Does this sound familiar?
It is 4am and the pager goes off. You see “75-year-old with a sore leg” or “65-year-old vomiting and diarrhoea” or an 18-year-old female “drunk”.
What would be your immediate reaction?
You probably, (myself included) have descended into the five stages of grief. Denial, anger, bargaining, depression, and hopefully, acceptance. Why? Because, whether we are aware of it or not, we believe that jobs like these aren’t what we should be going to. When university courses, TV shows, news articles and self-proclaimed “health advocates” on twitter focus so much on the high end of our work, why should we?
We believe our role, where we can practice our craft, is in the big work. We start to perceive our identity based on this belief.
When we associate this identity with an expectation and that isn’t met, we become discouraged, demotivated, and a little angry. And who do we blame? The person responsible for creating that feeling…the patient who called us.
So why could this be detrimental to our patient care?
An internal dialogue that starts with “We shouldn’t be going to this”, can easily lead to “I don’t think this patient requires an ambulance”. And because they don’t require an ambulance, my next thought might be, “this patient can’t be sick”.
This is the kicker. Based on little information, we have concluded that “this patient is not sick”
This is dangerous. This is bias.
Bias stops us from considering all the possibilities. Bias stops us from looking further once we have reached a decision. Bias makes us focus on the variables that affirm our belief that someone isn’t sick and ignore the variables that contradict it.
The sore leg can be septic cellulitis, the diarrhoea and vomiting can be acute adrenal crisis, and the drunk teenager can be having a stroke.
I’m no saint, and I will happily put my hand on my heart and say I am guilty of this. But being aware of your thoughts is the first step to correcting them. So next time you get a sore leg, or drunk at 4am, pause, acknowledge the bias, and try and approach the patient with an open mind.
Remember, to you it’s just another job. To the patient it may be the worst day of their lives.
To learn more about bias,
Check out Episode 5 – Deadly D and V