Professionalism and performance

The Triple C of ED by Emergency Physician John Scott

Dr John Scott – Emergency Physician

Last weekend, two of our senior nurses calmed a terrified patient with life threatening epiglottitis enough to tolerate BIPAP. They completely changed his clinical trajectory. Their ability to rapidly connect with their patient through a sea of fear arguably saved his life. How on earth did they do that?

This case was a compelling demonstration of the power of communication at its most critical.  It got me thinking about the role communication has more broadly, and to ask how does our communication, our connection and engagement with our patients help us to provide exceptional care?

It is in the subtleties of communication that we build rapport with our patients, enabling the exploration of their symptoms, their fears and concerns. When our interactions are guided by an open and compassionate mindset, our patients share the information needed for us to build a sound differential diagnosis.

It is how we listen and how we convey complex information simply and concisely that is fundamental to our patients’ satisfaction, understanding and compliance with our treatment.  This interplay of human factors forms the foundation of our therapeutic relationship. It is our most valuable and rewarding skill.

Like me, you may have the suspicion that as a result of a growing workload, staffing challenges, the electronic medical record and many other factors, we are spending less time with our patients.  The scientific literature on burnout in healthcare supports this premise and describes how, as we become physically and emotionally detached from our patients, the quality of the care we provide suffers. Metrics such as patient satisfaction deteriorate, and complaints and medication errors increase. We tend to order tests to compensate for a rushed history, the patient’s length of stay increases, and they are exposed to a greater risk of harm from unnecessary investigations.

We use algorithms to standardise and streamline care but they should not limit our thinking nor substitute for a thoughtfully taken history.

A troponin level can tell us that the 65 year old chap in A4 has not had a myocardial infarction. It cannot tell us that his symptoms were caused by the grief of the loss of his wife six months ago.

A paracetamol level can tell us that the 42 year old lady in B8 does not require a NAC infusion. It cannot tell us how her life has been turned upside down since being violently assaulted a year ago.

If we do not engage compassionately with our patients we can neither discover nor address the true cause for their presence in the ED.

What we do in the emergency department matters.

How we do it, how we communicate with compassion, how we connect and engage, is fundamental to the quality of care we provide our patients.

Two of our senior nurses demonstrated this last weekend: that it is our human connection that has the power to change and ultimately save lives. As we strive to meet the growing challenges of emergency medicine we must not lose sight of this.

If you’d like to hear more from John, check out these two Podcasts from On the Wards...

About John Scott

1 thought on “The Triple C of ED by Emergency Physician John Scott”

  1. Brilliant. So true.
    Communication v comprehension.
    I really liked the part about grief and how patients can present when they have suffered. Thank you. I can so relate.


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