More Than Medicine: Being responsive instead of reactive

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A simple equation to overcome emotions of outcomes.

Outcomes play a considerable role in our lives. Have you ever found yourself angry about an outcome, be it with a patient, something personal, about research, system-related or others?

In trying to understand better how we arrive at outcomes, our team came across an equation, introduced first in sports psychology and now applied throughout other fields. That equation is E+R=O.


  1. E stands for the “event.” For our purposes, let us say a patient presents in cardiac arrest. As much as we may want to go back and change how this event happened or change how the story has unfolded up until this point, we can’t. The event “is what it is.”
  2. R has two optional meanings, reacting or responding. Although they sound similar, they have very different basic meanings and different outcomes. To be reactive is to be equal and opposite to the event (there is an equal and opposite reaction). But, to be responsive is to train yourself to be calm, collected, calculated and your actions change the outcome you want to achieve.
  3. O of course, stands for the outcome. As previously mentioned, we live outcome-driven lives. Whether in the clinical arena (meeting sepsis, stroke or STEMI times), professionally (work advancement, publications), or in our personal lives (positive relationships, wellness, health, finances), there are measurable outcomes we all are trying to work towards.

So now that we have the equation, let’s give a couple of examples. In the clinical arena, out-of-hospital cardiac arrest is a common presentation where we as clinicians can make metered evidence-based decisions that may and proven outcomes.

Now, what if you walked in on a code, or there was poor communication, and “things weren’t just going right”? You probably were back to ACLS algorithms, focusing on good chest compressions, evaluation for cardioversion and good closed-loop communication.

You would do this because you’ve been taught and conditioned that doing the basics right can lead to an improved outcome.


Or let’s say you’re at work and the patient becomes verbally aggressive with you and other staff members. Would you be verbally aggressive in return? The answer is most likely no because you know that if you were, you would not get the desired outcome, which would be you and your patience being able to work in a safe environment.

But, if you were to call me to speak with a patient, get to the bottom of their problem, you may be able to deescalate and keep another staff member safe.

We could go on with more examples. But hopefully these two common examples can help you reflect on other situations where you can apply this equation and focus on being responsive instead of reactionary to improve your clinical, professional and personal lives.

Use this simple equation as it will change your life when you begin to use it in your daily interactions, both professionally and personally.



  1. Episode 63 #ConsistentBehavioralExpectations. EM Over Easy Podcast. 8 October 2018.


EM OVER EASY is a podcast by three EM physicians, Andy Little, Tanner Gronoowski and Drew Kalnow, with a focus on #MoreThanMedicine. The podcast can be found on Apple Podcasts, Stitcher and more. For more about the content and hosts, visit and follow them on twitter @emovereasy.

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