EMERGENCY FORUM
Public Relations in the Emergency Department Cyril T. M. Cameron, MD, FRCS, FACS Troy, New York
Cameron CT: Public relations in the emergency department. JACEP 5:894895, November 1976. emergency department, public relations; public relations. INTRODUCTION T h e r e is n o t one of us i n emergency medicine who does not need to know a great deal more about public relations_ Those who regularly work i n emergency d e p a r t m e n t s are less in need of t h a t knowledge t h a n those who go there only i n consultation, if at all. No doubt each one of you believes t h a t he or she can h a n d l e any matter involving public relations w i t h tact, d i p l o m a c y , f i n e s s e a n d promptness. Prior to 1974, I had also felt that my public relations i n medicine were fairly good. However, two years of full-time e m e r g e n c y medicine have g i v e n me m a n y n e e d e d lessons i n public relations a n d have t a u g h t me far more t h a n did the previous 20 years of m a i n l y surgical practice. I have visited emergency departm e n t s in 14 of the U n i t e d States. All \
From the Emergency Department, Samaritan Hospital, Troy, New York. Presented at the annual University Association for Emergency Medical Services meeting in Philadelphia, Pennsylvania, May 1976. Address for reprints: Cyril T. M. Cameron, MD, FRCS, FACS, Samaritan Hospital, 2215 Burdett Avenue, Troy, New York 12180.
Page 894 Volume 5 Number 11
of t h e m suffered from common faults i n t h e p u b l i c r e l a t i o n s a s p e c t s of e m e r g e n c y m e d i c a l care. All, of. course, d e m o n s t r a t e d favorable aspects, b u t it is n o t these t h a t are likely to be sources of trouble. SUPERVISION BY TRAINED PHYSICIANS P e r h a p s our greatest deficiencies are i n t e a c h i n g hospitals where patients are often seen only by the least e x p e r i e n c e d p h y s i c i a n s , m a n y of whom do not speak the patients' language. C e r t a i n l y we all m u s t l e a r n a n d keep on learning. However, it seems more reasonable to staff emergency d e p a r t m e n t s with t r a i n e d physicians who t h e n s u p e r v i s e h o u s e staff, r a t h e r t h a n w i t h h o u s e s t a f f or " m o o n l i g h t e r s , " w i t h no t r a i n e d physicians actually present but, maybe, available for telephone consultation. No one should deny t h a t in some aspects of emergency medical care the j u n i o r physician is u s u a l l y more capable t h a n the senior_ However, the y o u n g house staffer simply does not have the experience to give complete advice to patients, no matter how efficient otherwise. House staffers, and p a r t i c u l a r l y t h e m o o n l i g h t e r s , m a y be t i r e d from over-
work, hence short-tempered and not as careful in' h a n d l i n g p a t i e n t s as they should beHappily, m a n y emergency departm e n t s are now staffed with trained physicians, w i t h years of experience in one or more branches of medical practice or with specific t r a i n i n g in emergency medicine. The presence of t r a i n e d emergency physicians, young or old, has improved w h a t is called, in c u r r e n t jargon, our public "image" and, more imPortant, has improved our care of patients. The paradox of the "emergency" patient's receiving the less expert t r e a t m e n t is, I hope, well on the way to resolution. PHYSICIAN BEHAVIOR AND IMAGE Next, let us pay some a t t e n t i o n t0 ourselves_ Although there is no doubt that p a t i e n t s prefer warm, friendly, sympathetic, and understanding physicians who will listen, examine~ a n d l a t e r e x p l a i n i n s i m p l e und e r s t a n d a b l e terms, they like them even better if they also possess or do not possess certain other characteristics. It is not necessary to have our suits made i n London or by Bill Blass b u t we c a n w e a r c l e a n clothes or change our bloodied ones as soon as possible. We can be clean shaven or n e a t l y bearded, with our Cavalier or Roundhead hairstyles free from dan" druff. We do not have to chew gum constantly or talk with cigarettes iN our mouths. Although it is not neces"
November 1976 J ~ P
sary to wear the sex-attracting perfumes a d v e r t i s e d b y p r o f e s s i o n a l athletes, n e i t h e r is it n e c e s s a r y to have bad b r e a t h , fetor corporis or dirty f i n g e r n a i l s . If y o u t h i n k I'm exaggerating and t h a t none of our" emergency d e p a r t m e n t colleagues has a n y of these u n p l e a s a n t characteristics, j u s t come on a tour with me.
