The power of a positive attending

I walked into the emergency department and met my new preceptor, who introduced himself and told me to get access to electronic medical records.

“There is a patient in trauma room 1, status post MVA with several lacerations.  Are you comfortable with doing repairs using simple interrupted sutures?”  he asked.

I answered truthfully that yes, I know how to suture.  Then he told me to go do it.

“Don’t you want to observe me first?  To make sure I’m doing it the way you want?”

He answered easily. “Do I need to?  You know your own abilities better than I do and you said that you know how to do this.  I believe you.”

I know my abilities and I know how to suture. The part that was surprising to me was his reaction to my honesty.

I. Believe. You.

This attending doctor did not make me fight for his trust.  I was used to preceptors making me prove myself for the first three weeks of a rotation and then giving me quality experiences for the final week. Sometimes it seemed like I had to jump through many more hoops than my male counterparts to earn this trust.

This doctor assumed I was good and gave me the opportunity to prove him right instead of assuming that I was inadequate and eventually giving me the opportunity to prove him wrong.

A few shifts later, he asked me to go manage a patient who was complaining of bugs crawling all over his skin.  The assumption with complaints like these is that the patient is hallucinating.  I acknowledged that it was the most likely explanation, but ended up spending over 40 minutes with this patient.

Ultimately, the most likely explanation proved true.  The patient was suffering from pseudoparasitosis; visual, auditory, and tactile hallucinations of parasites crawling all over his body.

When I was confident that this was his diagnosis, I was honest with the patient.

“I know that you see, feel, and hear these bugs on your body, and if it were me, I would be desperate for help.  I am going to consult with a more experienced physician and will be back with my recommendations for treatment.  Our mutual goal will be to get rid of these bugs.”

I walked back to the attending and a man, an experienced emergency nurse,  marched up to us, clearly angry.  “Why would you do a full skin exam on that patient?  This is an emergency room, not a support group.  Stop babying the patients.  Stop coddling adults.”

I responded in the same way that I always do when reprimanded:  I apologized profusely and promised to do better.

The nurse rolled his eyes and left. The attending turned to me calmly, “Why did you apologize for making a decision that you believed was best for your patient?

“Do you believe you were wrong? Did he offer you even one compelling and evidence-based reason that your approach to this patient would result in a worse outcome?”

In a few short minutes, I would ask this patient to trust me with more than three of his senses. I asked him to see a specialist and to take psychiatric medications that I genuinely believed would get rid of his bugs.

Would I believe a stranger if put in the same situation? Probably not. If I did, it would be because they listened to my story, they examined my body, and they showed me genuine empathy.

I wasn’t responding to this patient in this manner because I wanted to coddle him.  I wanted to organically gain his trust so that he would comply with the treatment that would ultimately give him relief.

The truth my attending taught me through this encounter was unforgettable. Just because someone disagrees with me doesn’t mean that I’m wrong.