- Email: [email protected]
Thank You for Saving My Patient
The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–2, 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2015.02.042
Humanities and Medicine THANK YOU FOR SAVING MY PATIENT Joshua Bucher, MD and Boris Veysman, MD Department of Emergency Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, New Jersey Reprint Address: Joshua Bucher, MD, Department of Emergency Medicine, Rutgers–Robert Wood Johnson Medical School, MEB 103, 1 RWJ Plaza, New Brunswick, NJ 08901
We are accustomed to a different type of feedback from our colleagues. All too frequently, it goes more to the tune of, ‘‘Excuse me Doctor Emergency, why did you admit my patient John Smith to Dr. Doe and not me?’’ or ‘‘Why me and not Dr. Doe?’’ In the heat of battle, with incapacitated and noncommunicative patients and terribly strained resources, we do our best. Nitpicking technicalities while people are dying is lower in priority. We have become numb to lack of appreciation because patients matter more than our pride. While we juggle sharps placing an emergency dialysis catheter on the patient who arrested from a potassium of 9.5 so it is ready when the nephrologist arrives, other physicians rarely fail to remind us of more trivial matters. We need to learn to work together with our coworkers in order to take care of our patients. We need to adapt to the ever-changing landscape of medicine and place pride aside in order to make a difference. We have many areas we can work on. Maybe our colleagues do not have the same appreciation of resuscitation as we do, and the time-constraining nature of our job. Perhaps, our patients would benefit from a mutual discussion about these issues with our colleagues. However, we legitimately make mistakes. Like our evidence-based protocols, we collect information and use it to improve our process. We discuss our deficiencies and complaints at regular meetings to stay up to date on the
Doctor, Medic 201 is bringing in a post-cardiac arrest patient who had bystander CPR and regain of pulses after six minutes. They will be here in five minutes.
Medic calls like these, or a spontaneous pneumothorax in a patient with undiagnosed Marfan syndrome, or a septic patient that requires intubation and pressors to maintain an adequate mean arterial pressure, are only a handful of the many critical cases you can see in one shift. As emergency physicians, we care for people during their moments of crisis and peril. And these are the moments we look forward to, when we make a difference in the outcomes of sick patients. Our service then is often invaluable. Whether it be early goal-directed therapy for sepsis, therapeutic hypothermia for post–cardiac arrest patients, or any number of life-saving therapies we can offer, we continuously strive to improve. At work, we live to save. However, how often have you heard those words, ‘‘Thank you for saving my patient?’’ How often have you begun to treat a patient with an end-stage terminal disease only to realize that their goals of care have never been discussed before their emergency department visit? How many times has the internist appreciated your decisive initiation of therapeutic hypothermia on a postarrest patient, so the 55-year-old can keep ‘‘playing the piano’’ of his life’s work and remain fully able to appreciate and benefit his family?
RECEIVED: 25 April 2014; FINAL SUBMISSION RECEIVED: 13 November 2014; ACCEPTED: 27 February 2015 1
2
logistics of whom to refer, consult, and admit, and when. We utilize technology by listing admitting and consulting physicians in our electronic medical records system. Emergency physicians, as well as our colleagues, persist at our difficult work environment because we want to help our patients. None of us needs external validation, patient gratitude, or recognition of our skills on any particular day. Yet, as a community of valuable professionals, we deserve to be appreciated by the colleagues with whom we interact every day.
J. Bucher and B. Veysman
Despite the constant criticism, we do gain the subtle respect of our colleagues, even when we do not appreciate it. They will quickly rush any patient they believe looks ‘‘sick’’ straight to our healing hands, a tacit recognition of our ability to do good. It will happen. I will pick up the phone and hear ‘‘Thank you for saving my patient.’’ I will know I earned it, and return to my task with renewed enthusiasm and determination. And the appreciative colleague and I will share a patient who truly benefits from our teamwork.
http://dx.doi.org/10.1016/j.jemermed.2015.02.042
Humanities and Medicine THANK YOU FOR SAVING MY PATIENT Joshua Bucher, MD and Boris Veysman, MD Department of Emergency Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, New Jersey Reprint Address: Joshua Bucher, MD, Department of Emergency Medicine, Rutgers–Robert Wood Johnson Medical School, MEB 103, 1 RWJ Plaza, New Brunswick, NJ 08901
We are accustomed to a different type of feedback from our colleagues. All too frequently, it goes more to the tune of, ‘‘Excuse me Doctor Emergency, why did you admit my patient John Smith to Dr. Doe and not me?’’ or ‘‘Why me and not Dr. Doe?’’ In the heat of battle, with incapacitated and noncommunicative patients and terribly strained resources, we do our best. Nitpicking technicalities while people are dying is lower in priority. We have become numb to lack of appreciation because patients matter more than our pride. While we juggle sharps placing an emergency dialysis catheter on the patient who arrested from a potassium of 9.5 so it is ready when the nephrologist arrives, other physicians rarely fail to remind us of more trivial matters. We need to learn to work together with our coworkers in order to take care of our patients. We need to adapt to the ever-changing landscape of medicine and place pride aside in order to make a difference. We have many areas we can work on. Maybe our colleagues do not have the same appreciation of resuscitation as we do, and the time-constraining nature of our job. Perhaps, our patients would benefit from a mutual discussion about these issues with our colleagues. However, we legitimately make mistakes. Like our evidence-based protocols, we collect information and use it to improve our process. We discuss our deficiencies and complaints at regular meetings to stay up to date on the
Doctor, Medic 201 is bringing in a post-cardiac arrest patient who had bystander CPR and regain of pulses after six minutes. They will be here in five minutes.
Medic calls like these, or a spontaneous pneumothorax in a patient with undiagnosed Marfan syndrome, or a septic patient that requires intubation and pressors to maintain an adequate mean arterial pressure, are only a handful of the many critical cases you can see in one shift. As emergency physicians, we care for people during their moments of crisis and peril. And these are the moments we look forward to, when we make a difference in the outcomes of sick patients. Our service then is often invaluable. Whether it be early goal-directed therapy for sepsis, therapeutic hypothermia for post–cardiac arrest patients, or any number of life-saving therapies we can offer, we continuously strive to improve. At work, we live to save. However, how often have you heard those words, ‘‘Thank you for saving my patient?’’ How often have you begun to treat a patient with an end-stage terminal disease only to realize that their goals of care have never been discussed before their emergency department visit? How many times has the internist appreciated your decisive initiation of therapeutic hypothermia on a postarrest patient, so the 55-year-old can keep ‘‘playing the piano’’ of his life’s work and remain fully able to appreciate and benefit his family?
RECEIVED: 25 April 2014; FINAL SUBMISSION RECEIVED: 13 November 2014; ACCEPTED: 27 February 2015 1
2
logistics of whom to refer, consult, and admit, and when. We utilize technology by listing admitting and consulting physicians in our electronic medical records system. Emergency physicians, as well as our colleagues, persist at our difficult work environment because we want to help our patients. None of us needs external validation, patient gratitude, or recognition of our skills on any particular day. Yet, as a community of valuable professionals, we deserve to be appreciated by the colleagues with whom we interact every day.
J. Bucher and B. Veysman
Despite the constant criticism, we do gain the subtle respect of our colleagues, even when we do not appreciate it. They will quickly rush any patient they believe looks ‘‘sick’’ straight to our healing hands, a tacit recognition of our ability to do good. It will happen. I will pick up the phone and hear ‘‘Thank you for saving my patient.’’ I will know I earned it, and return to my task with renewed enthusiasm and determination. And the appreciative colleague and I will share a patient who truly benefits from our teamwork.