We generally do not spend enough of our limited time l i s t e n i n g to what our p a t i e n t s h a v e to say. All too often we are c o n t e n t to accept the history recorded by the n u r s e or the secretary, which m a y tell only part of the story or m a y actually be incorrect because the p a t i e n t may have had to give p e r s o n a l i n f o r m a t i o n under adverse circumstances. However busy, we can a n d m u s t m a k e the time to listen. We can and m u s t evince a n i n t e r e s t i n the p a t i e n t ' s history since the public no longer looks on aloofness as a sign of medical competence_ F u r t h e r m o r e , brief moments s p e n t i n r e a s s u r a n c e are mutually rewarding. Some m e m b e r s of e m e r g e n c y department staffs are too easily upset by patients. Some, indeed, actually seem to r e s e n t the patients' coming for t r e a t m e n t . C W h a t is she doing here a g a i n ? She was h e r e y e s t e r day.") U n f o r t u n a t e l y , constant work in the emergency d e p a r t m e n t breeds hardness rather than tolerance among the staff. Where practicable, there should be some rotation .with outpatient clinics and the intensive and cardiac care units, so t h a t the regular emergency d e p a r t m e n t staff could have periodic relief from the constant tensions of their work. One error to which physicians are prone is l i s t e n i n g to the opinion of a nurse or a n a m b u l a n c e a t t e n d a n t concerning a patient's behavior without l i s t e n i n g to t h e p a t i e n t ' s story. M a n y times a n u r s e says "Soand-so is here a g a i n " i n a tone of voice t h a t m a y easily prejudice the Physician a g a i n s t the patient. If you walk into a n e x a m i n i n g room with a preformed opinion, it m a y show on your face or i n your voice and m a y easily-cloud your j u d g e m e n t . It may Cause you to be less receptive or perceptive and m a y provide a source of friction between you and the patient.
J ~ F ) November 1976
THE IMPORTANCE OF PRIVACY The catchword is "dignity." There is n o t h i n g dignified a b o u t u s i n g a bedpan or vomiting i n a bucket after a dose of i p e c a c u a n h a . H o w e v e r , some semblance of the little dignity p o s s i b l e u n d e r the c i r c u m s t a n c e s may be m a i n t a i n e d if the p a t i e n t is a s s u r e d of p r i v a c y . We m u s t constantly r e m i n d ourselves and our n u r s i n g staffs t h a t people c a n see through open doors and unclosed curt a i n s , and t h a t our p a t i e n t s really don't like to show bare breasts, bellies and behinds to the passing public_ P a t i e n t s or their relatives s h o u l d not have to give personal details to the clerk or secretary w i t h i n h e a r i n g of other people. Similarly, advice to relatives about a patient's condition should be given in private, as should i n s t r u c t i o n s to p a t i e n t s r e g a r d i n g follow-up care. These latter instructions should be written, simple and legible, because p a t i e n t s f r e q u e n t l y do not u n d e r s t a n d v e r b a l i n s t r u c tions or m i s i n t e r p r e t them. MORE PR FAILINGS A m b u l a n c e a t t e n d a n t s are sometimes not treated as courteously by nurses a n d physicians as they should be; too often they are treated as incompetents and not as essential coworkers. There is frequently a tendency to belittle what efforts the ambulance a t t e n d a n t s m a y have made. H e r e , a m i l l i g r a m of t e a c h i n g is worth a kilogram of scorn. Volunteer a m b u l a n c e services often have people from all w a l k s of life g i v i n g t h e i r t i m e f r e e l y for t h e good of t h e i r communities. We should help t h e m in every possible way and thus help our patients and ourselves. A common complaint by p a t i e n t s and their relatives is t h a t they spend too much time w a i t i n g i n emergency d e p a r t m e n t s . Some do n o t u n d e r stand, or do not w a n t to, t h a t true emergencies m u s t take precedence. A sign posted in the w a i t i n g room exp l a i n i n g this fact and t h a t laboratory a n d x - r a y r e p o r t s also cause some n e c e s s a r y d e l a y , m a y be h e l p f u l . M a n y complaints may be avoided by h a v i n g a n u r s e or a n aide periodically explain to w a i t i n g patients the reason for u n d u e delay.
