I have always, always hated when people compare medicine with the aviation industry. “Look how standardized their approach to flying a plane is,” they joyfully declare, in awe of checklists and uniform handoffs. They conveniently ignore the fact that medicine has no standard fuel gauge, or altimeter, or speedometer. A slightly low blood pressure may be normal, a sign of mild dehydration, or the first sign of occult hemorrhage or overwhelming infection.
Instead, I'd like to compare emergency medicine with Disneyland.
I admit my recent Disney experience was more ideal than a usual Disneyland visit. I have no children. I went on two weekdays in January, just before their new Star Wars ride opened. I researched Disneyland strategy and optimized my rides accordingly. I waited no more than 10 minutes for any ride in the park, and mostly didn't wait at all.
My mind keeps veering back to how smooth the entire experience was, from pre-arrival to the end of the night. There are certainly lots of steps Disney has to take to get people into its parks, but I'm not about to compare the experience of intake and triage in the ED with the Disney experience. Disneyland visitors have a goal of having fun and riding rides at the happiest place on Earth, and they expect to wait.
They're typically not in pain and are generally well enough to spend a day on their feet, eating theme park food and spinning around in the Mad Hatter's tea cups. The visitor intent and patient intent are obviously quite different, but I keep wondering, “What if Disney ran an ED? What would that look like?”
I was blown away by how helpful (and kind) everyone was, from the security guards checking my bag to the lady selling popcorn. Any question seemed like a delight for them to answer. Is everyone Disneyland hires ooey-gooey bubbly sweet? Of course not. But they're at least trained to focus on the experience of their guests. (Employees are called cast members for a reason; it's at least partially putting on a show for the visitors.)
Contrast that with medicine, I'm certainly not the only one who puts up barriers and silos. I like to think I go above and beyond for patients, but if they ask for something we don't offer in the ED, I'm quick to tell them, “You need to see your primary care doctor for that,” or “Unfortunately, we don't do that here.” I'm the last guy who would recommend that the ED start offering even more services, but it's interesting to think what that might do to and for our patients.
It was also amazing to me how ingrained this helping culture is for Disney's cast members. Here we are in a helping profession with doctors and nurses who are paid handsomely to spend their lives trying to help people. Compare that with Disney's cast members, who are paid $10 an hour and will literally bend over backwards to make sure you are having a good time, even if their job is as monotonous as asking everyone to “show me the yellow tabs on your seatbelt” for hours a day. Of course, it's also much easier for Disney because they have abundant staff.
Cast members were everywhere. You can't look up without seeing someone with a Disney name badge on his chest. I wondered what all the staff walking around actually do. Then I realized many of them were just there to help guests, keep things clean, and solve problems. Wouldn't it be incredible if we had people roaming around the ED 24/7 just trying to help?
Everyone knows that Disney's posted ride wait times are typically at least 10-15 minutes shorter than they actually are—the quintessential example of under-promise and over-deliver. But even more than that, Disney tries to make the lines part of the experience; they are decorated with art; around every turn there is a new thing to look at, and as you progress along the line, your wait is constantly interrupted by something—a screen with C-3PO talking to you, an animatronic pirate explaining the safety rules, or a cast member handing out 3D glasses. I tried several times to estimate how much time I'd been waiting in a particular line, and I failed miserably.
Disney even provides updates on your phone: notifications when you should book your next FastPass, when your food order is ready for pickup, when the photos you took are available for viewing. So much of emergency medicine is waiting (in the waiting room, for the doctor, for medications to kick in, for test results, for the CT scan, for discharge), and I wonder what we might be able to offer to our patients while they wait. Education about the reasons for their tests? A general expectation of when their test results will come back? What the wait time looks like for CT? Recipes for healthy meals? Background information about their doctors and nurses?
Next month: Today's emergency medicine in a perfect world, inspired by some of these concepts from Disney.
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Dr. Walkeris 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 athttp://bit.ly/EMN-Emergentology.