Cutting through the chaos: ER docs with their tips for working in a system in crisis

Dr. Courtney Howard, emergency physician in Yellowknife I always warm up physically before ER shifts in order to make sure that I start off alert, emotionally centred and physically ready to reduce joints, help pull patients up in bed and do CPR. The very best is when I get to combine this with my travel to the hospital—a cardio-commute by bike or on foot is time-efficient and healthy for people and the planet—helping us to dial down the heat in more ways than one. Dr. Lucas Chartier, deputy medical director of the emergency department and medical director of quality and safety at University Health Network, Toronto One thing that I think we don't do as well as we should is to communicate with patients about the next step and to manage their expectations. For example, to see a patient and walk out of the room to order tests, which, statistically speaking, are hopefully going to be negative, and come back two to four hours later and to say, ‘Congrats, you didn't have a heart attack. Now you can go home,’ is often leading to a lot of confusion and frustration for the patients. Especially if they’ve been waiting for hours to see me and then I make them wait four hours while I'm doing investigations. And at the end of the eight hours, I say they can go home and that's a bit of a surprise to them. Read: Calls grow to streamline licensing for doctors as healthcare systems struggle It is a good idea to inquire up front as to what their underlying fear and concerns are and to understand their social situation. For example, it is different if you are 75 years old and living alone, and you're borderline frail versus if you're 25 and you live in a condo next to the emergency department. So, inquiring as to their underlying situation is helpful to proactively manage expectations by having a discussion and saying ‘I think that the CT scan and the report are going to take about two to four hours and I hope it's going to be negative and if so, that's good news. That means you didn't have a stroke and this is what I would recommend for the next few days and few weeks.’ Sometimes it is quite clear that this patient is likely to go home, so just set up that expectation. Give them time for the next two to four hours to think about what their next steps are going to be and to think of questions for when they're discharged. It is also extremely helpful to ensure that the nursing team is aware of the plan and is working towards it. So, letting the nursing team know that a certain action needs to be done prior to discharge, whether it's ensuring that the patient can walk or repeating their vital signs. To have this human interaction with the nurses is really helpful. I think it's much more reassuring for patients when the entire team is aware of the plan and they're all working together to enact this plan. Read: Do it now: OMA calls for more foreign-trained docs, hospice beds and creation of central ambulatory centres Dr. Raghu Venugopal, emergency physician, University Health Network and St. Joseph's Health Centre, Toronto When the ER is overwhelmed and over-run, I pretend 30 or 40 [patients] waiting to be seen is three or four waiting to be seen in my mind. You're still going to hustle as fast as you can, but this can calm your mind momentarily. On the converse, if numbers are low, I pretend they are high to make myself hustle. I see anyone, anywhere. So chairs, the nursing station counter, at the physician desk and standing in the hallway is typical for me. There are limits to this, such as privacy and acuity. Rather than be frustrated with a lack of beds, I just go see the patient, apologize for the lack of a stretcher and get their medical care going. Sometimes, I ignore the awful total number of patients waiting to be seen and just focus on how many patients I have seen. I can't save the system, but I need to ensure I am doing my best. If I do my fair share of work, sometimes that is all I can do. Next, I often ask one friendly personal question of my patient, such as what is their profession or with an older couple, I will ask how many years they have been married. I find a well-placed sincere question of this regard can make both you and the patient feel they are more than just one disorderly organ problem. I remember them as ‘the engineer with the eye problem,’ ‘the new mom with headaches’ or ‘the retired doctor with knee pain.’ I don't eat or drink during my shifts. I also don't take a break. I don't find any of this enjoyable. I'd rather actually enjoy my food before or after work rather than inhale it. Maybe that will change, but I prefer to muscle through my shifts and enjoy resting and eating after. The best way I relax after work is with my dog who will listen to my frustrations to no end as we prowl the streets no matter the time. Dr. William Cherniak, emergency physician, Markham Stouffville Hospital, Markham, Ont. I try to always make sure that I drink enough coffee and have enough to eat before my shift starts because you never know when you're going to get to eat or drink next. So always be well caffeinated and well fed. I find it makes me a lot happier. I think it is helpful to not let yourself get overwhelmed by the volume. To remind yourself to keep doing what you do, clear the list, see patients, collaborate with the team. Don’t get stressed out if there is an insurmountable volume of patients, because what can you do? And be nice to people. When you’re stressed and with patients who are sick and with colleagues, at least if everyone can be pleasant, it makes things a little easier. Read: POLL: Do you see high patient interest in the bivalent COVID-19 vaccine booster?

Cutting through the chaos: ER docs with their tips for working in a system in crisis

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