So, I should preface this by saying I will be drastically changing my life choices moving forward. My spouse and I have gotten into quite a few circular arguments about why I continue to pick up shifts at my previous institution despite

Having a new job elsewhere that I really do love and is 192038902174102984x better for my mental health and overall wellbeing

Hating my previous institution so much that he describes working there as "an active form of self-harm", which tbh, truth

Not being paid enough per shift I pick up there to actually even justify picking up the shift since it basically costs me as much to travel there from where we live now (example: a night shift at my previous institution pays approximately 1/3 of what I'd be paid to pick up the same shift at my current full-time job; they're notorious for this and really see no reason to change it because they figure that their reputation will keep bringing in the staff that they will hollow out and thoroughly destroy until they break or are driven away to be replaced by the next victims...)

I get anxiety, depression, and I'm just generally frustrated AF leading up to and after any and all shifts I've worked there

Anyway, this rant is illustrative of many of the reasons I feel the way I do about this place. It's very sad that this institution publicly advertises how it's one of the best hospitals and employers in my country, including bragging about how "well" it treats its staff... when literally they tried to refuse to pay nursing staff pandemic wages.

So one thing this institution is pretty renowned for is being cutting-edge because it pumps out research like that's its primary goal, above and beyond patient care (which, tbqh, working here this is definitely what they make you feel like lmao. As a healthcare worker you're so beneath the research giants they house here...). That being said, our electronic medical record has a lot of built-in protocols and best practices guidelines to try to reduce errors, improve quality of care, and increase patient safety... unfortunately, they also have a lot of arbitrary barriers that are set up almost entirely to communicate which specialties they consider inferior or less competent. Surprise! The emergency department is one of them!

We are also having this crisis right now where access to primary care is abysmal so a lot of patients come to the ED because they just have nowhere else to go or because they were unable to get their primary care problem treated as a primary care problem so now it's gotten really bad and it's an urgent or emergent care problem.

For this kid I saw, they'd been having vague symptoms for months but their primary care practitioner unexpectedly went on indefinite leave due to severe health problems (oh? Family physicians and all physicians are human too? Wow, shocker - my country's healthcare system is already collapsing and the fact that they treat us like a machine and not like human beings has absolutely nothing to do with it /s); based on their initial workup, there was a small possibility that their symptoms were related to a specific disorder that requires a slightly more specialized workup. This includes investigations I order ALL THE TIME at my full-time institution; surely this cutting-edge institution should be able to get this done no problem?

WRONG.

Listen, I just wanted to send this test for this poor kid who's been suffering their non-emergent but certainly frustrating and life-impacting symptoms for months. Sure, the test has a low chance of being positive but would be a part of the complete picture for whomever sees them in follow up and usually takes several days to come back; I referred to one of our local clinics since this kid has no primary care MD, but their wait times may be several weeks as well, so at least I could get some of these tests with longer turnaround times started... It is also one of the odd tests that is not covered by our public healthcare system even though it's widely used as standard of care diagnostic and therapeutic surveillance, so even if the patient had a primary MD to order it for them, they'd pay a pretty large sum out of pocket to get it done. At our hospital they cover it for the patients, who, again, are literal children.

Nope, hard stop on the ordering function of our EMR tells me in its condescending yellow highlighted text: "This is a specialized test, it can only be ordered with approval by the x-subspecialist on-call or a y-specialist".

Oh, interesting, because again, I order it all the time at my full-time institution without any issues, because maybe I have actually assessed the patient and determined, as a physician and an emergency pediatrics specialist, that it's indicated??

Okay, so it's 3AM and I hate calling people unnecessarily, but clearly if your x-subspecialty department made this policy then you're ready to face the consequences.

ALSO WRONG!

I get the x-subspecialist on call (who, btw, is literally being paid to take calls. It's their actual job, even at 3AM) and I'm all apologetic, "I'm so sorry for calling you for this, unfortunately this is the situation, and this patient has no way of accessing this test as an outpatient--"

They angrily scoff, "this is not an emergency. Don't call me about a routine test. It should've waited until morning."

Then, they hung up on me. They didn't even actually help this poor kid. So much for a team environment, huh? All of us working together for the sake of the children?

Also... if this is a routine test, as you've said, WHY THE F**K won't you let me just order it? Why did your department set up a policy making us call you if you don't want to be called?

At this point, I'm actually seething. This kid is going home, MY specialty is EMERGENCIES so I know what is and is not an emergency; I am not calling you at 3AM because it's an emergency, I'm calling you at 3AM because YOUR department put nonsensical stop gaps in my way of trying to do my best for a KID who clearly feels they're at the end of their rope with no healthcare system supporting them outside the safety net of the ED. This kid can't just wait in our department for your go-ahead for this "routine test" because you don't like getting woken up to do your job that you're being paid to do.

Thankfully, the y-subspecialty team was a lot more compassionate to this poor kid and helped us out. But this whole experience was just a bit of a wake-up call for me--I am slowly realizing that all of my medical training up to now has just been very slowly and sneakily breaking down everything I thought about my self-worth and how to be a person before being a doctor. My first thought when that person hung up on me was not, "That was incredibly rude, un-collegial, and unprofessional" (don't worry, that thought came later), but rather, "This is all because no one thinks I can do my job."

Anyway, if anyone has read all the way through this ramble, I want you to think about what makes you happy and what does not. I am realizing now that what I thought I was doing to help people (picking up shifts at the sinking ship that is the above-described institution to help the patients and help my extremely short-staffed colleagues), is just, as my spouse described, an active form of harming myself. If it's making me worse at my job, I will be even less helpful. So this is me, probably the worst human at saying "no" ever, telling you that it's okay to walk away. Let it go.

I think this last straw is enough to make me realize that in all these arguments I've had with my spouse about continuing to work here, he's just so frustrated that I'm stubbornly doing things that I hate so much, with little to no benefit to me (or, honestly, to the patients--like seriously, I'd do better just telling them that most of the people in this hospital have less than zero motivation to help them, especially at 3AM...), and yet I keep trying to defend this absolute dumpster fire to him? As if there's some reason that doing this to myself constitutes anything but very poor mental health?

tl;dr: Whatever or whomever it is in your life that is causing you suffering, it is okay to say no, let it go, and walk away, even if you think it might hurt other people. "It might hurt other people" is not a justification to continue hurting yourself. In most cases, those people would be hurting whether you join them or not.