A lion used to prowl about a field in which Four Oxen used to dwell. Many a time he tried to attack them, but whenever he came near they turned their tails to one another, so that whichever way he approached them he was met by the horns of one of them. At last, however, they fell a-quarrelling among themselves, and each went off to pasture alone in a separate corner of the field. Then the Lion attacked them one by one and soon made an end of all four.

–Aesop, sixth century BC

Find your circle of safety.

When I was a resident looking for a job, I made lists upon lists of merits of each hospital I interviewed at. This one had a cath lab, that one had a robust radiology department with 24 hour interventional coverage, and another one paid way more than the others but had no benefits. I stared at these lists for hours debating which job I would accept. Then, one day, I happened upon a hospital where the Chair took me around the ED and everyone was smiling and they seemed happy to be at work. That was the job I accepted and happily stayed for many years.

When we feel like we belong to a group and trust the people with whom we work, we naturally cooperate to face outside challenges and threats. Thus, a circle of safety is created and we flourish. When we do not have a sense of belonging, we are forced to invest time and energy to protect ourselves from each other. And in doing so, we inadvertently make ourselves more vulnerable to the outside threats and challenges just like the Oxen in Aesops story.

The next part of my talk is a map on how to create that circle of safety and be a leader in the ER. Leadership is not based on your title and your rank in the system. Leaders are influencers.

  1. Eat, drink and go to the bathroom on shift. Take care of yourself so you can take care of your patients.
  2. Be kind to your staff
    1. Make a point to say nice things
    2. Feed them
    3. Teach them
    4. Talk to them
    5. Praise them in public, and if you have critical things to say, do it in private. Challenge yourself to give positive feedback to at least five emergency department (ED) employees every day.

*According to a gallup poll in 2013, when our bosses completely ignore us, 44% actively disengage from our work. If our bosses criticize us, 22% actively disengage. And if our bosses recognize just one of our strengths and reward us for doing what we are good at, only 1% disengage. So- less people disengage if we are critical because at lest they feel we are acknowledging their existence.

  1. Introduce yourself to everyone- housekeepers, consultants, everyone in the patients room. Housekeepers save lives!
    1. Don’t be annoyed. If you feel annoyed, take a 5 minute break and do something to get yourself feeling better.
    2. Take care of the nurses and pcas
    3. Get to know a little more about one patient per shift. It keeps us human.
  1. You have one chance to make a first impression. Work on your introduction to patients and family. Show up early.
    1. People will decide right away if they like you- you have about 30 seconds.
    2. Make your patients feel comfortable. Shake their hand, sit eye level. Remember they are scared and sick. They are about to tell (or not tell) you very personal information.
  1. Practice your craft
    1. What do patients positively respond to? Repeat that behavior.
    2. Find someone you respect and emulate their behavior.
    3. Find a mentor
  2. Under promise and over deliver. A chest pain workup may take 3 hours, 3.5 with a positive d dimer. Tell patients and family it will take 5 hours. They will be happy when it takes 4 hours.
  3. If a patient is being rude to a nurse or you see a commotion, get up and get involved
    1. If someone is never going to be happy, don’t waste your time trying to fix it. Use that energy on patients that are on the border….
  4. Attending Doctors should be on a first name basis. Attendings are colleagues.
  5. No need to apologize for calling the specialist on call. It’s their job. That being said, have things set up for them when they come in so they can get to work and get back to their day. I thank them for coming in every time.
  1. Communicate with your Chair/chief
    1. Good things and bad
    2. Difficult consultants (they are nice to the chair)
    3. If there are issues- help think of solutions. Don’t just complain
  2. Parents: Don’t feel guilty about working
    1. Boston College- Graduate School of Social work study found that a child’s sense of well being is affected less by the long hours their parents put in at work and more by the mood their parents are in when they come home.
      1. Children are better off having a parent who works late and into the night than having a parent who works shorter hours but comes home unhappy
      2. So- don’t put up with miserable so that we may provide for our families


Great Thanks to Dr. Marjory Langer, MD, FACEP, Director of St Joseph’s Wayne ED and Past President of NJACEP, for this contribution and for sharing her experience!