As everybody in healthcare knows, working in emergency medicine mostly means that you are making decisions on a constant basis. Usually you have to postpone two decisions to make a more urgent one first. Then you are obliged to make the former ones while you have forgotten the most important input to do so in the first place.
An attending emergency physician gets asked by the triage nurse if we agree with their triage, the residents need approval of their medical plan, the nurses need an OK for giving fentanyl and the motherfucking coffee lady wants to know if her diabetic patient may have sugar in his coffee.
All of these may seem to be valid questions (well most of them anyway) – but there is only inferno for the one that truly answers each and any question with the same amount of attention. With every reflection and honest validation of the information presented, your brain temperature goes up 1 degree and whether this is in Celsius, Kelvin or Fahrenheit – with the density of problems to solve in our field of business, at some point your brain will start to cook. A cooked brain leads to terrible decisions, a hostile atmosphere and most importantly you will have no brain functionality left to flirt with the nurses – which was why we are in this field of practice in the first place.
Science clearly shows that there is a limited amount of decisions one can make in a given time. When you pass this limit – you cannot do it any more. Your mind will go blank and even deciding what kind of coffee you like in your milk will become impossible to do. How to cope with this? Well clearly – Take less decisions. Just refuse to. At least 5 times a day stand up for yourself and state you will not be deciding this one. Out of self preservation, out of pity with yourself and because you need brain space for that witty joke to Nurse Bridget.
Nurses don’t need approval of what they do, they just need doctors to be there for them when it goes wrong. Don’t reflect on their triage decision – just say “I am with you on this one”. “If you decide that patient needs fentanyl, then I will gladly enter the order”. The medical student that is in doubt wether to make an X-ray of a low risk limb, tell him: “whatever you decide, it will be fine as long as you involve the patient in the decision and as long as you don’t lie awake at night over this one”. And if the coffee lady is wondering about the sugar in the tea of the diabetic patient in room 6, tell her “tea is disgusting, real man drink whiskey”. And then wink at Nurse Bridget.
Dr. Gerard Rover MD 