Performing under pressure: advice needed

[rina33]

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How do you know if you'll be good at performing well in true emergencies? As a student on an EM rotation, you are generally not running codes and doing the most critical procedures. I am interested in EM (for its variety, shiftwork, interesting/challenging cases) but wonder if I am truly going to be able to make the snap decisions/think and perform quickly under pressure when I am finally the one responsible... especially in the fishbowl that is the ED with many others watching. How did you know you would be able to perform well under this pressure? Is it something that is learned? Or does it only come naturally- and if you don't have the sense that you have that ability then you'll never be comfortable doing it? Do you generally feel only excitement when a code happens- or do you feel nervous to the point that it affects your performance?

 

[Quimby2]

How do you know if you'll be good at performing well in true emergencies? As a student on an EM rotation, you are generally not running codes and doing the most critical procedures. I am interested in EM (for its variety, shiftwork, interesting/challenging cases) but wonder if I am truly going to be able to make the snap decisions/think and perform quickly under pressure when I am finally the one responsible... especially in the fishbowl that is the ED with many others watching. How did you know you would be able to perform well under this pressure? Is it something that is learned? Or does it only come naturally- and if you don't have the sense that you have that ability then you'll never be comfortable doing it? Do you generally feel only excitement when a code happens- or do you feel nervous to the point that it affects your performance?

Codes actually become pretty routine; of course, there is the occasional code on a pregnant woman or child --that makes most of us still soil our underwear. Regarding performing well under pressure, it may be natural to some but do not worry too much --it can be learned, that's what residency is for. Really the best skill set a potential ER doc can have is identical to that of a good waiter/waitress (no joking there). If you've ever waited tables successully at a busy restaurant then you'd probably be a great ER doc. (if I were a PD, I'd hire all former servers and bar tenders and the heck with USMLE scores).

 

[NinerNiner999]

Great Analogy. Seriously, being a good ED doc is not about making the right decision in the quickest amount of time (although this is a big part of the job). The thing that really makes this job hard is multitasking - handling 10 patients at the same time, making phone calls, responsing to nurses, answering family questions, performing procedures, dealing with consultants, and keeping a smile on your face the entire time. This is not an easy job by far, but ironically, the medical side of things isn't that bad...

 

[edinOH]

That's awesome. I've made that analogy several times myself. EM is alot like my experience waiting tables at a steakhouse during college. Fewer deaths at the steakhouse however.

 

[rina33]

Well, multi-tasking isn't a problem for me. I just worry about my capacity to really handle the codes and rapid decision-making, but I guess that's what 3-4 years of training are for...
any other thoughts from people in the trenches?

 

[roja]

Its definately a learned thing. (just please don't use the waiter/waitress analogy in your personal statement!)

I had done very little EM as a medical student. You learn the skills, and you get experience when you are a resident. 🙂

 

[grEMreapin]

Its definately a learned thing. (just please don't use the waiter/waitress analogy in your personal statement!)

I too have been a server to the needy. A rought draft of my ps intro:
"I can remember the first time I had customers yell at me. Some waiting to be seated, others waiting for their food or their bill. Many were the alcohol-induced tirades, colorful profanities, and racial slurs flung in my direction, and every time I end a night shift without a clean shirt or dry shoes, I am only further inspired to pursue this madness on a grander scale - thus, my choice for a career in EM".

Wassup!?!

 

[Jeff698]

"I can remember the first time I had customers yell at me. Some waiting to be seated, others waiting for their food or their bill. Many were the alcohol-induced tirades, colorful profanities, and racial slurs flung in my direction, and every time I end a night shift without a clean shirt or dry shoes, I am only further inspired to pursue this madness on a grander scale - thus, my choice for a career in EM".

You're in!

Take care,
Jeff

 

[EM2BE]

I feel like after the waitress thing, I'm definitely in. I didn't usually have the drunks, more the old stubborns and the young crying, screaming kids running around wildly because their parents didn't feel like disciplining them.

 

[Red Runner]

At our program we have signs in all the rooms that (I assume placed by management) state "We want you to be completely satisfied with your visit to our Emergency Department. If you are not satisfied please speak to your nurse or ask to see a manager."

