Pediatric emergency medicine trisk 30

It may be difficult in a brief encounter with a stranger to project the kind of humanism we would like to project The emergency department setting and circumstances make this difficult Yet there are some practical methods that can assist the emergency physician (Table 5.2 ) in promoting humanism Cohen and Sherif have listed 12 tips on teaching humanism in medical education INTRODUCTION AND JOINING The first important step in expressing humanism comes in the introduction of the physician to the patient and family This is the first chance to let the patient know who you are, why you are here, and that your goal is to help them On an average encounter in the ED the family sees many ED personnel, you need to make your role clear to them Meet and shake hands with everyone in the room Do not assume who they might be Show your interest in everyone Sit down even though you may be in demand elsewhere Sitting down shows your interest and that you will give the time that is needed for their child’s wellbeing TABLE 5.1 MEDICAL PROFESSIONALISM IN THE NEW MILLENNIUM: A PHYSICIAN CHARTER a Fundamental Principles • Principle of primacy of patient welfare • Principle of patient autonomy • Principle of social justice A Set of Professional Responsibilities • Commitment to professional competence • Commitment to honesty with patients • Commitment to patient confidentiality • Commitment to maintaining appropriate relations with patients • Commitment to improving quality of care • Commitment to a just distribution of finite resources • Commitment to scientific knowledge • Commitment to maintaining trust by managing conflicts of interest • Commitment to professional responsibilities a From the ABIM Foundation American Board of Internal Medicine; ACP-ASIM Foundation American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine Medical professionalism in the new millennium: a physician charter Ann Intern Med 2002;136(3):243–246 DETAILED SOCIAL HISTORY Time is short in the usual ED visit but take an extra minute to gather some social history Your concern is for the diagnosis but the extra questions about the child, his lifestyle, the family background and culture may help you with the diagnosis but also help to humanize the patient, and in asking these questions humanize yourself TABLE 5.2 METHODS TO IMPROVE HUMANISM IN THE EMERGENCY DEPARTMENT • Introductions and joining • Detailed social history • Personal information • Addressing fears • Frequent touch points • Parental presence • Setting realistic expectations • Follow-up communication • Humanism with colleagues—Teamwork • Humanism via self-care PERSONAL INFORMATION When possible and appropriate tell the family something about yourself For example you might say to the patient—“you are the age of my nephew or grandson,” “We live in that neighborhood.” Statements of this kind also serve to humanize you They should not be highly personal or inappropriate but just personal enough to serve to enhance the bonding process ADDRESSING FEARS Above all, find ways to show your concern Every child with abdominal pain is thought to have appendicitis, every child with a headache has a serious infection or tumor, every child with a cough has pneumonia Ask what the parent is worried about Sometimes the fear is obvious Sometimes it is far from what you might think Tell parents what you are not worried about and this will often elicit a sigh of relief FREQUENT TOUCH POINTS There is nothing more anxiety producing and dehumanizing than sitting in an ED room devoid of communication Always try to have frequent touch points of communication Let the families know what the planned steps are and where they are in the process Stop by, poke a head in the room just to create the sense of the good contact you have already worked hard to establish at the outset Being alone in a room without communication makes the parent feel that you and the ED team not care about them or their child PARENTAL PRESENCE In the recent decade there has been a growing movement to allow for parental presences for procedures, trauma, and code situations EDs that have allowed family presence have found it helpful for parents, patients and care providers It shows the families how much we care and how much effort goes into a resuscitation SETTING REALISTIC EXPECTATIONS Another method of increasing your humanism is to pay attention to the expectations you set Failure to meet expectations leaves the patient and family feeling that there is a lack of caring or a lack of competence Do not make promises you cannot keep There may be situations where families come to the ED with preordained expectations In such cases expectations must be realigned and made more realistic to the capacity of your center It is best to this at the time you are establishing your relationship with the patient/family CHECKING ON COMMUNICATION (FOLLOW-UP) Checking on the outcome of a patient’s course either through a visit to the in-patient unit or via a telephone call really demonstrates that you care Make this a routine part of your practice It not only aids your physician– patient relationship but also adds to your learning about the correctness of your diagnosis, effect of treatment, and evolution of disease course HUMANISM WITH COLLEAGUES AND STAFF (DEBRIEFINGS–TEAMWORK) Humanism is not limited to your interactions with patients and families It also applies to interactions with colleagues and staff members in the ED Teamwork is an important part of the humanistic approach when team members are respected, valued and shown appreciation Debriefing meetings help to actualize these values and allow for expression of human ... Foundation American Board of Internal Medicine; ACP-ASIM Foundation American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine Medical professionalism... patient, and in asking these questions humanize yourself TABLE 5.2 METHODS TO IMPROVE HUMANISM IN THE EMERGENCY DEPARTMENT • Introductions and joining • Detailed social history • Personal information