MANAGEMENT LESSONS FROM THE E.R. by Paul S. Auerbach M.D

Author:Paul S. Auerbach, M.D.
Language: eng
Format: epub
Publisher: THE FREE PRESS
Published: 2002-07-15T00:00:00+00:00

It’s virtually impossible for a medical practitioner to keep up with scientific advances and commit them to useful memory. The real value of information technology and the Internet in medicine will be to enable instant differential diagnosis and therapeutic decisions based upon the latest information. Automation and instrumentation are gradually replacing eyes and ears. One can only hope that the therapeutic touch will not become robotic. I see the same advances in the corporate suite, as leaders now respond to integrated triggers set off by acute data acquisition not possible even a few years ago. You don’t need my help with that. However, leaders are defined by their intellect, fortitude, ethics, ego, endurance, and disposition. You make decisions that require more skill than spread sheet analysis. It’s not enough to know the right things to do—you must actually do them. In this section, take some of the methods I’ve used in the E.R. and let them work for you.

Recognize When You Are Being Tested

The E.R. is a tough place, a true fishbowl in the parlor of medicine. I remember one day after I had just become the E.R. Director at a major medical center. I participated in the care of a patient of a famous transplant surgeon. The ill woman had come to the E.R. complaining of weakness, difficulty breathing, and abdominal pain. She had undergone a heart-lung transplant a few months previously, and this was her first presentation with symptoms of organ rejection. Her medication list was a mile long. To be honest, the resident and I didn’t recognize many of the drugs, which were beyond our area of expertise. At least one medication was experimental. Part of the patient’s problem was asthma, so the resident ordered some tests and began treatment, to which the patient responded favorably. I put in a call to the surgeon to inform him that his patient was in the E.R.

Fifteen minutes later this surgeon pillar grabbed my arm in the hallway, put his nose up to my face, and said, “Can’t you guys get anything right? Everyone knows my patients are supposed to go on steroids. Who the hell are you? What the hell are you doing? I want to be called for everything from now on.”

From a medical perspective, on a scale of one to ten, this was a zero. The patient was doing great, and the therapy chosen by the resident was just fine. Furthermore, I knew that this particular professor had a reputation for testing new people. There was even a twinkle in his eye as he sought to intimidate me. I looked behind me and saw a few people peeking around the corner. The resident was petrified, but I’d been there before.

In a friendly tone, I addressed the surgeon by his first name and said, “You know, you could be up in the operating room doing a transplant, and you could take an ice pick and stick it into somebody’s heart, and nobody would ever find out about it. But down here in the E.

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