (a young mother) and the emotional trauma of supporting her family, but because it so beautifully illustrated how an EM team could work together in those trying circumstances – the deep investment our EM staff had in each other, and their generosity in simply being available. In addition, the community response to the telling of the story reminded me that what our patients most care about is the simple fact that we care.
3) Most important career decision leading to satisfaction.
When I completed my EM training, I discussed with my boss about cutting back to part-time hours for the sole reason of “creating space” to decide whether I wanted to have children. Up to that point, I’d been too busy being busy to consider starting a family. There didn’t seem to be room (or need) in my life to embark upon that journey. Had I not actively created this space, I would probably have continued working full time and not “got around” to having children – and likely be enjoying a very satisfying career in EM, and a fulfilling life. But I’m glad I have my current life, which is busy and messy but happy.
4) What does future of EM look like?
In Australia, somewhat contributed to by national targets, EM has evolved towards a model of advanced triage and disposition. We are actively working to protect the value-add component of our profession – by ensuring that even within a constrained time frame, we are providing meaningful quality care to patients prior to their departure from our ER, whether admitted or discharged. I think we will need to work hard to protect this job description.
5) Greatest achievement / why giving back is important.
I have discovered and developed a niche in the wellness/performance space. This journey started in 2002 when as a second-year trainee, I experienced a version of burnout. My boss told me at the time that one day I would “do something useful” with the experience, and I’d like to think that I am. The legitimacy of the physician wellness agenda lies in its strong link to our clinical performance, individually and collectively. By simply starting the dialogue and giving permission to each other to experience and discuss struggle, we can start to create a safe and supportive environment, where everyone can be nurtured to thrive. This can only be of benefit – to us, and ultimately to our patients. Along these lines, I am involved in a collaborative called WRaP|EM (Wellness, Resilience and Performance in EM) – wrapem.org – which has created a free online curriculum and resources.
6) Favorite failure.
I have so many to choose from… A recent one is that I embarked upon some scholarly writing. The first draft that I sent to a respected colleague for review came back with more edits than original text, and a cover email that clearly suggested that not only was there a major amount of work to do on the manuscript, but it had been far too embryonic for the phase of high-level review requested. It was a lesson (revision) in humility. However, sometimes we do need the courage to be vulnerable and expose our deficiencies – without the feedback that I gained at that time, my manuscript would have stagnated, perhaps never to surface.
7) One thing you would change about our field.
If I thought really hard about this, I might say something along the lines of overt recognition of EPs as specialists (perhaps the last of the generalist specialists…) – recognition by our inpatient colleagues as physicians with a unique skill set who add value and not just work for inpatient teams, and recognition by the public, only so that emergency departments could be saved for emergencies. At systems level, I would like to see the ongoing evolution towards EM-based targets recognized as whole-of-hospital-based targets, rather than in isolation.
8) Something that you love that has indirectly impacted your EM career.
I love to write, and this has impacted my career in ways that may have been expected (e.g. letters to management) and some less expected (sharing stories of working at the frontline of healthcare). I also love to put some thought and energy into dressing neatly – so perhaps I should have become a corporate lawyer rather than a scrubs-wearing EP, but my non-clinical shifts and speaking gigs allow some outlet for this!
3 people you’d like to see fill this out
1) David Spain
2) Gerben Keijzers
3) Una Harrington