Recently I read an entry on EMcrit where Scott W. describes a technique for stress reduction based on breathing techniques and focuswords. Now as big a fan as I am of Scott (or anybody that is shorter then me for that matter), we must see his advices as second tier. True stresslessness comes from apathy and nihilism. For stress basically is fear of losing control and the conviction that you are the only one that can fix stuff. What if I do something wrong, what if I miss something, what if I am wrong. What if the patient dies. Allow me to explain myself.
Step 1
The bigger the craving for control, the bigger the fear of loosing it.
this is basically about having faith in others. The more you rely on others, the less fear you need that that one will fuck up. So essentially, pick good team members, or better, know what they are able to do. Give them credit for what they do right and check up on them when you know they are in over their head. Assume they will be wrong at some stage in the game, but not likely in the first 5 minutes. Step in at the point where they are likely to do stuff wrong, but don’t where they are perfectly capable.
Step 2.
Balance yourself on the narcism / nihilism scale.
Basically we like to feel that as teamleaders we are influential. We set the stage, we dictate what happens in our resus-bay. You are able to steer the ship and dramatically increase the teams potential to do good. Without you things will not be ideal or perfect and that means you have to be attentive of every single detail.
This feeling should be balanced by the concept of realisation of futility. As we are well aware, many hard-fought improvements, high-tec or low-tec, have been shown to be pointless when looking at survival or quality of life. We can discuss the role of steroids, choice of fluids, magnesium etc. etc. In the long run and on a larger scale these medications may save lifes, but for your individual patient in front of you, they will not make a difference. So what if your team misses a dose of amiodarone, or forgets to apply a nasal cannula before pre-oxygenating your patient? As a teamleader you have to try to balance. Pick those interventions that will be a big deal for this individual patient and be strong there.
In conclusion
Try to have faith in your team, because you know at what stage of the game they will fuck up. And wait for that moment to intervene. And then, be a little more nihilistic and a little less narcissistic.
Dr. Gerard Rover MD 