It was the first day of a course in medical ethics at the University of Vermont medical school. As a graduate student in public administration, I had been invited to sit in on the class because of my research interest in health care distributional ethics. That made me the only student in the room who wasn’t training to be a physician.
I entered the classroom and took a seat. I barely had time to say hello to a couple of other students before the professor walked in.
The professor’s style was to ask a question and then call on a student to answer it. I believe the objective of this method was to scare students into preparing for class. Those who came unprepared risked public humiliation.
The professor dove right into a case study, which came as a surprise. A young man had been brought into the emergency room with a compound tibial fracture. The administrative policy of the ER was to dump any stable patient who was uninsured to the local county hospital. The professor continued: “You are the attending physician. The patient is stable, but you quickly determine that if this patient faces the delay of being transferred to the county hospital, he will likely lose a limb. What do you do?”
“YOU,” he said, as he pointed at me. My stomach migrated into my throat and back down again. My classmates’ faces were etched with sympathy, along with relief at having dodged this initial bullet.
As a survivor of a broken leg, I was pretty sure the tibia was a leg bone. “Compound” sounded bad (it was). I knew I had to find a way to admit the patient.
I took a deep breath. “I’m going to call the administrator on call,” I said, “and tell her I am admitting this patient to the orthopedic service so that he does not lose his leg.
“I’m also going to tell her that she can thank me later for preventing a lawsuit,” I continued, “and then I’m going to end the conversation really fast, before she gets a chance to tell me how she wishes I would practice medicine.”
The professor had only one word: “Good.” I thus survived, along with the fictional patient.
Weeks later, one of my classmates finally told the professor that I wasn’t a medical student. That moment was priceless. And I have to say that up until that moment, I had enjoyed him not knowing.
Sara Ann Conkling
2 thoughts on “My First (and Only) Day in the ER…”
I have been that administrator in the hospital—– lol!
Thank you for saving your fictional pt’s limb!
Thanks so much for sharing this heartwarming story! It shows the value of an inter-professional approach to patient care. Sometimes it takes an “outsider” to come up with the best solution!