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Emergentology

The Less Sung, Less Thanked, Less Recognized

Walker, Graham, MD

doi: 10.1097/01.EEM.0000550374.97695.ba
Emergentology

Dr. Walker is an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc (www.mdcalc.com), a medical calculator for clinical scores, equations, and risk stratifications, which also has an app (http://apps.mdcalc.com/), and The NNT (www.thennt.com), a number-needed-to-treat tool to communicate benefit and harm. Follow him on Twitter @grahamwalker, and read his past columns at http://bit.ly/EMN-Emergentology.

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After signing out to me, a colleague recently texted me on his way home. “I hope Molly and Ron were able to get room 19 out like I said. He needed a lot of TLC during the shift.”

Nurses Molly and Ron certainly did: I didn't hear a peep from room 19, and the patient apparently left the ED without any issues.

Later that same night shift, I looked up to see a card taped to the wall with my name on it. “Dr. Walker, thank you for your care,” the note read. I'd run into the patient's daughter the night prior and said hello. The patient had been a fairly hairy ethical and medical dilemma about a year ago and was back after a fall.

I was showing the nice card to the night nurses and quickly realized that none of them received a card. Nor did the techs, nor the housekeepers, nor the patient care coordinator, nor the social worker. Not the nurse manager, or the ED director, or the unit assistant. No card for the phlebotomist. Or the materials and supplies worker. Or the pharmacist. Or the paramedic who was already gone. Certainly not the engineer we call when the tube system goes down or the heating or cooling goes haywire.

Sure, the doctor is often the captain of the ship in the patient's eyes, and the health care team certainly is structured that way, but often the entire fleet is barely staying afloat, and it's the entire team that is to thank for keeping our patients safe. I don't have much more to say in this month's column besides this: Thank you. Thank you. Thank you. My editor said I couldn't just repeat “Thank you” for another 600 words, so I'd like to highlight some examples of how much of a difference people make to my ability to see patients, discharge patients, and maintain my sanity.

  • The nurse who is able to answer all of the questions that I've already answered three times, so the patient doesn't ask to see me a fourth time at the bedside and so I can spend time at the bedside of a critical patient. Thank you.
  • The nurse who explains the plan and discusses the status of the patient to the first family member and the second and the third, so I can actually create the complicated plan. Thank you.
  • The patient care coordinator who knows everyone in the hospital and clinic and is able to get a neonate with a fever directly admitted to the NICU for his entire workup and admission, bypassing the ED. Thank you.
  • The tech who anticipates my needs and proactively predicts my plan: “Hey, I overheard you telling bed 3 it's a distal radius fracture. Is it OK if I get the fingertraps and some splinting stuff ready?” Thank you.
  • The housekeeper who sees that a patient has been discharged and immediately starts cleaning the room because she knows the waiting room is full. Thank you.
  • The social worker who pulls an amazing community resource out of his back pocket (that you never knew existed) to safely get a disposition nightmare to a better locale than the ED hallway for three days. Thank you.
  • The charge nurse who lets you take up a code bed for three minutes to suture a laceration so you can see the next patient. Thank you.
  • The nursing manager who pushes the house supervisor to get beds ready because a STEMI, a stroke, and three appys that will need the OR just showed up. Thank you.
  • The tech who does the road test and PO challenge for the patient and is experienced enough to know that the drunk patient needs a little more time to make sure it's a safe discharge. Thank you.
  • The paramedic who just had a suspicion about a patient and ended up putting in two big lines before the patient decided to code for no good reason. Thank you.

I know I often say that emergency medicine is a team sport, but the gratitude (and the blame) often go to the physician. But if the rest of the team weren't involved, we could easily be bogged down and unable to do that really critical piece of our job: documenting thinking about how to manage a complex patient, or who to consult, or how to address a particular issue. So I'll say it again, one last time: thank you.

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