The philosophies of St Emlyn

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the philosophies of St Emlyn

Here at St Emlyn’s we hold a number of the philosophies of St Emlyn himself central to our day-to-day practices.

E + R = O

St Emlyn, during his hours away from the Virchester Emergency Department, studied physics for pleasure (as many geniuses are wont to do). During a particularly uninteresting afternoon spent dwelling on the application of Newton’s third law (that every action has an equal and opposite reaction) he postulated that the application of this principle to human behaviour in the ED might shape the culture of a department. Thus, in 1843 following an extensive proof by induction he transcribed the equation below, concluding that:

Event + Reaction = Outcome

That is; we cannot completely control the events that occur around us, however we can shape our own reaction and in doing so directly affect the outcome.

This tenet is regularly cited among the St Emlyn’s team when a member has cause to recite a particularly irritating behaviour or circumstance by which they have found themselves affected.


During his early days as a senior clinician, St Emlyn found himself beleaguered with the anxieties and issues facing many of his colleagues from Emergency Medicine and other disciplines and was often heard to exclaim;

“Egad! Why doth every staff member harangue me so? Knowest thou not that I am not answerable for function of the infernal facsimile machine? Desist paging me with such trifles, one is trying to consume one’s kebab while it remains tepid.”

Finding this rebuke a frequently necessary but time-consuming response, it was on a Friday late shift in 1986 when St Emlyn coined the abbreviated form “N.M.F.P” to indicate in unambiguous terminology when issues extended beyond his specific responsibilities and to limit the expectations placed upon him by others. This abbreviation is sometimes used within the St Emlyn’s team today although rarely in the clinical setting, where they prefer to use polite explanation regarding the inappropriate nature of certain requests.


In his early days as an Emergency Physician (before he had begun to regularly engage in meditation and martial arts), St Emlyn was reputed to be somewhat emotionally labile, particularly when under stress or pressure. After a particularly gruelling weekend oncall in 1712 he found that by reciting the mantra “C.T.F.O.” he was able to regulate his breathing and reduce cortisol levels (he had been measuring these twice daily in salivary content for the preceding decade as part of an attempt to overcome his crippling impostor syndrome). This revelation spawned several of his published works (including “C.T.F.O. – the beachside edition”, now frequently taught in junior schools) and remains a popular mantra among members of the St Emlyn’s team in times of perceived unnecessary stress.


As a scholar of Ancient Greek, St Emlyn is perhaps best known for his Athena-inspired motto J.F.D.I. Recognising the Greek goddess as a supreme athlete and feminist, he was a mere medical student in 1801 when he hand printed his first cloak bearing the insignia to act as a reminder that much opportunity is lost when one has a good idea but awaits explicit permission to enact it. Of course, it was this particular mindset that drove him to partake in the suxamethonium wars of 1925.

Today, this motto is used to provide ongoing permission and encouragement to the members of the St Emlyn’s team who seek it, in pursuit of self-improvement, FOAMed and the furtherance of Emergency Medicine.


Ed – Hang on, what’s all this got to do with being an emergency physician? Let me explain.

Ok. Although the above phrases are clearly in jest, we do think that they are useful cognitive stops in clinical practice. Let’s delve into the reasons why these are some of the underpinning philosophies of the St.Emlyn’s team. Now some of this is a bit sweary, which is odd because we are not sweary people, and in practice the naughty words are in our heads rather than spoken. We hope you take these in the spirit in which they are intended.

E+R=O is frequently used to explain to people that although lots of bad stuff happens, it’s our reaction to events that makes a difference and defines the outcome. For example, a colleague tripping over a chest drain and pulling it out is a bad event, but there is nothing you can do about it happening. Unless you’ve got a time machine you cannot change this, it has already happened and although it’s not great, you cannot alter it. However, the outcome of this event is clearly dependent on what you do next. It’s up to you as to whether you get angry, shout at the colleague or panic, and if you do it’s likely to make matters worse. In contrast you could remain calm, support your colleague who made a mistake and sort the patient. When things go wrong most people focus on the event and put all the blame on that, in reality it is often our reaction to the event that truly shapes the outcome. Ask yourself which is better for you, your colleague and the patient. You are in control of R.

N.M.F.P. Not my ******* problem is similar to the phrase, ‘not my circus, not my monkeys’. It speaks to the fact that not everything is sortable by you, either because you cannot do it, or because someone else can do it better. For example, I often hear people getting stressed and challenged about bed availability on the wards. They might harangue in-patient colleagues to improve discharge rates etc. Why? Do they not have enough problems of their own in the ED that they should be sorting out? There are other people who are better suited, trained and available to do that job. By all means support them in their role, but don’t waste your time doing tasks that are not core to your role in your department. Malcolm Tucker likes this.

C.T.F.O Chill *********** Out, or as St Emlyn said, calm down please. Take a moment and just stop to think about just how amazing our job is. We do amazing things, with amazing people for amazing patients. There are days when it’s tough, but they are finite. We get to go home, we get paid and we do something really worthwhile. If you lose it in the department then it really matters, and everyone suffers. Imagine your department is a nice calm pond. If you’re in a bad mood, or behaving badly, it’s like throwing a pebble in the pond – it makes a big splash and the ripples go everywhere. The higher your grade, then the bigger the pebble. This is especially true for leaders; if you are chilled then everyone else will be too. If you’re raging around like an idiot then don’t expect good behaviour in anyone else and in all honesty everyone will think you’re a git.

J.F.D.I This can be summarised as it’s better to ask for forgiveness than permission (this is in Romanian, but features the truly inspirational Raed Arfafat – a truly amazing guy who the #FOAMed world needs to hear more from). If the St.Emlyn’s team always sought permission to do everything then we would be compromised by red tape and external validation. This is not the path of the innovator. If you want to make progress then don’t always ask for external support, just get started and do it. Sure, that may cause difficulties on occasion and you may even have to grovel for forgiveness, but so long as you don’t rock the boat so much that you sink it, you will make far more progress than if you are overly cautious. For example, if we had listened to all those who said that starting a blog and podcast was a bad idea, we’d still be pondering it now.


Natalie May


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Cite this article as: Natalie May, "The philosophies of St Emlyn," in St.Emlyn's, October 20, 2017,

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