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Editor's Notes

• #2: ----- Meeting Notes (05/11/2014 12:38) ----- Good morning. Thank you for the introduction. This morning I'm going to talk about some of the challenges we face doing research in Emergency Medicine and, by talking about my own personal experiences, about how and why we should all maximise our efforts to overcome them.
• #11: I want to start off with one of my favourite quotes, from a famous author, Stephen Covey, who sadly died a couple of years ago. It’s to “begin with the end in mind”, which Stephen Covey essentially suggests should be the foundation of everything we do in life. Consider what the ultimate goal is. What is it that we’re trying to achieve in our careers, our lives? I imagine that when we all decided to pursue a career in medicine, we had our reasons for doing so. We had an idea about what we’d be trying to achieve by practising medicine. Everyone has their ideas about what being a doctor is all about. So I want you to think about that for a moment. Why are you a doctor? What are you trying to achieve in your career, in your life? What would you say is the ultimate point of what we do? rest his soul, who was the author of one of the standout books of our time, The 7 Habits of Highly Effective People. Stephen Covey tells us that the first vital habit, which builds the foundations of everything we do, is to begin with the end in mind.
• #12: Some would say it’s about things like this… Money, prestige, power, sex, success…
• #14: … But most of us would say it goes deeper than that. It’s about using science to do all we can to help our fellow man - to prolong life in those who are too young to die; to ease suffering. That’s what I wanted to do when I signed up for a career in medicine… As I went through medical school, I was taught more and more that we should put an even more important principle before even thinking of the end that we have in mind – and those three words are the foundation of everything we do…
• #18: Now here's another thing that we often do very badly. I know that none of you would ever consider discharging a patient with chest pain just because they don't have any risk factors, but we do tend to place a lot of importance of the number of risk factors a patient has for ischaemic heart disease. If they have no risk factors, we feel a little bit reassured. If they have all 5, we feel worried. There's probably a good reason why we feel worried - we know that patients with risk factors are more likely to have IHD, so when they present with chest pain we rightly think that it could be an AMI. But what this study shows, again from our group in Manchester, is that the number of risk factors a patient has really doesn't seem to make any difference to the probability of AMI. Again, this is probably more of an emotional thing than a rational one. I suspect that some patients are being investigated for ACS simply because they have 4 or 5 risk factors, although clinically they really don't have ACS - they have something else. There's also an element of patient behaviour in there too - if you know you're at high risk of heart disease you're more likely to come in with any little twinge of chest pain than if you're previously completely healthy and never worried about your heart. I think the take home message is that we shouldn't ignore risk factors, but we certainly shouldn't place too much emphasis on them. What's much more important is what's going on right now. Don't let the past history interfere with that because it's what's going on right now that you need to deal with.
• #19: First, we asked them how they were suffering. What we see here is a word map. The larger the words, the more patients gave that particular answer. The answers tell us about the limitations to our current approach. I want you to think for a moment about what you do in your department to address suffering when patients first come in to the ED. We do tend to do something about it. We tend to ask patients to score their pain, perhaps out of 10 - but we don't do a lot else. Out findings show that pain is important - but it actually accounts for a minority of the total suffering that people are experiencing when they arrive in the ED. There are other physical symptoms that are almost as prominent - nausea, vomiting, dizziness, breathlessness, for example. And then there are the emotional symptoms - like anxiety.
• #20: Then we asked patients what they hoped we’d do to ease their suffering. The answer may seem quite surprising. The most common answers weren’t to do with fancy treatments or even simple painkillers. What people most wanted came from simple human interactions - reassurance and diagnosis.
• #24: Later, we asked patients what had happened to ease their suffering. What was really interesting is that the most common response was ‘nothing’. We did nothing to ease their suffering, which shows how far we have to go in this area. But, of the patients who gave a positive response, the most common ways in which we ease suffering aren’t to do with providing painkillers or any fancy treatments, but reassurance, explanations, being friendly. Simple human interventions.