This is the 67th #WILTW

Ed appears to be the cause of many problems. He missed the sepsis, the hairline fracture and the pneumonia. All on one shift. To make it worse no-one ever pronounces his name right either. It’s the “E” “D” people say. And then roll their eyes.

My colleagues and I spend a lot of time debugging problems caused by Ed. The last clinical conversation I had before going on leave last week was about Ed and why other specialities seem to dislike him so much. It was with this in mind that I spent a bit of time mulling over what I could do to help him. A few weeks ago I wrote a blog entitled “5 referral tips what won’t annoy a paediatrician.” While it proved popular with paediatricians I realise it was potentially an example of further implicit tribalism against Ed.

So for #WILTW an Ed fact-finder!

1. Ed is not one person – he didn’t miss the fracture; an individual did. Everyone makes mistakes but Ed seems to be charged as an entity that tarnishes all those working in Emergency Medicine with the same brush. Ed’s mistakes have obvious implications for specialities managing that patient. The mistakes are probably not substantially different than in-patient team mistakes but these remain confined to that team, not dissected at morning hand-over. While orthopaedic surgeons are often sterotyped it is still the case of the “that particular orthopod on-call last night”. Poor old Ed seems to single-handley run the Emergency Department 24/7.

2.Ed must be a jack of all trades and is a servant to all. He works in a high intensity environment but is also held to account for a number of quality indicators and (increasingly) national ‘pressures’. While admittedly the ‘time target’ appears to dominate all others he is also subject to scrutiny in the treatment of sepsis, the management of fractures in the elderly and public opinion of whether they would recommend his service. While these are relevant throughout many medical specialities no-one other than primary and intensive care will be managing such a range of conditions and be held to account across all of them. Ed does not like to whinge and whine – he choose his job for exactly this pressure. But feeling smug when you have met your one target against Ed’s potential seven should not be something to be proud of.

3.Ed manages unwell patients. Let me repeat that. Ed manages unwell patients. The very environment Ed works in means patients are sick. Yes – patients should always receive the optimum initial care and treatment the moment they are recognised as being critically unwell. Ed feels very guilty when he makes mistakes. But he cannot make all patients 100% better in the time available to him. Hospitals are there to manage unwell patients. Phoning Ed to tell him the patient he sent you was sick when he had told you this in the referral is not helpful to you or Ed, and certainly not the patient. Which leads nicely to…

4. Ed likes to learn. He likes feedback on how to improve. Overhearing how dreadful his referral was second hand in the queue for the canteen is not useful feedback. Useful feedback occurs in a fashion that does not intimidate, threaten or subvert. It may involve talking to Ed’s boss or may, hold your breath, involve actually talking to Ed himself.

5.Ed manages increasingly, and more often than not, appropriately expectant patients, parents and carers. Specialities know how it feels when an out-patient clinic is over-running and you have a room full of eyes on you everytime you call the next patient in. Ed works like this hour-in and hour-out. Ed see’s first hand the anxiety, the tears, the stress and the anger in people. Ed often turns this into relief, happiness and gratitude. But sometimes he doesn’t and every so often time is needed or another professionals’ advice. Ed doesn’t phone you up to tell you about all the patients he has discharged only the ones he feels you need to see. Sometimes all that is being asked is a simple opinion. But that simple opinion may be of huge relief and be a powerful intervention in itself.