Wellness, Speaker Report, Leadership Reports

Lessons from the ED

Finding humility, a servant's heart, and the ability to smile through adversity.

It still feels like yesterday when I wrote my farewell to residency. Since then I have worked countless hours as an attending in both community and academic settings. Between innumerable intubations, multiple septic patients, three precipitous deliveries, and an ever-so-memorable cricothyrotomy, my world has expanded beyond what I ever thought possible at the end of those short years in residency. Even with so many experiences, all the lessons I have learned so far can be summarized in one sentence: make friends — lots of them. The surgeons, the chief nursing officer, the scribes, the techs, the nurses, the janitors, the podiatrists — bring them all into your camp.

Do not underestimate how isolated emergency medicine doctors can be from the other medical staff. We work in teams, work very strange and varied hours, have little time for lunch, and often do not wear white coats. Without making an effort, it is easy to miss out on connections within the physician network. More than socially discouraging, the truth is that the life of your patient may one day depend on this rich potential informal network of remembered favors and allegiances. For example, I make sure to introduce myself to the cardiologist eating a sandwich alone at the cafeteria on a Sunday night. I ask about how her call is going, ask about any exciting cath lab cases, and then joke about keeping the ED quiet. When that 3 a.m. STEMI rolls in and I would like a quick set of eyes on the EKG, things go more smoothly; “Dr. Jones, I saw you at the cafeteria yesterday and we had a great conversation about aVR and left main disease. Can I fax you an EKG, and ask you to take a quick second look?” There is instant recognition, instant connection, and a friendly voice on the other end.

Part of being friends is helping. Offer to place a central line for a patient with poor access to help out the ICU physician; make the extra call to save your hospitalist doing it at 3 a.m.; offer to place a Quinton for dialysis access in the patient with a severe aspirin overdose. This is not to say that you should not delegate responsibility or let other physicians do their assigned tasks, but you should work exceptionally hard to create lasting bonds so, in turn, they will willingly go above the call of duty to take care of your patients when in need.

One of the greatest downfalls of new graduates is to misjudge how much patient care depends on non-physician staff. While we make medical diagnoses and perform life-saving interventions, the nursing and ancillary staff are the heart and soul of patient care. If you do not make friends with them, you do so at your own peril. In a busy community hospital, it is not uncommon to have multiple codes at the same time; your success as a physician will depend on the amount of trust and rapport that you have built with your nursing staff. Just like with your physician colleagues, make sure that you help every member of your team to ensure that the ED runs smoothly — get blankets for patients, start your own IV lines, place a Foley while your nurse is at lunch. Your efforts will be remembered, and the staff will have more of an investment in the team with you as its leader.

Finally, the lessons include finding humility, a servant's heart, and the ability to smile through adversity. It has been a great year since residency, with many demands, but lots of growth. It has certainly been made easier with my trusty EMRA apps and pocket guides, and with continuing education in the form of EMRA-sponsored podcasts. We all have a lot to look forward to as we progress in our careers from resident to attending, although we should expect some bumps and delays along the way. But, if we continue to pursue lasting professional relationships and personal education, the road will be a lot smoother.