This week I had a unique experience. I was discussing a case with a neurosurgeon by phone when he said “I think I should just admit this patient. He will need an MRI and then a long discussion about options before surgery, and there’s no point in tying up a bed in the ED. I know how long it takes you to get an MRI and you’ve got patients to see…”. I was stunned and almost speechless. All I could say was “Yes, thank you. I appreciate that.”
We often forget that work flows vary. Though we may work in a chaotic and loud environment, others may work in a steady and quiet environment. Locations in the hospital have differing scales of productivity and it can be difficult to communicate needs when there is not a good understanding of each other’s work environment. It is easy to become frustrated and even resentful of others when they do not respond as you believe they should. At times they may ask you to perform more work on their behalf. They may even behave as thought they have no appreciation for what or how much you do. But that is a product of a complex system with poor communication.
If we don’t take the time to explain the stressors, urgency, timing, and limitations of our own work environment, how can we expect others to understand their role in the frustrations we experience. Similarly, if we are not taking the time to ask questions and better understand the environment our colleagues work in every day, how are we going to understand how we contribute to their stress?
The comments from this neurosurgeon were not born out of a sudden epiphany. They were the result of numerous conversation, meetings, educational moments in the hallway, and honest discussions over a long period of time. They were also the result of a collegial relationship that allowed for open two way communication and a shared goal of doing what is best for a patient. It was a proud moment. It was also a moment that sparked a series of conversations about the differences between individual physician practices within the same hospital. The following infographic was born out of an attempt to better describe the typical emergency department atmosphere.