Tuesday, January 11, 2011


Have you ever wanted to be better? Better at your job? Better at sports? I think that we can all relate to the desire to be better. In emergency medicine, learning to be better is the name of the game. Better at diagnosis, better at management, better at flow. The list goes on. This desire to become better is the inspiration behind this blog. Through future posts I hope to explore topics related to this noble goal. Specifically, I plan to address topics that are near and dear to me: developing as a faculty member in emergency medicine, patient safety, and leadership.

I would be remiss if I failed to mention a book which opened my eyes to the possibilities ahead. "Better" by Atul Gawande is a must read for physicians determined to become "positive deviants." The book itself is a quick read contained Dr. Gawande's wonderful prose, but the real gem is in his afterward where he explains his personal thoughts on some simple steps to take to become better. These are:

1. Ask the unscripted question. How important is this in emergency medicine. The pressure to constantly see more patients, "move the meat," etc leads us into a habit of paring our conversations to the minimum. Taking a few seconds to ask a simple question, completely unrelated to the visit at hand can really change the tone of the encounter. Family, hobbies, previous experiences all can provide topics to ask about. I've had the pleasure of working with a resident who was very good at this habit. Patients seemed universally pleased with his care, just because he made himself more human and demonstrated to the patients that he cared. As the old quote states: "They don't care how much you know until they know how much you care."

2. Don't complain. Whoa. Easier said than done. He makes the point quite clearly though that complaining has the ability to change our mood and the moods of those around us. It seems that we never lack topics to complain about from consultants who are rude and demanding to patients who behave likewise. It sometimes is too easy to complain. This will be a skill that takes some practice for sure. . .

3. Count Something. Such a simple suggestion! One can not know how to become better if we don't have a starting point. There are so many things we can count in emergency medicine (some are counted for us). Pick something small but interesting and start to run a tally. Soon enough, you'll likely uncover patterns or trends. These will in turn lead you to solutions on how to improve, how to become better.

4. Write something. It doesn't have to be much. Like so many other people, you can write a few lines for a blog or publish an article in the local emergency medicine newsletter. Writing helps to focus our energy and forces us to step back and think about what we want to say. There is no better tool for guiding reflection than picking up a pen or keyboard and beginning to write.

5. Change. It sounds so simple, yet feels impossible at times. To be a positive deviant though, you must change. You don't need to be the first, but you don't want to be average either. To become better, you must recognize shortcomings and simply change.

These are only some of many ideas of what it takes to become better. Check back in the future and join me on this exploration into becoming better in emergency medicine!

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  1. Hey Rob,

    Years ago, I was told by a sage physician that I should 'learn one thing about every patient'.

    When I remember to do it during the not so hectic shifts, I often find funny, interesting, heart-warming stories that made my shifts better.

    I completely agree on the 'unscripted questions' point, and I would add it works both ways too.

    Welcome to the blogosphere!

  2. Stella,

    It's pretty amazing how the unscripted question gets patients to open up. We're so limited in our ability to please patients and form a relationship with them and through 1 question can complete set the tone for the remainder of their stay with us. Thanks for reading!

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