22 September 2008

It's about respect

There's a nice post over at ER Stories about treating other members of the medical staff, and in particular about how it can impact your relationship, as an ER doc, with your colleagues in other specialties.

The transformative power of these interactions, I think, is that it forces the doctor-patient to view the ER doc in a different way. I joke that ER docs are at the bottom of the prestige ladder in the house of medicine: everybody I talk to thinks I am an idiot because I know less about "their organ" than they do. They don't see the huge majority of patients we successfully manage on our own; only the cases when we need help. And then we seem weak. When I call, say, a cardiologist (invariably at 2AM) with a patient with a funny rhythm, it's often because I don't know the best way to handle it and I need help. The cardiologist, irritated at being woken with what is (to him) a trivial issue, may view this uncharitably. Similarly, when I call the orthopedist about a dislocated hip that I just can't get back in, he too may view this as yet another sign of incompetence on the part of the ER.

I recall, though, once when a cardiologist brought in his wife -- she had fallen on the ice and had a nasty trimalleolar fracture-dislocation of the ankle. I interpreted the x-ray at the bedside, sedated her and reduced the fracture, and splinted it. She went home with ortho follow-up. (I offered her admission, which she declined.) As they left, the cardiologist gratefully offered me the most awesome back-handed compliment I have ever received:

"You guys did great. I was really surprised -- I figured you'd just call ortho to take care of it. I didn't know you guys could, you know, actually do stuff."
Um, thanks. I think.

Seeing us manage issues that they do not know how, demonstrating that we do have competencies that they were not aware of, can be very powerful. As the author at ER Stories referenced: once you have done so, your future interactions with those individuals can be much improved by a new-found mutual respect. In fact, the more contemptuous the specialist is, the more dramatic the turn-around tends to be.

Add to this, of course, that the specialist probably may feel grateful towards you, and that there is the obligatory intimacy required when a colleague becomes a patient. There's nothing to teach you humility like having to let someone do a rectal exam on you when you were bad-mouthing them the day before!

I would be remiss if I did not point out that the vast majority of our colleagues in other specialties do, in fact, treat us with respect and courtesy. Even they, though, sometimes have their eyes opened a bit when they get to see us do our thing.

(Another great way to earn the respect of your colleagues is to be involved in the medical staff affairs of your hospital. Sitting in meetings with you and hearing you voice intelligent opinions on the affairs of the hospital also will help your docs gain respect, visibility and credibility in the medical staff. But that's another post.)


  1. I guess now you know how people that are not doctor's feel whenever we have to deal with one of you know it all quacks. Believe it or not the world is filled with people every bit as smart as doctors and they don't have M.D. after their name.

    So, think about that the next time some no it all ENT rolls his eyes or brushes you off. This is exactly how some patients feel.

  2. Viewing each other's clinical weakness...........it goes both ways.

    I've been drop-jaw astounded at doctor colleges who bring in family with garden variety pharyngitis, ankle sprains, trapezious strains, etc.

  3. Make that "colleages"

  4. This post really applies to organ/system specific specialists. What I don't understand is how some internists also look down on ER docs when they are in a similar situation of knowing a little about everything and having to call specialty consults as well?


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