My son’s team the Earthquakes just won their league championship, undefeated and scored upon only twice. Many games were played with no or only one substitute player, rarely there were as many as three or four, yet the kids played 30-minute halves and they played full-out. Mike and Dennis shared goalie duties for most of the season since more than half of the season my son, Zoey, couldn’t play the position his customary second-half after fracturing two metacarpals while playing the weekend I was in Chicago administering oral examinations for ABEM (or was it attending ACEP)? This was his third year with the team and because of our pending family move from Philadelphia to Brooklyn, it will be his last. He’s already asked me if he can come back to Philadelphia on weekends to play next year. Surely he loves the game and is excited to play with his teammates. How did this come about?
I credit Steve Fillebrown, one of the fathers, the Earthquake’s coach and the League Commissioner. Most games this season I watched my son—wearing his sock-covered splint play offense, but I kept being drawn to watch Steve, who in his march up and down the sideline and his squat in the dust at the edge of the field drew my attention with his concentration, his many comments to his players and his rare words to a parent.
At a post-season barbecue at one of the assistant coaches’ home, I spoke to most of the parents present. While during the season we had cheered together and spoken some on the sidelines as our children played, at the barbecue I had the chance to learn a bit about each of them: career, avocations, travel experiences and other children. Through the thread of all of this conversation on an exceptionally warm November Sunday afternoon into evening our conversations all returned to Steve and what he had given our children: confidence in themselves, ambition to do better, courage to challenge opponents on the field, trust in one’s teammates and most of all love for the experience of playing soccer together.
I wish I could better help my emergency physician colleagues find similar joy in our work. I wish I could help colleagues find the strength to play full-out even when there’s no substitutes to relieve them on the field.
For nearly two years I’ve been writing about "leadership" with a special focus on our role as service providers to both communities and patients. Yet, recent postings on emed-l (subscribe using "ED Subscriber" at the www.ncemi.org website) leave me feeling dejected. These postings in a thread titled, "ED abuse," discuss interactions with patients referred to the ED by community based primary care physicians and specialists. Most writers seem to believe that this behavior is both abusive of the ED and disrespectful of the emergency physician. One writer comments, "Locally there is a lot of ‘abuse’ by doctors. Many routinely refer patients to the ED who clearly have non-emergent problems that could be better dealt with in the office with the availability of old records, previous knowledge of the patient, and sub-specialty expertise of the ‘referring’ physician."
In another time I would have launched into a polemic. After citing data about marginal costs of care of non-urgent patients and the value of offering a generalist’s "second opinion" to a practitioner and patient in need I would have figuratively waved my finger in your face suggesting all the while that you were neglecting your responsibility to your medical community and patients. But I’ve learned something from Steve Fillebrown.
It’s a good ball—your idea about holding your colleague accountable for referring the patient off to you and the ED. But your sentiment about abuse is neither a good pass nor a goal scored, because it is just your sentiment, not your team’s action.
If this behavior on the part of your hospital’s medical staff is "ED abuse," what is your team doing about it? Who is your team? Is your team just a few grumblers in the ED or have you built a coalition with the rest of the medical staff? Are you attacking the challenge by developing an alternative for delivering the service or through planning an educational program you will present to the malefactors whose behavior you wish to change? Or is your role as another emed-l correspondent wrote, ". . . to figure out what they [the patient] need[s] and how to get it for them, if that is possible."
Based on my soccer field experience I suggest that our role is to work as a team—a committed medical staff—in the ways that have already been defined—playing the game by the rules—and that as a consequence sooner or later our ball will go into the net, i.e., the patient’s care will be optimized and the load on the ED mitigated. Complaining about it won’t change things, practicing with our team—ED colleagues and members of the medical staff may just bring a score—in the future.
It seemed like at least once a game Steve Fillebrown would specifically praise one or another opponent’s play. Maybe the referring physician when sending the patient to you is similarly "praising your play." The question is not whether you or I have neurosurgical (or some other sub-specialty) expertise—we obviously don’t. No, it is the "new eyes and ears" the different approach to problem solving that’s wanted. If you can’t handle the ball, try passing it directly or even across the field—talk to each other.
Coed soccer on the weekends is a child’s game for 12-15 year old boys and girls. The lessons of trust, communication, teamwork, respect for opponents (challenges faced) are all worthy of our attention. For myself, Steve’s example on the field encourages me to moderate my polemics and focus more on the positives of each medical staff member while remembering that through teamwork we buttress each other’s weaknesses and call forth each other’s strengths.