le pitt

And, to be clear, this is in no way attempting to undermine Samira's ability as a physician - she's clearly highly skilled and may be the department's most skilled physician (if we're going by a cut scene from season 1). But when discussions about whether emergency medicine may or may not be the best fit for Samira emerge, there's often a knee-jerk reaction to take those discussions as insults or bad faith critiques. And I just think that's not an entirely fair assessment on the topic or on her character. During the MCI, we see Samira rising to the occasion, practising medicine at pace and excelling - so clearly she can adapt. But Samira's also the only character (I believe) that we see turn slightly manic after the event and then experience a, likely mental, emotional, and physical, post-adrenaline crash (I've seen people compare that scene to Robby's panic attack scene, but I don't think the context actually supports the comparison - my opinion, though).

So then the question becomes, I think, to what extent should a physician have to adapt themselves and their style of providing care to better accommodate the system? Yes, Samira can adapt: she can get faster, she can see more patients, she can compromise on her thoroughness, she can tone back the extent of empathy she imparts on her patients, she can rewire entire aspects of her own self - she can do that. But should she have to? In the long term, would that level of adaptation not become detrimental to her wellbeing? The format of the show doesn't allow much opportunity to get firm answers to these questions, but they are, again, really important and topical questions that (I think) the show is highlighting through her character.

Emergency medicine already has relatively high burnout rates for various reasons: constant time pressure, unpredictable workload, emotional intensity etc. Even physicians who are well-suited to the pace can struggle with long-term sustainability in this discipline. With Samira, the issue isn't capability but the cost of adaptation. She's shown to be naturally more inclined to practise medicine in a slower, more deliberate, more emotionally engaged way, but is being asked to function in a system that rewards speed, rapid turnover, and emotional compartmentalisation. So to meet these expectations, she likely has to work against her natural pace, potentially truncate the kind of care she values (key!), or push herself into high-speed mode more often than is comfortable. That takes a toll on someone's mental psyche and emotional wellbeing, and that might mean she's more vulnerable to burnout. It's important to recognise that burnout isn't just about working to excessive demands. It can also be about a sustained mismatch between your values/working style and what your environment demands. For someone like Samira, that mismatch can show up as emotional exhaustion from investing deeply in patients in a system that doesn't always allow that level of care to be sustained; moral tension in not being able to provide the care she believes patients deserve; cognitive strain in constantly having to force herself to work faster or in a way that feels unnatural. The breakdown moment from season 1, I think, is a good example of this (if that was the intention); it suggests that she can operate in the way the system demands, but it's not her baseline, and doing it repeatedly may not be sustainable.

This is a real-world tension (burnout through adaptation) that many physicians have to face - just dramatically portrayed.

And this is where the geriatrics suggestion is interesting (to me).

Segue: What I found also quite interesting is that the show uses Al-Hashimi and Robby to present two different pathways into geriatrics; Robby suggests an elective, which is usually a few weeks per rotation during residency. Al-Hashimi suggests a fellowship, which is a more formal multi-year programme usually completed after board certification. Robby is nudging Samira to explore a field (he believes is) aligned with her strengths (though his delivery leaves a lot to be desired), and Al-Hashimi is suggesting a more concrete shift towards that speciality - neither are suggesting she leave emergency medicine, mind, though it's interesting that they've both identified the same discipline where her strengths may be more sustainable but are suggesting different pathways towards it.

What's interesting about the geriatrics point is how it corresponds to the real-world shifts that are taking place in medical practice. Emergency physicians are increasingly moving into areas like geriatrics, palliative care, hospice medicine, or even outpatient roles. This is happening. And it's usually due to reasons I've discussed above about what Samira may be (or may find herself in the future) grappling with: burnout and sustainability, desire for deeper patient relationships, alignment with personal values, pace and cognitive style, emotional sustainability. It also doesn't have to be a complete switch away from emergency medicine, it can be hybrid careers - split between the ED and another speciality, where a physician does both but part time. This is quite common now, I believe, as it allows physicians to find a balance between maintaining acute care skills usually practised in emergency medicine, and reduce burnout from full-time ED work.

I can appreciate that some people may not like this storyline for Samira, but I don't think it's inaccurate to say that, out of all the characters, this storyline works best for Samira. I've seen posts about how Samira's only been treating elderly patients this season, that her reaction to the suggestion shows that she doesn't like the idea. On the former - I'm not sure that necessarily changes much. The same style of care that she's known for is still the ideal style of care best suited for treating elderly patients - whether or not she treated elderly patients in season 1 doesn't necessarily change that fact. On the latter - the reaction isn't surprising. After nearly four years of residency (and maybe more, depending on how long she was set on EM) of believing that the discipline she's in is where she belongs, being told that she'd be well suited to specialising in or exploring elderly care can be jarring. But who's to say that, after trying an elective rotation or committing to a fellowship in geriatrics, she may not change her mind? That's the beauty of real life! People change their minds, people adapt, people have full career shifts - so looking at this objectively (purely from the perspective of Samira's methods of providing care) would this really not make sense for her?