Another of our weaknesses i n public r e l a t i o n s is n o t t a k i n g t i m e to give a brief report to the relatives of acutely ill or seriously i n j u r e d patients who are receiving immediate and u r g e n t t r e a t m e n t . It is always possible for one person, preferably a senior physician with a sympathetic m a n n e r , to take a few m o m e n t s to do this. Our greatest difficulty in terms o f public r e l a t i o n s is one over which, u n f o r t u n a t e l y , we have no control - t h e very n a t u r e of e m e r g e n c y dep a r t m e n t practice. The p a t i e n t has no choice of physician and vice versa. This fact gives n e i t h e r one the opport u n i t y to d e v e l o p t h e r a p p o r t so necessary for best medical practice. Because of lack of privacy, l i m i t e d time, and no follow-up - - apart from our own shortcomings - - there exists t h e p o t e n t i a l for t r o u b l e b e t w e e n physician and patient; all the more r e a s o n , t h e n , t h a t we s h o u l d be s p e c i a l i s t s not only i n e m e r g e n c y medicine b u t also in public relations_ No doubt all of you could recount m a n y i n s t a n c e s i n which improved public relations could have resulted in better care for patients. Perhaps it m a y seem to you t h a t I am asking all of you to behave like saints, never to get a n g r y even w h e n sorely provoked or very tired. That, in fact, is what I a m asking, in the hope that, by making you l a u g h at the futility of m y s u g g e s t i o n , you will recognize the u n d e r l y i n g truths. To show you t h a t I a m still learning and still need to learn, to demonstrate t h a t I am either perfectly perfect or perfectly rotten in my public relations, here are excerpts from two recent letters. F r o m T e x a s - - "Dr. C a m e r o n ' s forte should be i n pediatrics - - what amazing patience and kindness!" From Georgia - - "I would like to pull out every hair in Dr. Cameron's mustache for the way he treated me." In conclusion, I make a plea for all of us in the emergency d e p a r t m e n t to attempt better public relations which will certainly result in better care for our patients and m a y quite conceivably result i n less of the trouble at which I have hinted b u t have refused to name.
Volume b Number 11 Page 895
Public Relations in the Emergency Department Cyril T. M. Cameron, MD, FRCS, FACS Troy, New York
Cameron CT: Public relations in the emergency department. JACEP 5:894895, November 1976. emergency department, public relations; public relations. INTRODUCTION T h e r e is n o t one of us i n emergency medicine who does not need to know a great deal more about public relations_ Those who regularly work i n emergency d e p a r t m e n t s are less in need of t h a t knowledge t h a n those who go there only i n consultation, if at all. No doubt each one of you believes t h a t he or she can h a n d l e any matter involving public relations w i t h tact, d i p l o m a c y , f i n e s s e a n d promptness. Prior to 1974, I had also felt that my public relations i n medicine were fairly good. However, two years of full-time e m e r g e n c y medicine have g i v e n me m a n y n e e d e d lessons i n public relations a n d have t a u g h t me far more t h a n did the previous 20 years of m a i n l y surgical practice. I have visited emergency departm e n t s in 14 of the U n i t e d States. All \
From the Emergency Department, Samaritan Hospital, Troy, New York. Presented at the annual University Association for Emergency Medical Services meeting in Philadelphia, Pennsylvania, May 1976. Address for reprints: Cyril T. M. Cameron, MD, FRCS, FACS, Samaritan Hospital, 2215 Burdett Avenue, Troy, New York 12180.
