What's Your ER Experience?

My name is Anil Menon, and I am a first year resident in the Stanford-Kaiser emergency medicine program; however, this winter I found myself playing the role of the patient, which was less than stellar but eye opening at the same time. This experience caused me to reevaluate my interactions with patients and also taught me a lesson in heeding the advice of my mentors…

Being a health care worker, you’re exposed to many viruses and often become a victim of the very illnesses you are trying to treat. Rhinoviruses, coronaviruses, and the respiratory syncytial viruses (RSV) are the typical culprits that cause the “common cold.” Let’s not forget the enterovirus, which triggers gastroenteritis - in plain English, this means diarrhea and vomiting. The only means of prevention against these viruses is routinely washing your hands, getting proper amounts of rest, drinking fluids, and decreasing your stress levels – easier said than done, especially for a first year resident.

The flu virus is one you CAN nip in the bud by getting the flu shot. This is especially important for people who are at a higher risk of infection, such as health care workers…However, I ignored Dr. Bob’s advice and skipped taking the flu shot. Needless to say, I came down with the flu in February. If I were describing my case to one of my attendings, I might say "A 30 year old male, Emergency Medicine (EM) resident complaining of fever to 104 for 3 days, non-productive cough, runny-nose, decreased oral intake, tolerating liquids - looks like the flu." The compassion I received from my fellow residents helped strengthen me. They could easily commiserate, because a short sentence like that evokes a fear of non-existent down time. However, my experience with my own doctor wasn't as warming. Though I knew I had the flu and I knew the treatment would be oral rehydration and rest, I still scheduled an appointment to make sure I was not missing anything--as I said, I'm still in training. My doctor was behind schedule, when she whisked into the room, trying to catch up. She quickly looked into my ears and throat, before saying hello, and told me I was correct all along and probably should have saved my energy and stayed in bed. I've been there. I understand. Despite knowing the disease and knowing how the system works, I left disappointed and feeling overlooked.

Even more troubling was the fear that I might have treated some of my patients similarly while trying to manage new diseases and new systems. Different patient encounters flashed in my mind as I tried to reevaluate my interactions. My memories also brought me back to a class held at the Stanford Graduate School of Business (GSB) called interpersonal dynamics or nicknamed "touchy feely." In class we practiced giving, receiving, and eliciting feedback. Feedback is something they find hugely valuable in management positions--making it the most popular GSB course--but I thought was overlooked in medicine--spurring me to register. A moderator helped direct this free form discussion that would twist and turn in unexpected ways. It always surprised me how different my perceptions could be from the other people in the discussion group. The only way to find out was to ask them directly, and they were often happy to answer. Most were also receptive to suggestions that were based on feelings. Instead of saying you are a careless doctor, we started saying the speed of your examination made me feel unimportant. Both asking for and giving feedback can be anxiety provoking, but I think it would be worse to head on a trajectory of leaving people unsatisfied than not being able to ask.

I’m interested in hearing feedback and suggestions for improvement from any readers regarding your experience in the ER. I know Stanford Emergency Department is committed to improving customer service and I'm sure more people than myself are interested in hearing what you have to say. This year the Stanford ER staff even participated in a day long retreat focusing on customer service and areas in need of improvement. The role playing and discussion amongst ourselves was an important step toward our commitment to customer service, but nothing beats direct feedback. I also have to say nothing beats the eye opening experience of the doctor being in the patient’s role.

I invite you to leave comments about your ER experience,
Anil Menon, MD

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Straight Talk Is Back and Changing!

Hello friends! "Straight Talk from the ER" is, I am happy to say, back! And, I am excited about a new approach we are going to try! Over the last few months, it has become painfully clear to me that I just don't have time to "blog" on a consistent basis. My time is spread very thin between running the Stanford Division of Emergency Medicine, serving as a tactical physician on our Sheriff's SWAT team, volunteering for an Urban Search and Rescue team (California Task Force 3), and being a committed husband and father! Plus, I find that as I am writing my blogs, I get caught up in trying to tell the tale "just right," or wanting to be sure I have the information properly "polished" (part of my type-A personality...goes with the turf). So, the time I was spending writing each blog post was more than my schedule could handle.

So, what's the change? "Straight Talk from the ER" is becoming "Straight Talk from the Stanford ER"! Readers will be getting "the scoop" from several individuals who work, on a daily basis, in the trenches of a busy, level one trauma center. I have invited other attending Emergency Physicians, Emergency Medicine interns and residents in-training, and ER nurses--all working at Stanford--to join me in this project. Readers will gain insight into the different experiences and different approaches of these professionals in the ER, and I think this will make for very interesting and educational reading! How does a resident cope with the stresses of dealing with life and death decisions while trying to learn all he or she must to become a fully qualified "ER doc?" How does an ER nurse cope with conflicting priorities from patients, families, attending physicians, residents, and other nurses? This will be good stuff!

As a bit of an introduction, I thought I'd give you some background on the Stanford ER--to set the stage as it were. We are part of the Stanford University Medical Center, and, as a teaching hospital, we have responsibility for not only providing care to patients in our ER, but for teaching medical students, residents, nursing students and paramedics, and for doing research to expand the knowledge base of Emergency Medicine. Our ER sees over 42,000 patients a year. Currently, we're averaging almost 130 patients a day--in an ER built in the 1970's to see half that number! We're definitely "cramped" for space, but, amazingly, we still handle the volume. As a matter of a fact, we set a new Stanford ER record on February 11th with 173 patients treated that day!

Our facility, being over 30 years old, shows signs of wear and tear, but not our staff! We've got a phenomenal team of doctors, nurses and staff members who really make the place "hum." It's a frenetic place much of the time. Part of the draw for those who work in ER's is the fact that you never know what it's going to be like or what is going to come through those doors next. On any single shift, it can be boring, exciting, fun, sad, exhausting, uplifting...you get the idea!

We're a level one trauma center--the highest rating available from the American College of Surgeons. We serve as the trauma center for the northern half of Santa Clara County and the southern half of San Mateo County, and we take a lot of transfers of trauma patients from surrounding counties as well. We love taking care of trauma patients when they need us, and we're good at it. The "adrenaline rush" one gets from successfully treating broken, traumatized bodies is, frankly, one of the things that draws many folks into a career in Emergency Medicine. Even after 25 years of doing this, there's still nothing like the feeling of walking out the ER doors at the end of a busy shift knowing that your team managed to snatch someone "from the brink." Very satisfying.

We are also a center of excellence in pediatric emergency medicine. The one really nice piece of our physical plant is our Peds ER which we just opened in 2005. It really is "state of the art" with phenomenal amenities for our youngest patients and their families, including Macintosh computers and movies and games to take their attention off the scary things going on around them.

I am more than just a little proud of the people with whom I have the privilege of working in the Stanford ER. Beginning soon, you will hear "Straight Talk" from some of these professionals. Prepare yourself to be entertained, to learn a few practical tips, to have a few chuckles, and to shed a few tears.

Stay alert and stay safe.
- Dr. Bob

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