What to do about tension with other departments
December 1, 1999 4 minutes read
What to do about tension with other departments
By Larry B. Mellick, MD, MS, FAAP, FACEP
Chair and Professor
Department of Emergency Medicine
Department of Pediatric Emergency Medicine
Medical College of Georgia, Augusta
Some feel that the practice of emergency medicine evolved out of a slightly shady past. It may be true, in fact, that our family tree includes a few ancestors who we wished didn’t carry our specialty genes.
Who were the practitioners of emergency medicine before it became a respected and proud specialty? Sometimes it was the physician struggling to maintain a private practice or the young physician needing another source of revenue as he or she built a primary care practice. On occasion, physicians with personality flaws or social instability found themselves working in the ED.
Additionally, in some hospitals in years past, it was not uncommon for nearly everyone on the medical staff to have required shifts in the ED when staffing was limited. Your primary specialty mattered little. The dermatologist or psychiatrist shared equal responsibilities with the family medicine physician or surgeon. In other words, a burning love and attraction for emergency medicine was often not the reason that many of our ancestors ended up in the ED. While many fine ED physicians evolved out of these settings, there were others who left an indelible and dark mark on the specialty of emergency medicine.
Additionally, nursing personnel who "could not get along" were often sent to work in the ED. Furthermore, nursing leadership sometimes viewed the ED as a place for those with limited experience to gain a broader exposure and begin their nursing practice.
The socially dysfunctional character of many hospitals is another reason tension exists between the ED and other departments. Let’s face it: Most hospitals are not unlike large, dysfunctional families. And like most dysfunctional families, there is often a scapegoat or a family member who carries the weight of the family’s pathology. For many institutions, the ED traditionally has been that target child.
Many of us involved in the practice of medicine struggle with hypercritical attitudes. Naming, blaming, and shaming are dealt out with only the slightest principled twinge or hesitation.
Unfortunately, the "bay window" practice of our specialty makes ED nurses and physicians prime targets for these attitudes. Because we do practice in one of the most uncontrolled and exposed environments in medicine, we are especially vulnerable to Monday morning quarterbacking.
Incomplete information is frequently the basis on which our colleagues make the most damaging of assessments. Typically, little effort is made to get the rest of the story, and "evidence-based medicine" does not apply to the practice of personal criticism.
Specialty hubris
The data set or knowledge base of our specialty is often misunderstood. While many specialties and subspecialties focus on a narrowed patient or disease population and establish a depth of unique knowledge, emergency medicine covers a greater breadth and shares elements of its database with all specialties and subspecialties. While the cardiologist may have an extensive database of expertise and information, the total information volume and experience depth is not necessarily greater than that of the emergency medicine specialist.
Another way to visualize this concept is that our knowledge base could be considered predominately horizontal and less vertical. Unfortunately, the specialty hubris of our colleagues blinds them at times to the unique knowledge base of emergency medicine. Instead they perceive their own more focused and vertical data set as somehow more valuable.
While other specialties operate in a controlled environment that allows a strategic practice of medicine, our specialty practices in an uncontrolled setting that requires a more tactical practice. A tactical practice does not always match the tenets of good medicine taught in medical school and during our rotations on the internal medicine service. These differences are frequently not understood by our colleagues or even ourselves.
There is very little hope that this tension between specialties will ever go away. On the other hand, the final product and outcome of these differences remain largely within our control.
We do have a number of options and selections from which to choose. The options of protective isolationism, obsequious submission, hypersensitivity, festering resentment, and clever revenge are naturally occurring alternatives. However, those selections do not lead to programatic strength or personal emotional health.
Maximizing our knowledge base, practicing evidence-based medicine, representing the hospital well to our community, and taking leadership in our hospital medical staffs are some of the more productive options available. In other words, choosing to return good in exchange for the unkind and the unfair is the healthiest option. Not only is it the healthiest, it is also the premier opportunity to break the cycle of tension between our specialties and emergency medicine.
[Editor’s note: For more information about tension between the ED and other departments, contact: Larry B. Mellick, MD, MS, FAAP, FACEP, Department of Emergency Medicine, Department of Pediatric Emer gency Medicine, Medical College of Georgia, 1120 15th St., Augusta, GA 30912. Telephone: (706) 721-7144. Fax: (706) 721-7941. E-mail: LBMellick@ email.msn.com.]
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