Since patient satisfaction is supposedly related to better outcomes then I say forget hiring the extra nurse/tech/transporter and hire some college kid to be the ED waiter.

"I know your doctor made you NPO but we want you to be satisfied. Would you like your coke on ice? Would you like a straw? Can I take your plate."

"Would you like another percocet?"

"Which radiology modality would you like me to put you down for tonight?"

"Oh, I'm sure the doctor would be happy to send you another pain pill, perhaps some Demerol this time, I'll let the bartender know?"

I mean the PG scores would go through the roof if we just had someone waiting on all these entitled individuals. 😀

Despite all the BS, I love my job though and wouldn't trade it for any of those other suckers jobs in the hospital. I might trade paychecks with a few of them but thats about it. 😀

 

[grEMreapin]

Case in point:

A resident was going to let me sew up a forehead lac on a homeless guy on an EM sub-I I did. The poor guy got jumped for his firewood and took a 2x4 to the dome as payment.

When I introduced myself to the pt and said that I would take care of his wound for him, he got upset, refused care, and threatened to leave AMA. His complaint: he didn't want a med student sewing him up; he wanted somebody from plastics.😱 (Would you like cheese with that whine sir?)

 

[geekOCD]

I understand that you're trying to reference how many patients are ridiculous and will ask for a plastics consult or a senior attending rather than get it sewn up by a resident who's quite experienced (and may have more experience than whoever's on call for plastics)... or maybe you're making a point b/c the homeless guy isn't paying for his care...

but if I'm in the ED with a facial lac, I wouldn't want a med student sewing me up (or a july intern for that matter), and I am a med student, so no offense meant. Patients have the right to not be practiced on by med students IMO...now if they're being an ass and just don't want to do an extra HPI, that's one thing, but if it may cause them add'l pain or scarring, I think they're well within their rights. If a patient lets me stick 'em instead of the tech (and 99.9% do), they deserve a thank you in my book,but I wouldn't hold it against them if they refused...

 

[vtucci]

Codes actually become pretty routine; of course, there is the occasional code on a pregnant woman or child --that makes most of us still soil our underwear. Regarding performing well under pressure, it may be natural to some but do not worry too much --it can be learned, that's what residency is for. Really the best skill set a potential ER doc can have is identical to that of a good waiter/waitress (no joking there). If you've ever waited tables successully at a busy restaurant then you'd probably be a great ER doc. (if I were a PD, I'd hire all former servers and bar tenders and the heck with USMLE scores).

That is great- Dr. Mattu said the same thing at the ACEP conference the last two years-- he thought that being a waiter/waitress in a busy restaurant- dealing with demanding people and multitasking was the closest experience to being an ED doc (granted, no one ever died when I waitress, at least not that we were told but I would not be surprised with the quality of food )

 

[roja]

Its definately a learned thing. (just please don't use the waiter/waitress analogy in your personal statement!)

I too have been a server to the needy. A rought draft of my ps intro:
"I can remember the first time I had customers yell at me. Some waiting to be seated, others waiting for their food or their bill. Many were the alcohol-induced tirades, colorful profanities, and racial slurs flung in my direction, and every time I end a night shift without a clean shirt or dry shoes, I am only further inspired to pursue this madness on a grander scale - thus, my choice for a career in EM".

Wassup!?!

I am not saying the parallel doesn't have some truth about it. Just please don'tn write about it in your statement. Its an almost gaurantee to get many people to roll thier eyes and not read your statement. That and mountain climbing analogies.

 

[The White Coat Investor]

That's awesome. I've made that analogy several times myself. EM is alot like my experience waiting tables at a steakhouse during college. Fewer deaths at the steakhouse however.

Unless you count the cows

 

[The White Coat Investor]

Well, multi-tasking isn't a problem for me. I just worry about my capacity to really handle the codes and rapid decision-making, but I guess that's what 3-4 years of training are for...
any other thoughts from people in the trenches?

