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ER Goddess

ER Goddess

The Unsung Creative Genius of EPs

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000586480.73148.13
    emergency physicians, creativity, work-arounds
    emergency physicians, creativity, work-arounds:
    emergency physicians, creativity, work-arounds

    Nostalgia flowed over me as the bassoon solo in Tchaikovsky's “Capricio Italien” oozed from my car radio. I used to be a pretty good bassoonist before medical school, and hearing the song I had once played made me long for that artistic outlet. I lamented having given up that creative part of myself for medicine for the entire drive to work.

    Reality roared in when I walked into the ED. Patients were backed up, PACS was down, and thoughts of my bassoon days were supplanted by the tasks in front of me. I was assured that the radiologists had a backup system, but hours into my shift, I still had no CT results. I called the radiologist, and we realized that was down too. He couldn't see any studies unless we sent them by courier. Then came a magnificent aha moment: “Do you have an iPhone, and can you FaceTime?” I ran to the CT machine and scrolled through the images of my patient's CT, and he gave me a real-time preliminary read via FaceTime. Victory!

    As I reveled in our out-of-the-box problem-solving, it dawned on me just how much creativity we EPs routinely use to get our job done. We may not have time for the bassoon or other activities that fit the creativity stereotype, but that doesn't mean we aren't using our creative part. Creative thinking is any new way of seeing or doing things, and we do it every shift.

    David Berreby wrote in “The Science of Creativity,” Time's 2018 special edition, that “creations, whatever their form, aren't discovered until people are wrestling with a question. To see a solution, you have to think about a problem.”

    And who thinks about real and pressing problems more than EPs? Our creativity is inspired by necessity. We have no choice but to make connections and see answers if we want to handle ED craziness. Creative thinkers can adapt to any environment, and that is the hallmark of what we do. Creative thinkers also look at common things in fresh ways, and we do that with every patient.

    Light Bulb Moments

    Each patient presentation is a fresh permutation, as unique as the people in which it occurs, and each comes with a unique set of diversions. Customizing care to fit each situation requires flexibility, originality, and openness, which are the essence of creativity. Every light bulb moment we have in patient care (so many of which go unrecognized) is a small triumph of our imagination.

    It's time to celebrate our unsung creative genius. If you're a successful EP, rid yourself of the notion that you're not creative. Your little eureka moments all shift long may not be displayed in a museum or performed in an opera house, but they are still creative genius. With the emphasis on numbers and throughput, your creativity often goes unrecognized, but it is a huge part of your tool kit for making throughput happen.

    When regular pathways aren't working, you come up with workarounds. Take the night 30 non-English-speaking migrant workers came to the trauma center from a bus crash. They were all sleeping when the accident happened, they all hit their head, and none knew if he had lost consciousness. Would you CT scan 30 heads? “Find them some cards, turn some stretchers into tables, and have them play poker for a few hours. Whoever loses and whoever passes out gets a head CT,” was my EP boyfriend's idea.

    Without those aha moments, patient care gets stuck. Often no one even knows about or appreciates your small moments of brilliance, except maybe a nurse or your significant other, but they make a difference. I salute you, my ingenious colleagues, and all your 2 a.m. ideas that somehow find a means to an end. Here's to you clever warriors finding inventive solutions with the resources you have.

    Creativity during Chaos

    What's most laude-worthy about your underappreciated moments of ingenuity is that they are happening in one of the least conducive environments to innovative thought. It's one thing to look at art as a medical student or go home after a shift to play an instrument. It is another thing entirely to be able to tap into your creativity in the middle of chaos. That's why people tend to close their eyes or look up at the ceiling when puzzling out a difficult question; reducing visual stimuli helps us devote more energy to a task.

    That's why many of us do our best thinking in the shower because there is sensory restriction—white noise and minimal visual stimuli. The ED is the antithesis of sensory restriction, and we find ourselves attempting creative thought in the middle of visual and auditory distractions, not to mention interruptions. Did Jackson Pollock ever have people stop him while painting to say, “Excuse me, I need you to enter an order for that paint you just threw down?” Did Hemingway have people repeatedly burst into his study while he was writing to ask him to cross t's and dot i's on another manuscript? EPs have no studies, studios, or headphones, yet our powerhouse minds are still able to find novel answers to our patients' needs amid all the distraction and interruptions.

    Hang on to your creativity even in the face of standardization and time stamps. That can be a tall order, with endless documentation cutting into your time for pondering important clinical problems. These days ruminating about a patient or a question too much is implicitly discouraged because it slows us down; cogitation is bad for productivity. Algorithms have become so mechanized that often it feels that there is little room for contemplation. Unfortunately, forcing a standardized mindless approach to treatment without creativity could do more harm than good because, as you well know, there are no standard patient encounters. For your patients' sake, you must keep tapping into your creative genius and refuse to let metrics and check boxes impede your innovative thought.

    We are the artisans of medicine, not assembly-line workers. Think of your next shift as a blank canvas, and unleash your patient-centered creativity to make something beautiful. Dreaming up ideas to help patients get the care they need beautifies their world as much as the poetry books on their nightstand or paintings on their wall. You may not be painting, sculpting, or making music, but you are leaving your mark on humanity through the art of medicine, one patient care masterpiece at a time.

    Dr. Simonsis an emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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