Shift Change

Sometimes the most stressful part of the shift isn’t the patients.

One of the biggest stressors for me in emergency medicine is what happens at the edges of the shift.

The handover.

The moment someone either helps carry the load,

or criticizes your decisions at the exact moment you’re most exhausted.

I wrote this piece months ago, before many of you were here.

But given how many conversations I continue to have about exhaustion, resentment, and survival inside modern healthcare…

I think it deserves another read.

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The Malignant Handover

In residency, I had an attending who would always ask, near the end of a shift:

“Who are we handing over to?”

At the time, I didn’t get it. Handover was handover. Why should it matter who received it?

So I finally asked him.

He looked at me and said, without blinking, “Because some people are benign… and some people are malignant.”

I laughed back then.

Fifteen years later, I’m no longer laughing. I know exactly what he meant.

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The Expiry Time

Emergency medicine is hard work. Not “tired-at-the-office” hard—cognitively wrung-out, decision-fatigued, emotionally wracked hard. By the end of a shift, the tank is empty. No matter how tough you are, your brain hits its limit.

And that’s the whole point of shift work: when you expire, someone else takes over. The incoming doc is supposed to slide in, accept the remaining threads of your workup, and keep the department moving. It’s how the system stays safe.

The worst thing at that moment—the exact minute when you’re depleted and ready to leave—is having to defend, justify, or explain yourself to a colleague who seems intent on turning handover into a cross-examination.

Yes, handover is risky. Continuity breaks. Details fade. Investment drops.
It should be structured and thorough.

But that’s not what this is about.

I’m talking about the malignant sign-out.

The colleague whose name on the schedule makes your stomach tighten, because you know you’re about to face a pop quiz at the moment your brain has logged off.

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My Rule

One might hope karma balances these things out. It doesn’t.

So I made a decision early in my practice:

I will not torture a colleague who’s trying to go home.

I’ll listen to their story.
I’ll ask what I need to ask.
And if something is unclear, I’ll go to the bedside myself. That’s my job.

But I will not nitpick a tired physician into the ground over tiny decisions made twelve hours into battle.

Some colleagues give immaculate sign-outs—threads tied, bows tightened. Others hand over a bomb that detonates the moment they leave the building. Even the best sign-outs can unravel before the elevator doors close. That’s the nature of EM.

Once you’re in the driver’s seat, the department becomes yours—whether the engine is humming or on fire.

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What Kills Me

It’s the colleagues who make sign-out so miserable that I’d rather stay an extra hour past my shift than hand anything over to them at all.

And the irony?

Those who demand the cleanest sign-outs often give the worst ones.

If you’re going to be a challenging colleague, fine.
But you’d better hand over a case like it’s gift-wrapped.

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A Quiet Confession

I don’t love getting chaos on sign-out. No one does. But I accept it as part of the job. I never belittle. I never scoff. When it’s time for someone to go home, I respect that.

Still—when I peek at the schedule and see a malignant handover coming?

I’ll be honest.

In that last hour, I may not pick up as many new patients.

Not because I’m lazy.

But because sometimes, the most stressful part of an emergency shift isn’t the airway, or the trauma, or the crashing patient.

It’s the colleague waiting to receive your sign-out.

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