Monday, March 12, 2012

Rules of Shadowing an ER Physician

I need to rant about a few premed students who have circulated through the ER for a "learning experience". I sincerely hope I don't come off as arrogant. I simply think there are a few things premeds need to understand about shadowing.

The most important rule is that the staff, the ER, and the patients do not exist for you to learn about medicine or for you to "see something cool". Patient care comes before your questions and curiosity. This means you do not take the chart away from those who need it so that you can look at it in hopes you will understand anything. If you do not have a grasp of medical terminology, the abbreviations, the significance and normal ranges of vitals, you aren't going to get anything out of reading the chart anyway. You will hold up patient care which is against the rules.

Do not interrupt medical conversations between the doctor and doctor, doctor and nurse, doctor and scribe, or doctor and patient (or their family) for your questions. Remember, patient care comes first. Make a list during the conversation and ask after the conversation is over.

Do not knock staff over to catch up with the doctor. The hallways are long so you probably have time to go around that nurse to catch up.

It is more important that staff be in the room than you. If there is no room, do not shove people aside and stand by the crash cart. Should you choose to stand by the crash cart you may get an elbow to the face, knocked to the floor, etc. That is, if the nurse doesn't drop kick you out of the room.

Stay light on your feet. If you get to be in the room during a code, be able to move out of the way. Do not make someone ask you to move. If you see someone coming towards you, move. Shoulder checks from techs are worse than one from your favorite professional linebacker.

Don't interrupt while the doctor is trying to think. If you catch the doctor looking over some images, or musing over lab values, be quiet for a little while. I promise you won't explode. Give them five minutes to look or think it over. Trust me, an ER physician isn't going to take too long, so it can wait. Let them think.

Realize there is a point where a doctor's patience will run out. Don't ask about every single little detail. There's an amazing amount of information on Google. You can look up the minor things. You will prevent irritating people to the point they avoid showing you anything "cool" for fear of the 100 questions you're going to ask about it.

If someone needs to look up an image or labs on a computer you're on, "just a sec" is not the appropriate response. Remember, the chairs roll. We will move you. Or, if you start this up, more accurately it will be "remove" and you won't be welcomed back.

Do not ever, EVER state anything like "nurses don't know anything". Nurses know more than you think. Once they find out you think they're stupid, you will be destroyed, end of story. Your entire fantasy will end. Using an opinion like "nurses don't know anything" will not be a good conversation starter with the doctor. I can't say for other specialties, but most ER docs will look down on you for such thoughts. A nurse can make a huge difference in the outcome of a patient. And you pissing off one of their patient's nurse will make them hate you.

Just be courteous. Leave the ego at the door. A premed shadowing is lower on the totem pole than housekeeping because you can only hinder patient care and can't do anything to help (regardless of what you think). You are a shadow. Shadows do not get in the way. Don't ask the first thing that pops out of your mouth. Chances are it's a question that Google, which the computers in the ER have access to, can answer. A good physician will use resources available to them. Start practicing.

Bottom line-Don't be annoying.
If you're confident that you're not annoying, you probably are.

This post was written by Type-B Premed and originally appeared here