Page 894 Volume 5 Number 11
of t h e m suffered from common faults i n t h e p u b l i c r e l a t i o n s a s p e c t s of e m e r g e n c y m e d i c a l care. All, of. course, d e m o n s t r a t e d favorable aspects, b u t it is n o t these t h a t are likely to be sources of trouble. SUPERVISION BY TRAINED PHYSICIANS P e r h a p s our greatest deficiencies are i n t e a c h i n g hospitals where patients are often seen only by the least e x p e r i e n c e d p h y s i c i a n s , m a n y of whom do not speak the patients' language. C e r t a i n l y we all m u s t l e a r n a n d keep on learning. However, it seems more reasonable to staff emergency d e p a r t m e n t s with t r a i n e d physicians who t h e n s u p e r v i s e h o u s e staff, r a t h e r t h a n w i t h h o u s e s t a f f or " m o o n l i g h t e r s , " w i t h no t r a i n e d physicians actually present but, maybe, available for telephone consultation. No one should deny t h a t in some aspects of emergency medical care the j u n i o r physician is u s u a l l y more capable t h a n the senior_ However, the y o u n g house staffer simply does not have the experience to give complete advice to patients, no matter how efficient otherwise. House staffers, and p a r t i c u l a r l y t h e m o o n l i g h t e r s , m a y be t i r e d from over-
work, hence short-tempered and not as careful in' h a n d l i n g p a t i e n t s as they should beHappily, m a n y emergency departm e n t s are now staffed with trained physicians, w i t h years of experience in one or more branches of medical practice or with specific t r a i n i n g in emergency medicine. The presence of t r a i n e d emergency physicians, young or old, has improved w h a t is called, in c u r r e n t jargon, our public "image" and, more imPortant, has improved our care of patients. The paradox of the "emergency" patient's receiving the less expert t r e a t m e n t is, I hope, well on the way to resolution. PHYSICIAN BEHAVIOR AND IMAGE Next, let us pay some a t t e n t i o n t0 ourselves_ Although there is no doubt that p a t i e n t s prefer warm, friendly, sympathetic, and understanding physicians who will listen, examine~ a n d l a t e r e x p l a i n i n s i m p l e und e r s t a n d a b l e terms, they like them even better if they also possess or do not possess certain other characteristics. It is not necessary to have our suits made i n London or by Bill Blass b u t we c a n w e a r c l e a n clothes or change our bloodied ones as soon as possible. We can be clean shaven or n e a t l y bearded, with our Cavalier or Roundhead hairstyles free from dan" druff. We do not have to chew gum constantly or talk with cigarettes iN our mouths. Although it is not neces"
November 1976 J ~ P
sary to wear the sex-attracting perfumes a d v e r t i s e d b y p r o f e s s i o n a l athletes, n e i t h e r is it n e c e s s a r y to have bad b r e a t h , fetor corporis or dirty f i n g e r n a i l s . If y o u t h i n k I'm exaggerating and t h a t none of our" emergency d e p a r t m e n t colleagues has a n y of these u n p l e a s a n t characteristics, j u s t come on a tour with me.
We generally do not spend enough of our limited time l i s t e n i n g to what our p a t i e n t s h a v e to say. All too often we are c o n t e n t to accept the history recorded by the n u r s e or the secretary, which m a y tell only part of the story or m a y actually be incorrect because the p a t i e n t may have had to give p e r s o n a l i n f o r m a t i o n under adverse circumstances. However busy, we can a n d m u s t m a k e the time to listen. We can and m u s t evince a n i n t e r e s t i n the p a t i e n t ' s history since the public no longer looks on aloofness as a sign of medical competence_ F u r t h e r m o r e , brief moments s p e n t i n r e a s s u r a n c e are mutually rewarding. Some m e m b e r s of e m e r g e n c y department staffs are too easily upset by patients. Some, indeed, actually seem to r e s e n t the patients' coming for t r e a t m e n t . C W h a t is she doing here a g a i n ? She was h e r e y e s t e r day.") U n f o r t u n a t e l y , constant work in the emergency d e p a r t m e n t breeds hardness rather than tolerance among the staff. Where practicable, there should be some rotation .with outpatient clinics and the intensive and cardiac care units, so t h a t the regular emergency d e p a r t m e n t staff could have periodic relief from the constant tensions of their work. One error to which physicians are prone is l i s t e n i n g to the opinion of a nurse or a n a m b u l a n c e a t t e n d a n t concerning a patient's behavior without l i s t e n i n g to t h e p a t i e n t ' s story. M a n y times a n u r s e says "Soand-so is here a g a i n " i n a tone of voice t h a t m a y easily prejudice the Physician a g a i n s t the patient. If you walk into a n e x a m i n i n g room with a preformed opinion, it m a y show on your face or i n your voice and m a y easily-cloud your j u d g e m e n t . It may Cause you to be less receptive or perceptive and m a y provide a source of friction between you and the patient.
