Healthcare is a high-stakes, high-stress environment. Especially in recent years.
When we start our careers in healthcare, we do so because we want to help people. Some of us, a.k.a. me, have felt like we need to help at the cost of our own personal safety.
I was thinking about this topic because a patient recently pulled my stethoscope out of my ears while I was listening to her heart. She was an elderly woman with advanced dementia who had a major fall at home.
When I came into her room, she was chatting with someone who wasn’t there. I introduced myself, and although she was calm, she was completely unaware of what was going on.
As her resident physician, I had to check her for any other injuries or obvious medical causes for a fall. As I was listening to her heart, she smiled and pulled my stethoscope out of my ears.
It wasn’t painful or anything, but it served as a good reminder about the vulnerable position we put ourselves in by working in healthcare.
By safety, I’m talking about physical and emotional safety. In my post on learning, I talked about how we need to feel safe in order to learn. We also need to feel safe in order to keep working year after year in an often-stressful environment. Protecting your personal safety is imperative to longevity in any healthcare profession.
Without further ado, here are the ways I’ve learned to protect my own safety at work:
1. I assess risk before every patient encounter
Harkening back to my physio days working in Geriatrics, I quickly learned the importance of assessing risk before mobilizing patients.
Step 1: Assess the patient
This means I look at the patient’s chart for anything that might make the encounter riskier for me. This could include:
- Violence alerts
- Patient agitation
- Any altered level of consciousness
- Intoxication
- Something off (for instance, a note in patient charts saying they left against medical advice in the past)
This list isn’t to judge patients. It’s just to alert myself to be a little more cautious about my own safety.
Step 2: Assess the environment
Always assess the environment before seeing a patient. In First Aid and CPR courses, we’re taught to assess the scene as the first step in helping someone. This is specifically to avoid hurting yourself in the midst of trying to help someone else.
Although it can be easy to assume that the environment we work in is stable, like working in a clinic or hospital, it can change at any point.
For instance, I’ve found uncapped needles in patients’ beds, spills on the floor, and another person seemingly hiding in a patient’s room. Take a minute before setting foot in a room to peek in and check for anything amiss.
2. I stay (outwardly) calm
No matter what happens in healthcare, staying calm is vital.
When I was in medical school, I was involved in a lot of codes, by which I mean when a code blue is called for a medical emergency in hospital (I did a lot of electives in critical care, surgery and emerg.) Every code that felt smooth had something in common – the leader was incredibly calm. Their presence infused a calm energy into the room, which helped patients, family members and healthcare workers alike.
We see people on what very well might be the worst day of their lives. Of course emotions are going to run high. Of course patients are terrified, angry, or stressed beyond belief. But no matter what energy is in that room, my role is to portray a calm exterior.
How do you stay calm when stakes are high?
I don’t really know… Practice? Deep breathing? Dissociating? I just know that the more intense a situation is, the calmer I outwardly seem.
3. I have a low threshold for leaving the room
The number of times I’ve been yelled at by complete strangers in astounding.
When emotions are high, people can make bad choices. And I certainly can’t fault them for that. We’re all human, and we all lose are tempers. However, what I can do is leave the room if I’m unable to de-escalate things.
I’ve left the room politely, saying, “I can see that you’re understandably furious. I’m going to come back when things have calmed down.”
I’ve also left the room without saying anything.
4. I let people know when they’re crossing a boundary
There is a clear-cut hierarchy in medical training. Staff physicians are at the top, residents are next, and medical students are at the bottom. This hierarchy creates a culture of silence, where medical learners don’t want to speak up about anyone above them for fear of a bad evaluation or miserable rotation.
I stand firm in the belief that I have the right to tell anyone, even those evaluating me, when they’ve crossed one of my boundaries.
As a soft-spoken female in medicine, I’ve had many preceptors and patients cross boundaries. Here are two of the tamer examples: As a medical student, a preceptor introduced me to a patient as his “beautiful assistant.” As a pregnant resident physician, an older male patient said I should come to work wearing a dress next time he’s in.
When people say comments like these, they’re (hopefully) unaware that they make me feel uncomfortable/unsafe. So, what do I do about it in the moment?
I remind myself of what I deserve
The first thing I do is to remind myself of my worth. I don’t deserve to feel unsafe at work. No one does.
I aim to right the wrong immediately
The second thing I do is promptly let the person know they’ve crossed a boundary. I’ve practiced this enough that I can do it tactfully with preceptors and patients alike.
When my preceptor introduced me to a patient as his beautiful assistant, I said, “wow, that was wildly inappropriate,” which thankfully elicited a laugh and apology from my preceptor and the patient saying, “ya doc, you can’t say things like that anymore.”
I’ve never failed an evaluation for letting my preceptor know that something they did was inappropriate.
What about with patients?
This can be tricky.
I often try to get them rethink what they said:
“Did you really mean to tell your doctor that she would look prettier in a dress?”
“I think I heard you say [insert inappropriate comment here], but there’s no way that’s what you meant.”
By pointing out inappropriate behaviour, I’ve done two important things for myself – set my boundaries so it doesn’t happen again, and showed myself and others that I’m worthy of respect. This leads to me being a better team-member and provider of patient care.
I’ve never had it backfire on me. No one has ever yelled at me or demanded another provider because I defined my boundaries. And the day it does backfire, I’ll stand by my decision to prioritize my safety.
5. I practice
I’m serious.
I’ve had over ten years of practicing how to sense when I’m in danger, when and how to leave a room, and how to call out inappropriate behaviours. It’s taken practice for me to do these things in a way that shows that, a) I care about the other person, and b) that I’m also a thinking-feeling-human who deserves respect.
As exemplified by my patient pulling my stethoscope forcibly out of my ears, I’m still learning how to protect my personal safety. I want to be a doctor and care for patients for a very long time, so I’m going to keep working at it.
Please let me know if you have any strategies or resources you use to prioritize safety in healthcare in the comments!
Stay well friends,
Dr. Kuhnow
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