The Helicopter Hover: Counterfeit Cognition #WILTW

This is the 149th #WILTW

-“Stop being a helicopter consultant..


-“..just standing around and hovering

I’d been called out by a colleague for something I’d never heard of but which made perfect sense.

There is a perception that Emergency Medicine is a dynamic, all action job in which you are constantly on the go with no time to think or reflect. This can certainly be true but while there are periods of high intensity the reality is not always as shown in popular television series. There are also times when a particular patient or situation can take up a disproportionate amount of time. You might be heavily involved in delivering a treatment or intervention, you might be having difficult discussions with other specialties, or you might be closely supervising a junior member of staff.

But sometimes you’ll find yourself ‘hovering’. This can be an almost subconscious endeavour, perhaps noticed more by other staff than yourself. A sign perhaps of not quite wanting to leave at the end of a handover leaving you just standing at the end of the bed drumming your fingers against the bed rail. The cause of this ‘action in inaction’ is multifactorial (and inconsistent) but there are some common themes:

  • Active Thinking

This is typified by a difficult clinical case. You are creating space to weigh up available evidence so that you can make the most informed decision.

  • Passive Thinking

This is essentially procrastination. You are not sure what the best course of action is or perhaps feel there is not one best approach. If enough time passes it’s likely the correct management will become clear. While it might appear to others you are deep in thought you are actually just killing minutes.

  • Counterfeiting

This is the least easy hover to admit to. Although it may look like you are focused on one patient you are actually listening into a conversation about another. Or another method involves excessive tidying up, or record keeping, allowing you stay and see what happens to a patient you are keen to see the outcome of. Perhaps you feel like you’ve dropped a ball earlier in their care? You don’t need to stay but find a reason to.

The counterfeit hover is not always a bad thing and passive thinking may well be in the patient’s best interest. It is an interesting behaviour though. One I will be watching out for in others, and certainly in myself.

What have you learnt this week? #WILTW

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5 thoughts on “The Helicopter Hover: Counterfeit Cognition #WILTW”

  1. Where I learn,t we were taught to hover.
    Inaction is observation ( to paraphrase someone I know). Hovering isnt passive. It takes work. It stops me intervening when I want to GFDI. It lets me give learners an opportunity to flourish.

    Its also a game of ‘chicken’. Many that know me have side-bets on when Im going to interfere.

    Lastly its just sometimes the right thing to do.

    Im a better consigliere than a doer. Ive grown old. Im happy to let the younger bucks “get the line in”. I comfort myself with the knowledge that attitude (“when to do” and “why to do” are as important as “I can do”) .

    Over the years some have said “it was nice knowing you were in the background”.

    As a very junior ED doc 28 years ago my SR told me he liked to drive fast and only lived 6 miles away. But as he left for home he gently informed me that he would “kill me if I called him”. Three weeks in on a Sunday morning he asked me how the night went.

    “I felt like calling you after the second shooting but when the status epilepticus in the 2 year old came in I forgot.”

    “Thats alright” he said “If you were struggling the nurses would have called me and let me know!”. Who’d have thunk it that back then there were “drones” watching silently in the corner of resusc?

    1. Thanks Hugo

      I like the concept of it often being a game of chicken (the balance between active and passive thinking)

      And like your SR recognising when sister is ‘hovering’ is a fundamental insight all doctors need to develop….

  2. Everybody regardless of their role does this. I see it with pre-hospital staff that bring children in to resus, my nursing and medical colleagues, right through to myself. A lot of the time when I do it myself, it can be for multiple reasons. These range from curiosity (I want to know the outcome) to learning (a presentation I have not seen before and can learn about/from).

  3. Thanks Felix. Think I’ve tried to make a complex area a little too simple! Agree observing is vital for education – I was trying to pin-point the situation when you are in a flux zone of involved/not involved and how that might not always be a good place to be.

  4. Hi Damian, love this post! I hover too. It’s impossible not to, but more important to learn how to do it stealthily.

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