Today I had the opportunity to observe Emergency Medicine (EM). Since I did not enjoy shadowing EM previously, I decided I would give it another chance. I was excited to get back in the hospital for shadowing and I was not let down. The first patient I saw was one who had a minor issue, but one that definitely interferes with everyday activities. The patient came in for ear pain and decline in hearing. I was super excited when Dr. Barrett asked me to do him a favor by holding the otoscope for him as he flushed the patient’s ear. Dr. Barrertt was super helpful in explaining everything in a simple way and it was quite obvious that one of his priorities was to educate his patients. This was a constant quality of Dr. Barrett in every room we went into. What I noticed in both times I shadowed the EM was that it is a very fast paced department, however while the physicians are in the work room, they are very relaxed. I found that each patient was waiting on something to be done, whether that be a CAT scan, cardiologist reading, the psychiatrist, etc. It was a waiting game for both the patients and the doctors.
I learned so much from the short few hours I shadowed at Emergency Medicine today. I was able to clearly see Oral Communication and Ethical Responsibility to Self and Others as two main AAMC Core Competencies during my observation.
As an Emergency Medicine physician, one has to be extremely clear in their communication. A principal in this role is to be able to effectively communicate not only to your team, but also to your patients. From the introduction to the patient, delivery of news, to explaining the diagnosis, without proper communication there is so much room for something to go wrong. Dr. Barret walked into every room, offered a smile, and a handshake to each patient and family member he encountered. By doing this, the patients begin to open up and become trusting of the physicians. The first patient explained that he had hypertension in “stroke territory.” When Dr. Barrett heard this, he explained to him and his wife that there is no such thing as “stroke territory” as long as you are asymptomatic. In a simple manner, Dr. Barrett said that when one is hypertensive for an extended period of time that the brain is now adjusted to the constant high blood pressure, it is worse to start taking medicine to lower it. The sudden lowering of blood pressure is what would be likely to cause a decrease in blood flow to patients, failing to provide blood flow to some areas in the brain and ultimately leading to a stroke. Because Dr. Barrett explained this to the patient in a calm manner with simple analogies. I saw the patient letting out a sigh of relief and his nerves beginning to calm down. This is what led his blood pressure to decrease too. In my day to day life, I have to carry on this role of simplifying complex situations and even diagnosis at times to my non-English speaking parents. Being their voice, I have learned to be an effective communicator when translating from Arabic to English. When translating back from English to Arabic, I tend to find ways to detangle difficult sentences in a way that my low education parents would understand. Carrying this forward to my patients as a future healthcare professional, it will have been a common practice of mine for 10 years ever since moving to the states.
Ethical Responsibility to Self and Others is another competency that was very present in the EM. I overheard Dr. Barrett and another physician mention how expensive a medical bill was to a patient for a very simple procedure. Soon after this conversation, Dr. Barrett went to see his patient who came in for abdominal pain. Knowing that she too would get billed an enormous amount to get medicine at the EM, he went out of his way to inform her that it would be a lot cheaper over the counter. The patient greatly appreciated this information and left the EM saving a ton of money that she would have otherwise lost if she did not get lucky with a doctor who owed it up to himself and others to continue being ethical and moral in his role as a physician. I also noticed that he never once told his patients what to do, but continued to explain everything thoroughly and without any bias to leave the decision completely in the hands of the patient. Only when he was asked did he mention his suggestion, but even then he made it clear that the decision was still up to the patient. While working at Chick-fil-A, I found myself in a similar situation. When I noticed that a family was getting a separate count of nuggets, or were ordering a few cups of sweet tea, I always recommended the family meal, or found a way to purchase their needs in a cheaper manner. Especially for the customers who showed concern for how much something was, I always tried to make something work by finding cheaper options to still satisfy their needs. As a future healthcare professional, I will continue to be patient and flexible with those I serve to make sure that they are completely heard and can still get the things they need in the way that suits them best.
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