Why I WraP EM – Charley McNabb

Charley McNabb
Dr Charley McNabb – Emergency Physician Princess Alexandra Hospital, Brisbane


I have a chronic condition. It’s called imposter syndrome. The only tribe of medicine that has ever extended group membership to me is the eclectic emergency physicians. Even with that, confidence and self-belief are issues that I have had to work on especially during Fellowship training. I had great supervisors, great peers and fantastic mentors who negated and mitigated all the less positive interactions, situations and people in practicing and learning medicine.

Some years on, my clinical identity is patient centred, I am active in education and training, in mentoring and in supporting mentoring in emergency medicine. I have a working hypothesis of wellness, if you like, based on a Code Blue/Resuscitation metaphor.

For years, we acted on trying to resuscitate (usually unsuccessfully) patients on the ward who had effectively died – no pulse/no breaths – a code blue. Then, after careful consideration, we asked, “What if we got to these patients before they lost their vital signs? Maybe it would result in better survival, in quantity and quality?” This was, at least for some – the MET/MERT response. Then, with further deliberation, the science was there to recognize the deteriorating patient (RDP) and we recognised that, by intervening at this time, we could even prevent high stakes incidents of near-death.

We now mostly monitor the sick and injured through recovery or resolution. Sometimes we even proactively promote health, rather than reactively respond to illness or injury.

So how does this act as a metaphor for wellness?

In my wellness experience at work, the Code Blue was the jarring news that a colleague had become physically or mentally unwell and no one had picked up the signs. Real harm had resulted. Everyone was shocked and reacted, but did not do anything to prevent the next event.

By contrast, the MERT is when a colleague would pull me into the drug room or the pan room and disclose the issue they were wrestling with, usually well advanced and needing fairly intensive input to help. Still reactive.

Then we started as individuals and groups to talk about human factors, and to identify risk and attributes that lead to or signify non wellness – the RDP model.

Next we invested in deliberate, supported, structured mentoring programs where all manner of topics and stressors could be dealt with.  Realistically we are monitoring the situation and are now responsive cf reactive.

All of these modalities are supporting Wellness but it is time to intensify the momentum into effective, high-yield promotion of health and wellness, in the emergency medicine context – to hold open, empowered conversations about issues affecting us and our colleagues, and therefore our families and the general community.

That is why I WRaP EM

About Charley McNabb

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