I promise, this is related to Emergency Medicine. Stick with me…
Recently, I went to get my hair cut. I am by no means picky about my hair, and it seems a rather simple ‘do. I go to a chain, but I go to the same location and usually one of two people cuts my hair.
Last week, I went in during my week off (sorry for lack of posts). The two people who usually cut my hair were there, and when asked if I had a preference, I said no. Of course, a random guy I have never seen before came out of the back, and told me he would be helping me. I’m not picky, so I said ok.
When I described the cut, which again is pretty simple, he seemed confused. He asked me multiple times what I meant by things that most people who have cut my hair found to make total sense. My spider sense was up, but then he seemed to act like he understood. As he began, I could tell he was very new (which he had not told me); not putting enough pressure on the clippers, shaky hands, doing things out of order compared to usual. When trimming the top, he trimmed millimeters at the time. He was completely disorganized, and flustered. Even when I showed him how much I wanted cut off the top, he seemed out of sorts.
At one point, he asked “Have you ever just shaved your head?” My response: “Yes, twice, and it looks horrible.” Him: “Are you sure? Seems you have a good head for it.” Me: “No, trust me it’s lumpy and looks terrible.” I’ve never had someone cutting my hair just ask about shaving my head, and I can tell you it is disconcerting to say the least.
He stopped and said “What do you think?” It was jagged, the sides were uneven, and he had totally missed a large patch on top. It was about what I’d expect a lawnmower would do. I told him It looked uneven, unfinished, and generally really bad. He then went to get my usual barber. I heard him whisper to her “I’ve never cut hair as short as he wants it, and I don’t know how to make it look right. Can you help me?” She came over and in ten minutes it looked reasonable enough to see daylight, and after a week of hats, it looks pretty good.
This got me thinking about our patients in the ED. As I said, I am not too picky about hair, and I was getting nervous as this debacle went on. I started thinking about, say, a person with their first laceration, or a parent of a febrile newborn. If I was that nervous with a haircut, how would I feel if a resident who acted like this guy was coming at my two week old with an LP kit? I thought about a few take home points:
1. Introduce yourself and your position. One of the more common complaints I hear from patients who are cared for by residents is that they were not introduced properly, or they did not know who the resident was or what a resident is. If this guy had told me he was new, I would have been ok with it, but my expectations would have been set properly. I would not have expected a quick neat cut. Make sure your patients know who you are so they don’t wonder why the person fixing their lac has such shaky hands.
2. If you don’t know, ask. This guy clearly did not know how to use clippers properly. He did not even know what I meant when I described the cut. If you are put in a situation where you don’t know what to do, get help early before you find yourself in a nearly unfixable mess. Getting help is not a sign of weakness, it is the sign of an intelligent doctor that knows their limitations. This is true even beyond residency. From a supervisory standpoint, I would rather do the whole central line procedure with you than have you come out and get me once you dropped the lung.
3. Give good informed consent. Informed consent is not just the risks of the procedure, but also making sure they know who you are, what your doing, your level of experience, and supervisory expectations. Do not lie to patients about how many times you have done a procedure. Make sure they know you are being supervised and that you will not put their safety at risk at any point. If this guy had told me “I am new, and your usual barber will be watching me. If I need help or get lost, I will get her involved right away so we do this correctly,” I would have had no issue. If you tell me “I am a doctor in training. I know how to do lumbar punctures, but again I am in training. My attending will be here at all times, and if I have any trouble or get to a point where I need help, they will be right here so we make sure your child is safe and so this is done in the safest way possible,” I am ok with you taking a stab.
4. Don’t lie to your patients, and answer their questions truthfully. Multiple times, when I asked the barber why he didn’t do x or y, or if he had forgotten x or y, I was answered with “No I didn’t forget, this is how we always do it.” I knew that was not how you do it. Likewise, your patients are not stupid. People can tell when something is not going well. Be honest. Second, if they have a question, address it and do not blow it off. Keep them in the loop, and keep the lines of communication open.
5. Do not lose your patient’s confidence. We have a unique job. We have about 5 minutes to meet someone and have them trust us with their medical care or the care of their loved one. If you do not introduce yourself, if you do not address questions, if you are not up front, and if you are caught whispering to your attending “I have no idea what is wrong with this guy or how to fix him, and I may have really messed up” when you told them everything was fine, you have lost their confidence. We need our patients to trust us to do the right thing, and we owe them the best care we can provide.
Introduce yourself. Talk to your patients, and set their expectations properly by making sure they understand how things will go and who you are. Reassure them that you have only their best interest, and not your ego, as your primary concern. Get help if you need it. Ask for help early. Answer questions, and if you do not know the answer, tell them that you do not know, but you will find out. Do everything you can to make sure your patients have confidence in you and the care you are providing for them. And please, don’t start cutting if you don’t know how to use the clippers.