J ~ F ) November 1976
THE IMPORTANCE OF PRIVACY The catchword is "dignity." There is n o t h i n g dignified a b o u t u s i n g a bedpan or vomiting i n a bucket after a dose of i p e c a c u a n h a . H o w e v e r , some semblance of the little dignity p o s s i b l e u n d e r the c i r c u m s t a n c e s may be m a i n t a i n e d if the p a t i e n t is a s s u r e d of p r i v a c y . We m u s t constantly r e m i n d ourselves and our n u r s i n g staffs t h a t people c a n see through open doors and unclosed curt a i n s , and t h a t our p a t i e n t s really don't like to show bare breasts, bellies and behinds to the passing public_ P a t i e n t s or their relatives s h o u l d not have to give personal details to the clerk or secretary w i t h i n h e a r i n g of other people. Similarly, advice to relatives about a patient's condition should be given in private, as should i n s t r u c t i o n s to p a t i e n t s r e g a r d i n g follow-up care. These latter instructions should be written, simple and legible, because p a t i e n t s f r e q u e n t l y do not u n d e r s t a n d v e r b a l i n s t r u c tions or m i s i n t e r p r e t them. MORE PR FAILINGS A m b u l a n c e a t t e n d a n t s are sometimes not treated as courteously by nurses a n d physicians as they should be; too often they are treated as incompetents and not as essential coworkers. There is frequently a tendency to belittle what efforts the ambulance a t t e n d a n t s m a y have made. H e r e , a m i l l i g r a m of t e a c h i n g is worth a kilogram of scorn. Volunteer a m b u l a n c e services often have people from all w a l k s of life g i v i n g t h e i r t i m e f r e e l y for t h e good of t h e i r communities. We should help t h e m in every possible way and thus help our patients and ourselves. A common complaint by p a t i e n t s and their relatives is t h a t they spend too much time w a i t i n g i n emergency d e p a r t m e n t s . Some do n o t u n d e r stand, or do not w a n t to, t h a t true emergencies m u s t take precedence. A sign posted in the w a i t i n g room exp l a i n i n g this fact and t h a t laboratory a n d x - r a y r e p o r t s also cause some n e c e s s a r y d e l a y , m a y be h e l p f u l . M a n y complaints may be avoided by h a v i n g a n u r s e or a n aide periodically explain to w a i t i n g patients the reason for u n d u e delay.
Another of our weaknesses i n public r e l a t i o n s is n o t t a k i n g t i m e to give a brief report to the relatives of acutely ill or seriously i n j u r e d patients who are receiving immediate and u r g e n t t r e a t m e n t . It is always possible for one person, preferably a senior physician with a sympathetic m a n n e r , to take a few m o m e n t s to do this. Our greatest difficulty in terms o f public r e l a t i o n s is one over which, u n f o r t u n a t e l y , we have no control - t h e very n a t u r e of e m e r g e n c y dep a r t m e n t practice. The p a t i e n t has no choice of physician and vice versa. This fact gives n e i t h e r one the opport u n i t y to d e v e l o p t h e r a p p o r t so necessary for best medical practice. Because of lack of privacy, l i m i t e d time, and no follow-up - - apart from our own shortcomings - - there exists t h e p o t e n t i a l for t r o u b l e b e t w e e n physician and patient; all the more r e a s o n , t h e n , t h a t we s h o u l d be s p e c i a l i s t s not only i n e m e r g e n c y medicine b u t also in public relations_ No doubt all of you could recount m a n y i n s t a n c e s i n which improved public relations could have resulted in better care for patients. Perhaps it m a y seem to you t h a t I am asking all of you to behave like saints, never to get a n g r y even w h e n sorely provoked or very tired. That, in fact, is what I a m asking, in the hope that, by making you l a u g h at the futility of m y s u g g e s t i o n , you will recognize the u n d e r l y i n g truths. To show you t h a t I a m still learning and still need to learn, to demonstrate t h a t I am either perfectly perfect or perfectly rotten in my public relations, here are excerpts from two recent letters. F r o m T e x a s - - "Dr. C a m e r o n ' s forte should be i n pediatrics - - what amazing patience and kindness!" From Georgia - - "I would like to pull out every hair in Dr. Cameron's mustache for the way he treated me." In conclusion, I make a plea for all of us in the emergency d e p a r t m e n t to attempt better public relations which will certainly result in better care for our patients and m a y quite conceivably result i n less of the trouble at which I have hinted b u t have refused to name.
Volume b Number 11 Page 895
