Positives this week – seeing leadership and new confidence express itself in an ED registrar’s board round. Plus nurturing the leadership wings in a member of an ED Frailty Intervention Team (that I am responsible for).

The monthly ED journal club continues to mature, in particular relationships and shared learning between the registrars. An opportunistic teaching moment this week – reinforcing the ethics/integrity that must be at the heart of everything we do as clinicians – research and beyond.

My most difficult moments this week – experiencing the physical symptoms and the hit to psychological safety that arise from management meetings without good governance. Observable changes in concentration, mood, energy levels, headache – not dissimilar to carbon monoxide poisoning!

Personal area to grow – allowing myself the self compassion to focus on what matters most and let go of career aspirations that necessitate carbon monoxide type toxidromes.

What does “human factors” mean in an Emergency Department world of Covid 19 and how can my ongoing training in it make a difference to where I work ?

As a first step, I am introducing Zoom based sessions on quality improvement methodologies, adapted to my local setting. Gently redirecting attention from our circle of concern to our sphere of influence – individually and collectively.

My belief – action and agency in these difficult times help relieve suffering and maybe even promote well being in the workplace. Compassion in practice.

Which comes first – my role as a doctor or my role as a human being ?

Recently, with clinical need exceeding inpatient bed availability, patients have been forced to spend the night boarded in their local Emergency Departments. Which brings me to my dilemma.

Imagine I come in at 8 am. I start with a “ward” round on these overnight patients. I come to patient number two and find a frail 81 year old lady who has been in ED for hours with very little to eat or drink. I look for a health care assistant or hospital volunteer who could bring my patient some breakfast. There isn’t anyone. I look for my patient’s nurse and find she is stretched between several other patients, about to start antibiotics on someone septic while simultaneously organising the urgent transfer of a patient she needs to take down to CT. (gone for another 30-40 minutes at least). So it comes down to me –  do I  stop the round and make tea and toast for this lady and other overnight stay patients myself ? Or do I delegate the task –  knowing it may be an hour or more before it gets done – and instead check whether the remaining boarded patients have serious medical problems to sort ?

I honestly don’t know. Like Australian Lieutenant General David Morrison, I believe the standard you walk past is the standard you accept. And this is a standard I can not accept.

My friend and colleague Damian Roland wrote about being the kind of consultant who answers the telephone.

Another friend (and fellow ED consultant) routinely pushes patients on trolleys to the CT scanner when a hospital porter isn’t available.

While noble and good for the individual patient concerned, I wonder if such actions might weaken the system further, putting future patients (and staff) at greater risk. (“We don’t need more reception staff / porters / health care assistants – the doctor can answer the phone / push the trolley / get breakfast…”)

I guess some of it depends on how we as doctors communicate these issues to hospital managers, and how hospital managers in turn respond.

Till then however, my dilemma remains …