Emergency medicine is practised in a fast moving, ever-changing environment. The individuals who work in emergency departments are required to think even faster and adapt even more frequently.The skills needed to perform at this level go far beyond the extensive medical training they all receive. The art of listening is equally important in the practice of any medicine, but doubly so in the emergency department. Every piece of information, every personal experience, every second opinion and every voice in the room may mean the difference between immediate and delayed action, sometimes even life and death.The tales recounted here illustrate how the tiniest detail can unlock a medical mystery, calm a child, comfort a loved one, or save a life.
Dr. Gene Dagnone is professor emeritus of Emergency Medicine at Queen's University in Kingston, Canada. He has authored and co-authored a wide range of emergency medicine articles in the medical and health services journals in Canada, United States and Great Britain. He has served on the editorial board of two emergency medicine journals. His learning, teaching, research and clinical care experience spans half a century.
In clinical practice, teaching and research, Dr. Dagnone and his emergency department colleagues are in search of the ‘best answer'. When answers are not available or weak, in terms of sensitivity and specificity, there are always better questions to ask and other possibilities to consider. The sharing of this anthology of experiences ‘in listening in the emergency department' focuses on the trust and translation of the listening that occurs between caregiver and patient, caregiver and ‘next of kin', caregiver with each other.
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The art of medicine seems hardly considered anymore, supplanted by the science of its practice. We as a society have, in many ways, given up on the idea that the practitioners of medicine are anything other than the purveyors and pushers of medical technology.
Increasingly, in the emergency department, each health issue — or presenting complaint in medical lingo — is reflexively subjected to medical testing to rule-out diagnostic possibilities: blood tests, X-rays or increasingly, CT or MRI scans, sometimes in diligent efforts to make serious diagnoses, other times to reassure anxiety-ridden people living in a stressed-out time.
But what is at the core of the art of medicine and is it still important? Perhaps not surprisingly, it takes a retired physician with nearly fifty years of medical experience to remind us this art of medicine is profoundly tied to the act of listening.
Gene Dagnone, professor emeritus and former emergency physician at Queen’s University in Kingston, Ontario, Canada and a mentor to a great many Canadian emergency physicians currently in practice, presents us with 28 clinical vignettes, each demonstrating the importance of talking, listening and interacting. A competent physician asks questions, listens to the responses of the patient and his family and adjusts his (her) list of diagnostic possibilities accordingly. Equally, because no emergency physician is an island, he (or she) also considers the input of nurses, resident doctors and colleagues who sometimes have unexpected, surprising insights. The consequence of not asking the right questions or ignoring the responses, Dagnone seems to suggest, is one path to medical error and poor outcomes.
Most of all, Dagnone reminds fellow physicians, residents, medical students, nurses and emergency department patients that the single most important contributor to a successful interaction in a busy, modern ER is not the blind application of medicine’s technological arm, rather it is old-fashioned human communication. Listening is part and parcel of the practice of medicine, which no amount of indiscriminate test-ordering can replace.
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