During my year as an emergency department physician in a ski resort a woman came in with a sore throat. As I was working through the diagnosis, she stopped breathing. I remember her lying on the gurney, turning blue. I immediately shifted from the steady rhythm of a routine work-up to emergency mode – focused and fast. She required an emergency tracheotomy (making a hole in the trachea, or breathing tube). We had neither the equipment nor the specialists to stabilize her long enough to figure out what was going on. We loaded her into a helicopter, flying her from our rural town on the eastern side of the Sierra Madre to a fully equipped trauma center.

As I think back on this I recall traits necessary in an emergency situation. Clear, focused thinking and being calm in pressure-fueled situations are critical. I didn’t have time to say, “Oh, I’ve never done this before. I don’t know how to do it.”
I still have the letter from that woman thanking me for saving her life. It’s like penicillin to the infection of the Imposter Syndrome – not a cure-all but definitely a strong broad-range ego antibiotic.

Leadership Anemia

Managing a patient with only hypertension or managing a patient with only diabetes is much simpler than managing a patient with both conditions. Caring for patients, especially with chronic diseases and comorbidities requires a team. Some medications for hypertension are not recommended to be used in diabetics, and diabetics with hypertension may need additional medications. In such a case, the care team could include a primary care physician, a cardiologist, an endocrinologist/diabetologist, an ophthalmologist, a nephrologist, perhaps a surgeon, a diabetes educator and a nutritionist, each of whom may be communicating asynchronously with the others. Or not.

Hospital medical errors are now the third leading cause of death in the US. Poor communication is one of the leading reasons for preventable errors – often during the time when the care of a patient is handed off to the next physician or team.