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Cruise Control: All The ED's a Stage, and EPs Are Merely Actors

Cruz, Joseph DO

doi: 10.1097/01.EEM.0000520071.79490.e3
Cruise Control

Dr. Cruzis an emergency medicine attending at Kennedy University Hospital in Cherry Hill, NJ. He is a 2012 graduate of the University of Medicine and Dentistry School of Osteopathic Medicine and a 2016 graduate of the Rowan School of Osteopathic Medicine Emergency Medicine Residency, both in New Jersey. He is currently the emergency medicine clerkship director at Rowan.

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One of my attendings told me while I was in residency that most of the job is pure repetition. The actual art of being an emergency physician is improvising while navigating unique social or public relations issues with patients or family members. The algorithm and evidence-driven decision-making of our profession is invisible to our highly judgmental viewers. The only thing they care about is if they liked their doctor.

Patient satisfaction should matter little on paper — patient safety and evidence-based medicine should supersede all roadblocks to care. But you realize very quickly that patient relations can literally change the course of your department when a patient becomes angry with your treatment plan or when a family member continually approaches your desk while you are trying to manage other patients. That is why we smile when the curtains rise and the spotlights shine on the stage.

The ED is a stage, and we are the actors. Patients judge us based on how we look, how we present ourselves, and how we communicate with them. Many other factors contribute to their “experience,” but it seems to me they become most upset when their expectations aren't met. A patient who came to the ED for narcotic medications to treat his chronic pain and received none, for example, would become upset, sometimes even belligerent. But consider this, what if a patient expected a Caucasian doctor with white hair, a long white coat, and nice shoes to walk in? Would he be disappointed if a 30-year-old who looks like he just graduated high school walks into the room instead?

And so we arrive at the esoteric discussion over gender, age, and race, among other factors. As a Filipino doctor with a Hispanic last name in his early 30s who, as stated earlier, looks like he could pledge a college fraternity, I find it fascinating what a large part my demographic plays in my interactions with patients. In fact, it probably influences my patients' experience much more than whether I follow the standard of care that I spent eight years working so hard to memorize.

I conducted a personal experiment as a first-year attending. I began the year wearing a polo shirt, a pair of khakis, nice shoes, and a stethoscope around my neck. The casual doctor look, if you will. Many patients commented, “You're the doctor?” Or “How old are you?” And the ego-destroying, “Are there any older doctors here?” Then, as the winter months crept in, I donned the white coat, and the skeptical comments visibly dissipated. In fact, patients were generally happier with my care even though I hadn't changed a thing about my actual practice.

We can only scoff at the societal bias that we can do little to change. I find no shame in devoting conscious effort to making sure my patients are happy. The nurses and residents will belittle your brown-nosing, but, in the end, you accept the things you can't change, and go full force with the things you can.

The most basic advice I could give to combat patients' bias and skepticism is to simply act your role. Look clean, press your clothes, talk professionally, carry yourself with dignity, and, most importantly, look like you are working. I find that eating at your desk and joking around with your coworkers creates an open season for patients and their families to label you and write you off. From start to finish, I try to tell myself each shift that I'm in a reality show or TV drama — people are always watching. The true medical decision-making goes on in your head, but unfortunately, a requisite of the job is to portray the doctor that patients expect.

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