There are many demands in the emergency department, some of which come from patients and their families. This post in the Art of Medicine series looks at those situations in which patients/parents are wondering whether or not you are qualified to be caring for their child.
As I noted in the last post in this series the ED is a stressful environment. Parents are legitimately, and rightfully scared for their child’s well-being. July (or late June at many training programs) is a time of anxiety for providers as well. So in this post let’s take a look at some common scenarios that you might face.
Are you real doctor?
I’ll get it out of the way – Yes I have been asked this question. It can be pretty uncomfortable. And the natural first reaction is one of defensiveness. After all you just spent four years in college, then four years in medical school – all the while accruing a Scrooge McDuckian level of debt. And now you have had your freshly minted credentials questioned. Certainly this can be an uncomfortable situation. Let’s first take a look at why the parent is asking this question. Remember what I said earlier specifically parents are scared. If you had something major wrong with your car would you not want the best mechanic? I think that in many cases parents feel the same way. That uncertainty can be legitimately paralyzing. Parents are worried that another one of those uncertain variables is an inexperienced provider. Just take a look at some of these articles from the web and you can see how they can arrive at the conclusion that July is a dangerous month to visit the hospital:
- Don’t Get Sick in July – The New York Times, 2012
- Why you should never go to the hospital in July – CNN, 2011
- If you go to a hospital in July, get ready to die – Gawker, 2012
Even the medical literature paints a worrisome picture. So this, my dear readers, is what you’re up against when the mother asks you “Are your real doctor?” So how should you respond to this question? The answer is simple – Be honest! I wouldn’t go into a long diatribe about how long it took you to get here and what the USMLE meant to you blah, blah, blah. Just say “Yes I am a doctor – Specifically an intern/resident which means that after I get a chance to know you and your child I will develop a plan in conjunction with my supervising physician a.k.a. the attending.” In my experience that is sufficient. Don’t be offended, don’t be hurt and most of all don’t take it personally. After all remember that this parent is not questioning your professional qualifications – they are just trying to assuage their fears that their child is going to be okay. This loss of certainty and control can lead them to try to shore as many assurances as possible. One of these, and maybe the most important in their mind, aside from what’s wrong with her child, is just making sure that their child is being treated by a qualified provider. And you’ve made it this far, so yes you are qualified!
Have you done this procedure before?
If you follow the theme about these questions then you should know how to answer this one as well. Procedures are potentially pain and anxiety inducing experiences in the ED and a parent has every right to worry about whether or not they will be performed by qualified practitioner. So again, be honest. If you done the procedure before say “yes.” If you haven’t, then say so, and tell the parent that you it will be performed alongside your supervising physician who has certainly done the procedure many times. Even if you haven’t performed a particular procedure before that doesn’t mean that you shouldn’t be intimately familiar with the indications, risks and benefits. A thorough knowledge of these will go a long way in proving that you are indeed qualified. Spend time doing a bit of background reading, and seek out colleagues, including veteran nurses and support personnel (like the invaluable Child Life Specialists) for advice and assistance.
Can I speak with your boss?
Sometimes, despite your best efforts at doing an appropriately thorough history and physical and explaining pathophysiology, a parent will request to speak with your attending. This too should not be taken personally. Remember, the parent is not specifically targeting you as an inadequate physician/medical student. Instead, they are likely worried. That worry is driving them to seek out the best possible care. The aforementioned question doesn’t mean that you’re not trusted – though I know it can feel that way. This is especially true for parents of complex/medically fragile children. Remember, they’ve been through this before and already know what it means to come to the hospital in July. You should avoid arguing with the family, and instead calmly let them know that after you have completed your exam you will certainly get your attending. Reiterate what it means to work with a team – and assure them that you are all working together in the interest of their child’s well-being.
These are just a few of the many questions that you may be asked in your early months of training. Above all else, don’t take it personal. If you are kindhearted and honest you will never go wrong. Your first day on a new rotation can be anxiety inducing. Don’t subvert those feelings with a veneer of faux-confidence. Acknowledge them, put yourself in the parent’s shoes, be honest and always ask for help when you need it.