Risk Management: Rules of the Road for Emergency Medicine

Risk management are words that strike fear into the hearts of many physicians. It is like seeing police lights in your rear view mirror. There are many physicians who constantly worry about being sued. Ironically, these are the ultraconservative who perform every test possible to exclude any and all potential liability. It’s like driving ten miles an hour to ensure you won’t wreck. Risk is all around us. Every time we step into our vehicle or work a shift in the ER, we take on enormous risk.

Driving and practicing emergency medicine have a lot in common. They both can be exciting–taking a tight corner in the mountains or managing a major trauma patient. They can also be as mundane as your daily commute or the 5th sore throat of the day. They also share the risk of fatality and/or litigation.

This risk doesn’t prevent one from driving and it should not preclude an enjoyable career in emergency medicine. We just have to remember a few certain principles as we take our vehicle on the road and come to work.

Two basic points before we get started — don’t get behind the wheel impaired and get good insurance. If you can’t do those things, get out of the vehicle. Moving on, here are a few simple rules to follow that will make your journey more enjoyable: Obey your speed limit. Don’t go faster than you can responsibly manage your patients. You are bound to have an accident if you can’t control your vehicle.

The important corollary is don’t overestimate your abilities while in the driver’s seat. Beware of shortcuts. By all means, check your map to find the shortest route. However, sometimes when you take a shortcut, you may just end up at a dead end. Cutting corners can be dangerous on the road and in the ED. Yield to oncoming vehicles. Consultants and family members may not always have the right of way, but any temporary advantage you gain by cutting them off will ultimately backfire. Mothers know best. So look both ways before you cross and listen to her when she says that her child is sick. There will be traffic jams. Try to anticipate the bottlenecks and take an alternate route if possible. If you find yourself idling at a stand still, recover that time and do something useful. Getting to know your nurses is always time well spent. Avoid road rage!

It may be hard to remain empathetic during that 3 am dental pain patient who complains about his twenty minute wait. However, you will only end up hurting yourself if you let these people get to you. Approach intersections with caution. Sign out at the change of shift is a high risk crossroad in patient care. Be extra vigilant at this red-light. If you get lost, ask for directions. I know this one is hard for the male physicians out there, but you can’t know every alley, path and road.

If you don’t know something, look it up or better yet, ask an experienced colleague. Be willing to be wrong once so that you can be right later and every patient there after. For all the risks involved, being in the driver’s seat can be a real pleasure. Who would give up the freedom of the open road or the buzz we get from emergency medicine just because there was some risk involved?

Be sure to follow the rules of the road and then put the top down and enjoy the ride. It can be a lot of fun.