“If you want others to be happy, practice compassion. If you want to be happy, practice compassion.” —Dalai Lama

 

The emergency department is quite possibly the most exciting place in the hospital, but it can also be the most challenging and chaotic. Patients arrive at all hours of the day, families are scared and frustrated to be there and sometimes we can’t work fast enough to take care of everyone in a timely manner. We are also constantly taking phone calls from other institutions to help decide whether a patient from another hospital needs to come to us, and how (helicopter, fixed wing, or ambulance).

Needless to say, it is a stressful environment. Sometimes stress can make us (any one of us, from a resident, nurse, attending) anxious. Sometimes this anxiety manifests by treating members of our team poorly. When I discussed our shame culture, I talked about this a bit.

I used to get really anxious when the ED got busy, especially if I was fielding lots of phone calls, and felt as though I was being spread too thin.

There is nothing scarier than to think I might miss a diagnosis or not see a physical exam finding because I am too busy. I used to translate that anxiety into barking orders and being impatient with my team, which unfortunately, only increased anxiety!

I have since learned how to improve my interactions and communications with my patients and colleagues. But I know all too well how easy it is to project these feelings onto others, and sometimes it is also hard to recognize we are doing it.

Recently I had a patient that was sent to us for subspecialty care. My senior resident tried to discuss the patient with the consulting physician. Unfortunately, this particular consultant treated the resident with irritation and general nastiness, asking some slightly irrelevant questions she didn’t know the answers to, then shaming her for her lack of knowledge.

He also told her it was ‘inappropriate’ to call him when she was ‘unprepared.’  This kind of interaction (consultants being exasperated with patient consults) is quite common in our field and brings me back to my shame post (which describes in better detail how this manifests). I don’t always have the opportunity to give feedback to the perpetrators of this behavior, partly because I am not always aware it happens, or I get busy with my day, and it gets forgotten.

 

This blog post is for my angry consultant.

I see you.

For what it’s worth, please know that I recognize we both have really hard jobs.

I know that deep down, under the years of clinical practice, you and I really are the same person, bright-eyed and big hearted, who entered into this magnificent career of medicine with a desire to help others and possibly change the world.

Our jobs turned out to be a lot harder than we pictured they would be in those days. We sacrificed time and relationships, and life moved quicker than we anticipated. The cost to continue in this career has interest, and the rate routinely increases, with no one asking if we have the ability or stamina to pay.

I see you. We are the same.

But for some reason, you have found joy in making others around you squirm. Your ego feeds off of the power this gives you, and it makes you feel entitled to treat others as ‘less than.’ You get frustrated that no one understands the pressure, that every minute of your day is spoken for, and you act on that frustration by being mean.

I promise when you enter my world, there is no judgment. I know you are doing the best you can, and behind the delayed response to your page is a list of patients, a scared parent, and your own family at home. Everyone is asking for a piece of you, but no one is really appreciating the place you are in, the struggles you have.

I promise to see you with the same compassion I see my patients. I promise to thank you for coming by, that I truly appreciate your expertise. I hope that maybe someday you can see me, too. Know that like you, I really try to do the best for my patients every day. I try to only call you when I am worried about a patient, or concerned about the family’s ability to get answers and navigate our difficult health care system.

I see you. I care about you too. Maybe next time you can show me a picture of your dog, or your vacation, or your children, and we can talk about how hard it is to be a doctor, a parent, a friend and how it never feels like enough. How sometimes we give our best self to our job, and how it always feels like someone is getting short-changed.

We can’t forget those people we once were, the bright-eyed ones, that jumped into this crazy field. We are all in this water together, sometimes it actually feels good to help one another swim.

I see you.

 

XO,

Annie

Your Friendly ER Doctor

 

 

11 comments

  1. LJ says:

    I’ve been on the receiving end of a pompous specialist’s venom. As a midlevel the disdain for “wasting their time” comes on fast and furious. I’ve also worked with brilliant, accomplished specialists who always remained kind and professional. If they thought I shouldn’t have called, they said so, explained why, and helped me learn and do better next time. The world would be a much nicer place if we all remembered to trade vacation stories and baby pics from time time!

    • Annieslatermd says:

      Yes! Thank you for sharing your experience. I definitely remember the kind ones the most, and always want to emulate their ways. 🙂

  2. Lisa Davidson says:

    I appreciate the idea of understand the shoes we all walk in, including an unfriendly colleague. The opposite can leave one deflated, wondering about one’s competance, when communication fails to assume the best of each of us. Looking at the interaction with Grace and understanding, as you point out Anne, builds confidence and relationships.
    Than you for sharing your thoughts! I am encouraged to practice positivity and grace.

    • Annieslatermd says:

      Thanks Lisa! I think it is what we all want, to be viewed as though we ARE trying our best. I think that practicing grace in these instances can have a bit of a domino effect, where the behavior is modeled, and others can learn! I appreciate your comments, and am cheering you on in your practice! 🙂

  3. HOLLY TIEDEMANN says:

    Amazing Anne! I feel this is definitely something anyone can relate to. That fear you have when you’re asking questions to your provider only to have them degrade you. Degrade you without ever knowing your name. Its difficult to navigate through this field. I always appreciated you. You NEVER once made me feel that anxiety or shame of being”less than”. With that being said, it made me want to do the very best when working together as the respect was mutual.

    • Annieslatermd says:

      Thanks Holly! I hate when physicians degrade others, whether it be other physicians or members of the team It really serves no one. I want to show that it is SO much better to be respectful of each of our members, and it breeds respect. It does come back to the idea of ‘psychological safety,’ and how when we treat each other this way, the team works more fluidly.

  4. Max says:

    The intereting part is the reason they are there should be the reason they should feel honored. In other words, I don’t know what I need to do, so I need your help. Additionally, the entire point behind being a consulatant is to guide the person seeking information and help them learn. If I called you and it was uncalled for, then teach me why I could have managed it myself. Alternatively, if I called you and you really needed to be there then reinforce that experience with validation of my knowledge so that I do the right thing next time. Lastly, your organization is a teaching hospital, and one of your roles is to teach the next generation of doctors what behaviors are acceptable. Modeling negative pompus behavior shiws the resident that it is ok to treat people thst way. Furthermore, the impact to patient safety is huge. Here is the dialogue in the residents head after they were scolded by the consulting physician, “So, I just got embarrassed and scolded for expressing my concern about a patients condition, I will be sure to wait until I have the right information before I request a consult.” So, the resident is going to ignore their suspicions about the patients condition and potentially delay care because they don want to make a mistake. Lastly, it ruins the patient experience, if I was a family member and I heard a physician speak to a resident in the manner you described I would be hesitant to ask questions for fear of being looked down upon by the physician.

    • Annieslatermd says:

      Thanks Max for the response! No worries about the typos:)
      I completely agree with you! That is why I struggle so much when it seems like such a task for the consultant to help us out in the ED. It is SUCH an opportunity for learning for everyone. If the consultant is unapproachable, it really hurts everyone on the team….

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