Every now and then I run into a resident who really has a hard time doing it. They tend to migrate toward an urgent care practice after residency, which isn't a bad gig anyway. Most of us love it so it is easy to become good at it. The adrenaline stops pumping after a few years except on rare occasions.

 

[medivac]

I understand that you're trying to reference how many patients are ridiculous and will ask for a plastics consult or a senior attending rather than get it sewn up by a resident who's quite experienced (and may have more experience than whoever's on call for plastics)... or maybe you're making a point b/c the homeless guy isn't paying for his care...

but if I'm in the ED with a facial lac, I wouldn't want a med student sewing me up (or a july intern for that matter), and I am a med student, so no offense meant. Patients have the right to not be practiced on by med students IMO...now if they're being an ass and just don't want to do an extra HPI, that's one thing, but if it may cause them add'l pain or scarring, I think they're well within their rights. If a patient lets me stick 'em instead of the tech (and 99.9% do), they deserve a thank you in my book,but I wouldn't hold it against them if they refused...

See, now I disagree with this. If you are at a teaching hospital, then you have to accept that you will be the learning subject. How is someone supposed to learn to suture? It is one thing if it is a difficult or complicate laceration through the vermillion border, in the delicate eye tissues, etc, but a forehead lac? That's a med student's/intern's bread and butter. I find that if this is explained to the patient, and if good supervision is given, then everyone's happy in the end.

 

[emrevue]

yeah, i've found most patients don't care if i sew them up as a student. i tell them 1. i've done it before and 2. i have more time to make it look pretty than anyone else in the department.

but how do you guys handle people who want plastics? just curious as i haven't been in this situation yet.

 

[deleted109597]

I agree with students suturing. The 'terns and seniors don't have 3 hours for complex closures usually. The students do. Often, if there isn't a student, they will get plastics/ent/optho to come close up stuff that takes a long time (anything on the face).
I agree with the patient's ability to refuse, especially if they were brought to the teaching hospital by ambulance and not by choice. The problem I have is when people go to the peds clinic and refuse students/residents. Seriously, there are other places in town to take your rugrat.

 

[Febrifuge]

...if I'm in the ED with a facial lac, I wouldn't want a med student sewing me up (or a july intern for that matter), and I am a med student, so no offense meant. Patients have the right to not be practiced on by med students IMO.

I totally agree, and I'm a student as well.

On the other hand, when I went in for removal of some benign fatty cysts from my noggin, it just so happened that the head of the Derm Surg center did them... and left me a lovely dent in the back where no hair will now grow.

Stuff happens, so I'm not mad about it, but if I had it to do over again, maybe some resident or fellow who lives in fear of the consequences of not achieving perfection would be better. The guy who evaluates everyone else but is not himself evaluated may not worry so much, y'know?

 

[grEMreapin]

Agreed - pt's should be thanked for letting us (students) work on them. However, MS 3s and 4s are often able to spend the most time with them, especially in terms of thorough exams and history taking. I've had nursing home pt's laugh at me bc I still ask for any IVDU or STD risk factors 😀

It's about the best thing I feel I can do at this point...life in a short coat is pretty humbling.

 

[Hard24Get]

Agreed - pt's should be thanked for letting us (students) work on them. However, MS 3s and 4s are often able to spend the most time with them, especially in terms of thorough exams and history taking. I've had nursing home pt's laugh at me bc I still ask for any IVDU or STD risk factors 😀

It's about the best thing I feel I can do at this point...life in a short coat is pretty humbling.

Not to mention - many of us have recently done surgery rotations (maybe even plastics!). I did EM right after Surgery and was praised for my lovely closures. If I got a face lac, I'd let a med student close it, but with them or anyone else I'd be checkin' it out in the mirror to make sure it was nicely apposed in case I needed to ask for a do over. 😉

 

[edinOH]

When I was a medical student I witnessed a situation where a family member was insisting that plastics be called to the ED to close a facial lac. They were not interested in allowing the ED attending to do it. In accordance with the family's wishes, the plastics intern was paged and he promptly responded to close the lac. I believe the intern is a senior ortho resident now.