By Bradley Chappell, DO, MHA, FACOEP, FACEP

It is that time of the year again.  July is the month we bid adieu to our experienced seniors, welcome the new juniors, and spend a little time enjoying the warm summer fun in the sun.  As you transition to a new stage in your career, there are many things to consider.  This month we will discuss professional and personal priorities, how to win friends and influence people, and when to draw a line in the sand.  Managing people will be a skill you develop over time and is critical to your success in the ED.

It is an exciting season – change is in the air.  Completion of residency, summer weddings, kids on summer break, long awaited vacations – these are only a few examples of the life-changing events and memorable experiences that may impact your life in the coming months.  I would like to take a few minutes of your time to reflect on some of the potential issues that may arise as you transition from your current role, whether as medical student, intern, senior resident, new attending, or as you potentially switch jobs.

This is a chance for a new beginning – you can take this opportunity to become the person you have always wanted to be.  The following are a few tips and words of experience that may be of benefit as you start your new role (what better way to learn than by avoiding the mistakes someone else made!).

Remember your priorities.  In our profession where most are paid per shift, it is often tempting to fall into the money trap.  “If I work one more shift each month, I can buy that car I really want.”  Then it is the bigger house, fancy cruise, etc.  Suddenly you find yourself living to work instead of working to live.  I enjoy each and every day I come to work.  Frankly, I love my job.  By finding a position that combined academics and administration with a reasonable number of ED shifts, I have compromised the higher paying job for a life experience I truly enjoy.  It took some patience and searching, but I was able to find a career in a location close to family.  I will always have the things I need, and I have the ability to flex my hours to attend pre-school graduations, plays, and summer VBS with the kids.  And thanks to the local grandparents, date nights exist again (there is life after kids)!  So for me it is God, family, then work … but you will have to decide for yourself what your personal priorities are and how they rank – and it is ok for them to change as your life evolves.

When working in the ED, the reality of the transparent fishbowl is often striking – you will be judged from every angle (patients and especially their families, your peers, those both junior and senior to you, the nurses and techs, administration, consultants, outside facilities receiving or sending patients, EMS, etc).  What can you do to avoid judgement?

Always be kind.  Follow the Golden Rule (for those of you unfamiliar with this reference, if you don’t want someone to do it to you, don’t do it to other people).  Manage up whenever you have the opportunity:  “Amy is the best nurse; you are lucky to have her taking care of you today.”  Remember to dispose of your own sharps – you have grown up now and your mother is not there to clean up after you;  and housekeeping is as scared of hepatitis as you are.  Try to understand the surrounding circumstance and others’ perspective.  Yes, the child only had a fever for the past few hours, it is 2 am, and after 10 years of schooling, this seems like a ridiculous visit to you; but to the mother whose son had a fever then abruptly died of meningitis, this is an emergency.  Imagine, this guy had the nerve to come to the ED at 7 pm for a medication refill!  However, his doctor’s office is closed, he just finished his day shift, and he is in a rush to get home and tuck his kids in bed before going to his second job in a few short hours.  There is typically more than the face value of each story; you just have to take the time to ask.

Be genuinely grateful.  When someone goes out of their way to help, thank them for going the extra mile.  When the pharmacist catches your medication error, express gratitude to them for stopping the near miss.  When your tech does great chest compressions, compliment their efforts.  When people do quality work, don’t just blow it off as someone doing their job; make sure everyone knows they did well.  Don’t always complain to management;  let them know when line staff are exemplary.  This will buy you social credit and ultimately earn the respect of your team.

Be nice to your scheduler (they rarely get a simple thank you for accommodating all your insane requests).  Be flexible and help pick up shifts when there are emergencies.  One day, you will need the favor in return.  I still have a call shift owed to me from my intern year, but a grandmother’s funeral is important to attend.  As much as I planned the arrival of our first child, he did not adhere to our timetable.  The night after our baby was born, it was my former program director that picked up my shift so I could spend time with our new baby.  Thanks AJ!

Speaking of shifts, when you are schedule to arrive at 8am, be there at 7:50.  Nothing makes you smile like seeing your relief arrive, especially after a rough shift.  In return, do your best when on shift to clean up before sign-out.  And never sign out a pelvic exam – not cool!

Be humble and do not be afraid to admit when you are wrong.  It is ok to make mistakes, but you are better served to ask for help when unsure.  If you are not comfortable with a procedure, don’t do it!  Make friends with consultants.  They should be the most knowledgeable people in their specialty – and you cannot possibly know everything about every disease.  There is no better time than in residency, especially when an off service resident is in the ED or you are the off service resident on another service, to build bonds that can last a career.  When the admitting physician trusts your judgement, there will be little pushback.  When they know that you do quality workups and do not typically admit garbage, they will respectfully make it work when you honestly tell them that grandma does not meet admission criteria, but she is not safe to be discharged home.

Choose your battles wisely.  If the patient is still staying in the hospital, don’t fight about obs vs ward.  If you did such an incredible job resuscitating the patient that the MICU intern (in their first week of being a doctor) does not feel the need for the patient with varices, who initially had a BP of 60/40 and just received her 4th unit of blood but now has a normal HR and adequate BP, to be admitted to their service, it is ok to put your food down.  At the end of the day, always do what is best for the patient – you may be their only advocate at 3am.

Be open to feedback.  Solicit it from those you work with – peers, nurses, and your director.  Ask the admitting physician how that patient from last week did.  Better yet, follow up on your own patients – you will learn from the inpatient management and get feedback on your initial impression in comparison to the final diagnosis.  That is why I love triage – I get to see a high volume of patients, and the residents are all too eager to point out the missing lab or how the case turned out, especially where there is a cool or rare diagnosis.

If you are in an academic institution, welcome the new students and residents – they are our future, and remember what you felt like your first month (excited, scared, confused, overwhelmed, ignorant bliss).  Be patient with the newbies, but also keep close watch over the patient who is trusting in the care provided in their time of need, not necessarily knowing the experience difference between “student doctor” and “attending” (after all, we are all constant learners, right?).

Lead by example – you set the tone for your department; as captain of the ship, take the helm and inspire the crew to greatness.  When in doubt, listen to that small voice – whether it is your conscience or that spidey sense that makes you take a closer look or order a critical test.  Most importantly, always do your best and have fun doing it.  The best shifts are often the most exhausting, but at the end of the day, you go home knowing that you made a difference.  Congratulations on your successes to date and good luck in your current and future careers!