Heuristics, Preconceived Notions, and Little Ones

They say that 95% of EMS is bullshit and 5% is "oh shit." This might be a mild exaggeration (or perhaps not - depends on whom you talk to), but the general principle is disconcerting. Yesterday I went on more calls than usual due to Duke’s and Central's graduation ceremonies (on a side note: please do not wear your Sunday best to May graduation in the state of North Carolina when it's 95 degrees outside with 90% humidity; that just doesn't make any sense, people. Wear something more weather appropriate!). Most of the trucks in the county were responding to calls of people "falling out" under the force of the morbid heat. At one point, Medic 41 was the only truck available in the entire county. Nevertheless, people still called 911, even in the lamest of circumstances, seriously stretching the definition of the word "emergency." I responded to quite a few of these "life or death" situations. For fear of violating some privacy statute, I will let your imagination run wild thinking up BS health emergencies, but suffice it to say some people call 911 when they have a cold or stub a toe. Drive yourself over to an Urgent Care facility if you are really that concerned.

But, it's days like these that I have to catch myself, take a deep breath, and take one person at a time. I had to catch myself last night.

Just because a man calls 911 to give some legitimacy to his "injury" for the purposes of a filing future lawsuit (slip and fall in a Target = $$$), doesn't mean that the next person who falls is looking for a big settlement as well. And that can be tough. Calls begin to blend together by the end of the day (I certainly can't remember all the details from yesterday's eight dispatches), but all of them start out with "oh shit" potential. Sick calls and alpha responses can turn into code blues quickly.

I write to reflect and remind myself why I am here, why I want to be a physician. Later, I hope to read and recall past experiences, good and bad, that will make me a better doctor. Around 6pm last night we were dispatched to "26 year old male, abdominal pain" from an Urgent Care clinic. Of the prior calls, I would guess that we'd seen only one person who actually needed to be seen by a physician immediately. I was tired; I wasn't feeling well. We walked into the patient’s room and he was doubled over in pain, sweating profusely through his athletic gear. He was Caucasian and clearly educated. The physician strode into the room and gave us a history, even developing a differential diagnosis at the end. As we loaded the patient into the truck, he refused morphine (eventually accepting a little), because he wanted to be clear-headed. Halfway through the call, once we were enroute to the hospital, I realized that I had given this patient more credibility that any other person I had seen that day. He was young (as opposed to older), clearly an athlete (as opposed to someone who doesn't take care of himself), he had a physician advocate (most patients aren't that lucky), and he refused pain meds (did I think he was somehow tougher?). But I was most disturbed that I noticed he was white. Now that last fact absolutely did not affect how I cared for this patient; but I noticed, and that's what's scary. I noticed.

I gave this man more credibility because I identified with him, and that's not fair. It's not right at all, actually. I am disappointed with letting myself get caught up in the heat of the moment, letting my fatigue get to me. I didn't take a deep breath in between cases; if I had, I would have taken the call more seriously not because the patient looked and talked like me. I would have taken it as seriously as I took all the calls earlier simply because someone called 911, and someone was scared.

If I take anything positive out of this, it's that I was able to stop myself. I was able to recognize that I was using heuristics and preconceived notions to determine how I felt at the time. For anyone who says that medical schools should stick to teaching about the science and forget about other classes meant for enrichment and personal growth, this is a perfect example of why these courses are so important. I know that a year ago I would not have recognized this mistake. Yesterday I did. What changed?

Fortunately, my day was saved by the next call: a nine month old with febrile seizures. Baby Autumn held my pinky all the way to the Duke Pediatric ED. She was precious.