EM Mindset: Rob Bryant – Seven rules that make me nicer to work with (when I remember them)

Author: Rob Bryant, MD (@robjbryant13, Adjunct Assistant Professor of Emergency Medicine (clinical), Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine; Attending Physician, Utah Emergency Physicians, Salt Lake City, UT) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

The emergency department is a big sandbox; just like in elementary school there are people who play in it all of the time (nurses, techs, colleagues) and there are those that visit now and then (patients, consultants). We need to play nice with all of the people with whom we share the sandbox.

I propose a set of rules that took me over a decade to learn, and that I still sometimes forget.

1. Be nice.

No matter how well prepared you feel on graduating residency, or how many years of exceptional care you have delivered, you still need to be nice. Even if you feel that you are God’s gift to emergency medicine, your patients and your nurses will not care how much you know, unless you show that you care.

‘People don’t care how much you know until they know how much you care.’ – Theodore Roosevelt.

‘Don’t be an imperious wanker’ – Rob Orman MD

The nicer you are to your staff, the more they will have your back when things get ugly. This starts from the first day of training.  The nicer you are to your patients, the more leeway they will give you if wait times are longer for that CT read or if there is a poor outcome following their visit.

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If you do not care, or something about the patient’s personality or social situation makes it hard for you to care, at least engage those acting skills and pretend to care.

‘Medicine is show business for ugly people’. –Greg Henry MD.

As physicians, we set the tone for the department and if we seem like we care our nurses and techs may start to care a little more too. It took me a long time to learn that some patients just want to be heard, and that we do not have to prove ourselves correct in every patient encounter.  Think about your last interaction with the parents of a non-vaccinated child:

• Who won the argument?
• Did any behaviors change?

2. Know where the blanket warmer is, and know how to put your patient on the cardiac monitor.

It still amazes my nurses and techs when they see me bringing a blanket to a patient. They are equally amazed when they enter the new patient’s room and I have already placed the patient on the monitor. It takes more mental energy and time for me to find a tech to fetch a blanket for the patient in room 33 than it does to get it myself.

We are all capable of learning new skills, and the skill of being able to put a patient on a monitor will pay big dividends with your overworked staff.  There is nothing hard about learning where the red, white and black leads go.

We should know how to work and troubleshoot every piece of equipment in the department. (Infusion pumps are still on my to-do list.

If you are interested in reading the rest of this and other EM Mindset pieces, please see “An Emergency Medicine Mindset,” a collection evaluating the thought process of emergency physicians. This book is available as ebook and print on Amazon.