Enhance your ED by enhancing yourself first.
December is a crazy month, with a lot to do professionally and personally. At least professionally speaking, there’s likely a couple of holiday parties to attend and/or plan, insure you’ve made your annual contribution to your hospital foundation and time to plan your end of your review for your group. It’s also important to reflect on the past year and think about what we can improve in the next year.
This year, I’m challenging everyone to make a resolution to become a better colleague. I surveyed friends and colleagues to find out what they think makes the ideal emergency physician colleague. Accepting that none of us are perfect, I bet there’s at least one characteristic or behavior from the list below that you can work on in 2020.
There’s so much to be said around shift change. Essentially everyone I spoke with included something related to shift change. Showing up on time is not enough. There’s no worse feeling than wondering where your relief is or whether you should start the next ESI 2 patient that just rolled in. In fact, one colleague said that his nights were infinitely better when one of his colleagues showed up 30 minutes early having already reviewed the EMR and was asking for sign out.
Given that it takes five minutes to get settled and get signed into the EMR, strive to be the colleague that is known for being five (or even 10) minutes early. It goes back to a saying I’ve used for years—“early is on-time.” And then ask the question, “What can I do to get you out of here?” Every ED has a different sign out culture and I’ve long accepted that my shift really ends 30-60 minutes after the scheduled time, but at some point, it’s in everyone’s best interest if the doc we’re getting sign out from leaves, so find a way to facilitate that.
Get there early enough to spend a few minutes being social. Start by rounding on your colleagues to say hi and check in when you arrive. They want to know you’re there and ready to go and it’s a chance to make a little small talk. Then, round with everyone again to say goodbye and thanks when you leave. (This is even more important for our nursing and staff co-workers). We all like socializing during our shifts, but typically we’re putting our head down and plowing ahead. Shift change is the opportunity to touch base with your colleagues.
And as the doc taking the sign out, add a brief note in the chart (or start a new note) about what happened to the patient. Add in the test results, reevaluate the patient and document the conversation you had with the patient. The patient should be hearing the results and plan from you, the oncoming doc, not from the nurses as they discharge the patient.
As the doc getting off shift, take pride in the patients you leave waiting. It’s really disheartening to show up for a shift and have multiple patients that have been waiting in rooms for a long time. As the outgoing doc, unless the department is empty, don’t be waiting with your coat on and car keys in hand. Generally the last 30 minutes of a shift is spent charting and making dispositions. Use some of this time to provide “quick” medical evaluations of the patients waiting in rooms. I’ve heard this referred to a PT (physician triage), expedite (as in get the patients moving through the system) and RME (rapid medical evaluation).
The goal is to introduce yourself to the patient (thus stopping the door to provider clock, which prevents left without being seen incidents), explain that you’re at change of shift, but want to get their care started, perform a brief history and physical, and then go enter orders. At my shop, we actually built a physician triage note into our EMR, but we’re not writing the full note or taking credit for the patient. It’s just considered good citizenship and as it turns out, it’s really good for patient care and the department metrics.
Be comfortable being uncomfortable. I’ve heard this line a lot recently. Your favorite colleague probably has mastered this tip. Few of us prefer taking care of the tachypneic, febrile three-week-old versus a 55-year-old STEMI patient, but we can’t run away from either patient and we need to be comfortable with the pit we get in our stomach when the charge nurse calls overhead for a doc stat.
It also means when there are a lot of patients to be seen, we have to push ourselves outside of our comfort zone of managing six to eight patients, but rather get comfortably uncomfortable managing 12-15 patients for a while. And finally, unless you’re in the last hour of your shift, don’t cherry pick the easy cases. Take the “next up” to be seen, whether your group decides this based on acuity or wait time or both, everyone eventually needs to be seen and it’s unfair to your colleagues if you leave them every 85-year-old weak and dizzy patient.
Pay it forward. One of the hardest parts of our job is living in a 24/7 world where we really don’t call out for shifts. Our schedules are sometimes made months in advance, long before you realized you had a family event. Other times, you know you’re just too sick to go to work and you want to find someone to cover tomorrow’s shift. If you need someone to cover your shift, make sure that you’re volunteering to cover someone else’s shift down the line.
If you put an email out requesting coverage and one person emails you directly to take it, send a reply all to the whole group profusely thanking them. And if someone else requests or needs shift coverage, step up. They’ll be more likely to help you down the line and the group culture of helping each other improves every time someone does this and everyone knows about it.
Do something that will benefit the group. This could be teaching a new skill to your colleagues, getting gift cards for everyone’s scribes, or anything else that benefits the team. I love that I have a doc who remembers to collect money for scribe gifts every year. It’s one less thing I need to remember in December, the scribes love it, and Dr. R and the rest of the docs get positive vibes from the scribes.
Assume the best. Assume everyone else is working at least as hard as you, taking as many referrals, signing as many EKGs, seeing as many complicated patients, etc. And set the example for doing the scut work, such as taking physician referrals, pharmacy calls, lab culture results, etc. The rest of the ED team will follow and it makes the entire team look overwhelmed (or like slackers) when there’s multiple overhead pages that docs aren’t responding to.
Bad moods and negative attitudes are contagious. Don’t bring down your co-workers by complaining about every patient you pick up or that registers to be seen (same goes for repeatedly complaining about the nurses, scribes, techs, secretaries, etc.). There’s no surprise that not every case is critical care. While we don’t get to control what patients come to the ED, we do get to control our reactions to them.
We have to remember that they’re all there to see us and our team and the patients respond to our professionalism and our attitude. Work is more fun when we have high staff and physician satisfaction and this is hurt by a negative attitude.
Our new hires are really the lifeblood and future of our group. We don’t get them that often, but they’re critical to our success. Help them transition to being an attending and understanding the culture of your department. This could be EMR shortcuts, clinical wisdom, political pearls, or just how to get patients through the system at your facility. I’ve really enjoyed mentoring new doctors through the years and I’ve learned a lot from them. Every one of us has something to offer these new docs and it’s actually in our best interest to make sure they’re successful.
There are so many things we can do to improve the general wellness and attitude of our group.
- Check to see if your colleagues have eaten or want you to cover their patients for a few minutes while they grab something to eat or a cup of coffee.
- When you know a colleague is involved in a rough code or case, pop in the room and see if they need any help (airway, lines, ddx, etc.). You’re not looking over their shoulder because you don’t trust them to handle things, you’re just trying to help. Also check if any of their other patients need anything or if there are patients they’ve signed up for, but can’t get in to see. And make it a priority to keep moving patients when your colleague is tied up. It’s pretty frustrating to come out of a critical patient’s room an hour later, knowing you need to document, call the ICU or the ME, talk to family, etc… only to find a rack full of patients to be seen.
- Invite work colleagues to a purely social function (dinner, happy hour, party) outside the hospital. It could be an event that includes your non-work friends or just your work colleagues.
- Take time to learn about your colleague’s families, hobbies and interests.
- Find ways to get your colleagues credit for things. Email the chair about a great post arrest huddle, management of a difficult airway, etc…or nominate them for physician/APP of the month for an outstanding case.
I hope you have a wonderful holiday season and can incorporate one of these resolutions into your clinical world in 2020.
