I’m on my way back to Sydney from Adelaide in South Australia, where this week I was honoured to be a keynote speaker at the fifth EMSA conference (#EMSA18) as well as speaking in a couple of other sessions including one on “Lessons Learned”.
Emergency South Australia has been around since 2005 when the South Australian branches of the Australasian College of EM (ACEM) and the College of Emergency Nursing Australasia (CENA) co-hosted their first conference. They were joined by the SA branch of Paramedics Australasia in 2007 and what has resulted is a biannual, wonderful, multi-disciplinary conference representing all three professions and addressing common issues in Emergency Care.
I spoke on better feedback in the day 1 keynote session (more on that at a later date in a separate post) and on day 2 I was invited to join fellow speakers nurse educator extraordinaire Jesse Spurr (of Injectable Orange and Sim podcast Simulcast), EM physician and sim enthusiast Ian Summers, multi-skilled paramedic Gary Berkowitz and all-round-awesome rural doc Tim Leeuwenburg for a session entitled “Lessons Learned”. We were each invited to share a five minute reflection on some hard-acquired wisdom from our careers. My talk is at the end of this post; I’ll tell you about the learning points I extracted from the other four first. Hat tip to Brad Mitchell for this excellent summary tweet:
5 lessons learned @EmergSA— Brad Mitchell (@BradMitch85) August 4, 2018
1 – involve everyone in handover @FatamboGary
2 – be mindful of personal biases @_NMay
3 – consider timing and necessity of interventions @IanMeducator
4 – create what you want to love @Inject_Orange
5 – train the way you mean to fight @KangarooBeach
Gary was up first with a story about the challenges of handover. His story involved a near-drug error, which followed a handover he was not completely part of due to a language barrier. An excellent reminder that good communication prevents error and potentially saves lives – this sounded very much like a lesson hard learned.
Handover is a really risky time; we’ve talked before at St Emlyns about how important it is that we appreciate the fragility of information transfer in healthcare settings. You can read more about my thoughts on handover and miscommunication here.
In his section, Ian Summers talked about the challenges of prioritising interventions in prehospital care. There is much we can do in the prehospital setting (and much we can’t!) – it makes sense to take the time to work out what is necessary and what order to do things in – and to recognise that actually sometimes it’s better to just get going. We have to balance planning and pragmatism against our urge to get stuck into patient care straight away, but a little investment in developing and sharing a mental model makes it a lot easier for us and for our teams. This is definitely a lesson transferable to work in the Emergency Department.
Jesse spoke about the challenges of career development, particularly for nurses. Many nurses find that career advancement takes them into management roles, not infrequently at the cost of a move away from direct patient care. Jesse’s thoughts centred around the importance of reminding yourself where your values lie, of avoiding the seduction of “advancement” in career at the cost of your values, and the inspirational message that if your perfect job or career doesn’t yet exist, you might well be able to build it yourself. Jesse’s message also echoed in some of the themes of his later resilience talk, particularly that defining your passion and articulating your pride in your professional identity can be very helpful in maintaining wellness (see Martin Seligman’s PERMA model for more on this) – an important thought as our departments get ever busier.
P – Positive emotions— Natalie May (@_NMay) August 4, 2018
E – Engagement
R – Positive relationships
M – Meaning
A – Accomplishment
Seligman says most people need 3 of 5 for fulfilment https://t.co/FpCZ8gIigD #FOAMed #wellness@Inject_Orange #EMSA18
Tim wrapped up the session with his talk, which he had deliberately given a clinical focus after hearing our planned topics in advance. Tim described a challenging ED situation with a soiled airway (very fitting considering how much work Tim has done around Jim Ducanto’s SALAD simulator). There were some great clinical tips – for example, remember that the laryngoscope is a left-handed instrument so if you need to move your soiled airway patient into a lateral position to aid drainage, roll them onto their left as right lateral lie makes laryngoscopy even harder – but we couldn’t avoid the human factors reflections around preparedness and “training the way we intend to fight.”
Lessons [Hard] Learned
It was really interesting to see that five healthcare professionals, asked to provide a short lesson learned, all gave non-clinical, human factors or teamwork based reflections. It’s hard to imagine that at a conference a few years ago and I think it’s actually a really good thing. Of course there are clinical lessons we learn the hard way, but there was something very refreshing and impactful hearing wisdom on these topics from some really wise and reflective practitioners. The fact that all five experienced clinicians had selected lessons around “soft” skills is an excellent reminder that sometimes “soft” skills are actually the really hard stuff.
So, what did I talk about?
Well, I decided to talk about a paediatric ED interaction that led me to reflect on my power and privilege, both in society and in the healthcare setting. The transcript of my Lesson Learned is below. If the recorded video of the talk is released later, I’ll add it here.
I trained in paediatric emergency medicine because I love working in the paediatric emergency department. There’s something wonderful about connecting with families and providing reassurance and advice when they are worried about the thing that matters most to them in the whole world – their child.
One of the most important tools in a paediatric consultation is rapport, both with the child and their family. For school-age kids, I build this by letting them run the consultation and giving them as much agency over their care as I can.
“Hello, I’m Natalie – I’m the doctor. Who’s this you’ve brought with you?”
This also avoids the awkward situation of calling someone “grandma” and finding out quite swiftly it’s actually “mum”.
For pre-schoolers, particularly non-verbal kids, it’s all about smiling and seeming non-threatening. Babies are pre-programmed to respond to physical facial cues which means you can say almost anything to a baby and, as long as you have a big smile an a sing-song voice, they’ll smile back at you. This gives opportunities to build rapport with parents by being, quite frankly (albeit by my own assessment), hilarious.
I admit, I mock crying babies. My favourites are “life is very hard, it’s good you’ve noticed early”, “you need to learn not to trust strange women” and “with that much snot on your face, how will you ever get a boyfriend?”
Until one day, a mother of a little girl called me on it.
“With that much snot, you’ll never get a boyfriend,” I said.
“Or a girlfriend,” her mum shot back. It was like a slap in the face.
Because I consider myself what kids these days would call “woke” (I also know I’m too old to ever use that word again). I’m a huge advocate of LGBTQIA rights (yes, I know what all the letters stand for); I marched twice last year for marriage equality and I wear a rainbow pin badge on my uniform to indicate that I consider myself an ally, which is important to those who feel alone during what can be the most difficult time of their life.
But I am white, educated, middle-class, affluent, heterosexual. That is my perspective on the world and I take it into every single human interaction in my life. I could only be more privileged if I was a man.
Our patients represent the whole of society. However “woke” we consider ourselves, we have implicit biases – if you don’t believe me, I challenge you to undertake the Harvard implicit association test. It’s free, it’s relatively quick, and it’s eye-opening.
In interactions, sometimes my implicit biases mean I get things wrong, and that’s ok.
It feels uncomfortable to be confronted with my bias and privilege – and that’s ok too, it absolutely should.
It is an important reminder that my perspective is not my patient’s perspective, and that I should remain humble and strive to understand.
And in the healthcare setting, regardless of my gender, sex, sexuality, race, weight – I am the privileged one. I have the power. My patients come to me with a need that I can fulfil – or not.
One of the most memorable quotes from the first Spiderman movie was “with great power comes great responsibility”. I think we need to add the phrase “and privilege” to this statement.
Let’s stay humble and keep learning.
Bias. It’s uncomfortable to think about but vital to acknowledge and confront, especially while assuming positions of power / privilege in healthcare or otherwise. Important reflections from @_NMay shared at #EMSA18. Stay #woke and offer people the compassion we all deserve. 🙏— Ben Wingrove 🍃 (@BenWingrove2) August 4, 2018