Sunday, December 2, 2012

Hug Your Emergency Doctor.

We had a really interesting day at clinical teaching on Thursday - we had a MOCA session, or a Management of Clinical Aggression session which I thought was invaluable. We were taught how to deal with patients who were aggressive and to recognise and defuse potentially dangerous situations that we may come across in our day-to-day work.

The Emergency Department can sometimes be a very dangerous place. We are not your typical desk job, surrounded by sterile cubicles, flickering computers and personalised mugs, exchanging pleasantries with work mates to find out how their weekend was (okay, we do have that too).

We are, instead, an organised chaos of needles, cannulas, drain tubes, blood, scalpels, stitches, sputum, faeces and urine, medications coming out of glass bottles and enough paperwork to give you potentially fatal paper-cuts.

Add to that mix the agitated drug and alcohol affected patient, the psychotic patient who is terrified and screaming, the scared demented elderly patients who dig their nails into you, some downright abrasive and almost criminal personalities, families or patients who have waited for hours to be seen - their patience wearing thin from the rate things are happening - and you have a rough sketch of what it looks like in our office space.

We somehow manage to work in this environment and keep it civilised most days, but you can see how things can quickly escalate in this pressure-cooker environment, and how important communication and risk management becomes. We do everything we can to ensure the patient's well-being and make sure that the workplace is safe once more.

Unfortunately medical school does not prepare you for this.  It does not tell you how to deal with a patient who is yelling at you or to stand two arms' length away from an aggressive patient who might just grab your neck and hold you up against the wall. It does not teach you to talk in an even tone, or to assert yourself by repeating your requests calmly.

Medical school does not tell you that a simple act like offering a patient food and drink and apologising for the wait can quickly defuse a lot of the pent-up frustration in the emergency department. It does not teach you how to manage five patients at the same time, ensuring that patient and family members are updated on their progress. There are no training sessions on how not to take racial slurs personally, or how to keep calm in the face of ongoing verbal abuse.

Maybe medical school doesn't want to talk about it, in case you changed your mind.

All we have at the start of our careers is our instinct, and our personalities in handling these tricky situations. Which is why I think we needed sessions like Thursday's to be taught in our medical schools, or at least to our fledgling interns and residents, who like myself, quickly lose any illusions that we deal with perfect people who will always be grateful for all the help and good that we thought we were doing as doctors (and nurses, and paramedics).

****************************** (not shuriken stars)

One of the interesting things we did during the session was a practical class on how to break away from arm grabs, choke-holds, hair pulls and bites. We laughed and had a bit of fun as we practised with each other on some basic self-defense moves and how to safely restrain a patient who is aggressive and a threat to themselves and others.

Don't get me wrong - we do not enjoy these situations. No one goes to work and hopes for a day of being yelled at or physically handled or threatened. I am not saying it happens all the time. It does happen, and we need to be trained to deal with it in a safe manner.

****************************** (not shuriken stars)

Although the MOCA session was really useful, I know that sometimes simulation is just that - simulation. Who knows whether you will have the clarity to remember what you were taught in training when faced with a real-life dangerous situation. Some knowledge and a little training, however, is better than having no idea at all about what to do in scenarios like this.

I remember a story from a friend of mine who was a classmate during my university years in Malaysia. She recounted how the night before, as she was getting into the lift, a guy nervously followed her in.

As she pressed her floor, he anxiously pressed the number to the second floor, his fingers trembling. That was when he turned around and flashed her. All her years of training of taekwondo up to the level of a black belt, and all she could do was scream, and scream, and scream. He ran out when the doors opened, leaving her alone in the lift, pressing the close button repeatedly. She had to shower several times that night as she recalled how she felt 'dirty' from that harrowing encounter.

I remember that story, and all I can think about is how simulation is different from reality, and we can only hope for the good grace of God to protect us and to give us clarity of what to do if we are ever caught up in these terrible situations.

So do spare a thought for us Emergency doctors next time. Yes, we chose our professions because we do enjoy (dare I say, love) it, but man, it can be pretty hard sometimes.

So give us a hug the next time you see us, but not too hard, alright, just in case our training kicks into action and you find yourself on the floor, wondering how you ended up there.

********************* (actually shuriken stars, haha!)

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