EM Mindset: Matt Pirotte – My Attending School
- Nov 30th, 2015
- Manpreet Singh
Author: Matt Pirotte (@ – Assistant Professor / Assistant Residency Director, Dept of EM, Northwestern Memorial Hospital) // Edited by: Manpreet Singh, MD (@MPrizzleER – Clinical Instructor & Ultrasound/Med-Ed Fellow / Harbor-UCLA Medical Center) and Alex Koyfman, MD (@ – EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital)
The year is 2006, I’m a 3rd year medical student at Loyola University Chicago Stritch School of Medicine on my Surgery Clerkship. The scene is weekly Morbidity and Mortality Conference. A senior surgical resident is attempting to explain what happened during a difficult abdominal surgery and describing the issues he was having with exposure and control of bleeding. A laconic trauma surgeon chimes in and said, “you know, the first thing they teach you in attending school is to make the incision bigger.”
Obviously this brought chuckles from the room which quickly moved on with the case. I never forgot the term or the mindset though. With that in mind, I would like to describe the 10 most important things I have learned in my 3 years out of residency – my attending school.
- Do not fight system level problems at an individual level: Obviously we have major issues in our healthcare system with over-testing and application of diagnostic tests for reasons of marginal value. The challenge is to work to change this culture at the level of hospital, state, and national policy and not to make each clinical shift an individual crusade.
- Do not let patients mistreat staff: There is an epidemic of violence and abuse against health care workers in America. A very large percentage of acute care nurses report being threatened with or subjected to violence at work. Part of that problem is undeniably us. We tolerate behavior from patients that would get them thrown out of any other business. Obviously we have a duty to care for them, but that does not extend to a duty to take infinite verbal or physical abuse. If a patient is being abusive towards your staff, tell them that it is not appropriate, not acceptable, and will not be allowed to continue. In certain scenarios patients who are medically stable may need to be removed from the department by security or the police. Trust me – the staff will notice. It is a great way to build rapport with staff that has the added benefit of being the right thing to do.
- 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.