As a family doctor and team physician, I have been involved in many medical emergencies in the hospital and on the playing field.  Training programs provide the algorithms and protocols – the “hard knowledge” – of what to do in these situations.  But even the best training doesn’t guarantee good performance.  Some people have an “it” factor that allows them to keep a cool head, see things others miss, and elevate team members to give the best care possible.  It is these “soft skills” that make them good leaders and thrive under pressure.  

Thankfully, we can all learn these traits to improve our performance.  Practicing these five soft skills can help you feel more confident and provide better patient care during a medical emergency.

1. Be Present.

When patients are facing a crisis, the least they can ask is to be treated by a focused doctor.  However, it is easy to freeze when the stakes are highest.  Sirens are blaring, the lights are bright, and someone is in mortal danger.  Understanding what brings you into the moment can help you think clearly.

This is different for every person.  A common maxim in medicine is “Before taking the patient’s pulse, check your own.”  One of my physician mentors always takes time to don a pair of exam gloves before entering the room where an emergency is taking place.  Another clearly delineates roles from the outset.  As for myself, I have to physically touch the patient in order to get focused; if I don’t, I feel disengaged, like I am only observing.  

So how do you know what makes you present?  Practicing stressful situations makes perfect, but we would prefer to have this figured out before the heat is on.  Often, things that help us focus in other high-stakes situations will work in medical emergencies.  Think of another time you faced something stressful, like taking a big test or speaking in public.  The same techniques you use to calm your nerves in those environments will also work during a medical crisis.

2. Be Patient.

When we encounter an emergency, many of us want to dive in and solve it immediately. It’s an emergency, right?  It needs to be addressed now!  However, there is no situation so dire we can’t make it worse by rushing.  I remember helping a new physician perform a C-section, and the baby was stuck inside the mother’s pelvis.  Both the mother and baby were stable, but the physician panicked.  She began pulling hard, trying to disengage the baby’s head.  This wound up causing tissue trauma to the mother requiring a complicated repair.  

If there is no immediate risk, take time to evaluate the situation and make a plan before acting.  If the patient is having a hard time communicating because of pain, give them time to calm down and explain what is happening.  Work fast enough to address a problem before it reaches a critical point, but don’t go so fast you make mistakes or have to do things twice.  In tense situations, I often think of Jesus’s words to Judas Iscariot in John 13:27: “That thou doest, do quickly.”

3. Be “Humerus.”

I am not saying a crisis is the time to try out your stand-up routine or discuss the latest episode of your favorite sitcom.  However, a little lightheartedness can give the medical team and the patient permission to take a breath and think through problems.  “Humor can be a great mechanism for dealing with stress,” says Art Markman, a cognitive scientist at the University of Texas.  “A key element of jokes is that they force you to look at the same situation in different ways.”  

I worked with an athletic trainer who referred to all female patients as “Chica.”  When she approached an injured patient to start her assessment, she would begin with, “Hola, Chica, what’s going on?”  This often caught the patient by surprise, and you could see her thinking, “What did she just call me?”  Then, the patient would laugh, calm down, and explain what hurt.

I also had a colleague who, while performing surgeries, referred to a large pair of forceps (surgical tweezers) as “Big Betties.”  This wasn’t their correct name, and everyone knew it, but it always elicited a chuckle from the surgical team.  In emergencies, this lightened the mood and helped everyone focus.

Dr. Markman emphasizes, “Humor can benefit people experiencing stress, but only if it is used in the right way.”  When employing humor, focus upon jokes that build and empower your team.  Doing so can make even a medical emergency a growing experience.

4. Be Organized.

You may need to access equipment quickly, and knowing where things are reduces stress.  Nothing raises blood pressure like hunting through your medical bag while a patient is languishing.  Here are a couple tips:

• Be thoughtful about how you pack your equipment.  Put things in logical places so you can find them easily.  Group similar items together.  

• Practice accessing your equipment.  Use scenarios where you must find items for specific problems.  You can even gamify this for team building.

• Take inventory of your medical bag and restock frequently, but don’t overpack.  Filling your bag with things you don’t need makes it harder to find things you do.

5. Be Mentally Prepared.

Most sporting events I cover start with the national anthem.  While the song plays, I close my eyes and do something that may seem morbid: I envision myself putting a patient on a spine board.  I mentally run through the assessment on the field.  I think of where my tools are, who will help me, and how to stabilize the neck.  I also think of other potential life-threatening emergencies that can arise during the event.  By the time the song ends, I have put myself through a dry run of the worst things that can happen that day, and I am ready to rock.

When you come to work, take a moment to think through problems you may encounter.  This exercise might involve others on your medical team.  At sporting events, it is called the medical timeout; in the hospital, it happens at shift change.  Visualize encountering a problem, and then visualize yourself responding appropriately.  If you realize you need to prepare further for a potential issue, do so.  This helps you plan for success before the emergency occurs.

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