Evaluate, Don’t Judge

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Our highly trained, creative brains move to solve potential problems in an orderly way by addressing the airway, breathing, and circulation as we record and note the vital signs.  What can we do immediately to address the deficiencies? Do we need an airway? IV fluids? Mechanical ventilation?  We compare our very real sick or injured patient to the ideal person with normal mentation, respirations, normal body temperature and ideal blood pressure. In this process of evaluation, we assess what is not working and what needs immediate attention. We start IV fluids, blood transfusions, and medications to address the problems. This sort of evaluation is constructive and useful.

Sometimes our evaluation takes a more negative turn. Doctors and nurses are human beings who’s thoughts naturally skew negative. Our brains default to negative thinking because this once served our caveman ancestors to scan for danger on the horizon. Their lives literally depended on that ability. We are experts at noting what is wrong and what appears threatening. In the case of a sick or injured person, evaluative thoughts are exactly what is required.

Additional thoughts churn in the background of the doctors and nurses. They are judging.   They are comparing the behavior of the patients to some idealistic version of how they think “good” patients should behave.

Those thoughts sound like this:

The parents should have given the child something for fever.

The patient should have been taken to the trauma center.

That guy shows up drunk every week.

That kid should have been wearing a helmet.

How come this lady did not get vaccinated?

The physicians and nurses judge that a person or family member is “difficult.”  We know about confirmation bias.  We have a tendency to search in the world for evidence of something which we already believe. If we believe that a person is difficult, a bike rider is careless, or a parent is negligent, we will certainly find evidence to confirm these beliefs.

Could we train ourselves to accept patients and their families exactly as they are?  Maybe they don’t understand how to give medications for fever? Perhaps that lady is frightened of getting the vaccine?  Maybe this is the only place that injured person could get to? Maybe that man did not understand how badly he could get injured on a bike? Can we give our patients the benefit of the doubt?

If we could remove the harsh judgment; we could generate kinder and more compassionate thoughts and feelings.  We can see that an injured bike-rider is someone’s son. The guy who shows up drunk is someone’s father. He needs medical evaluation, fluids, and shelter until he can be safe to leave. We can nudge our thoughts to ones that serve us and our patients better. Don’t focus on what has gone wrong; find something that has gone right. Don’t find ways to blame them; find ways to help them.

Dr. Joan Naidorf is an emergency physician, author and speaker located in Alexandria, VA.  Her book, Changing How we Think About Difficult Patients: a Guide for Physicians and Healthcare Professionals, is published by the American Association for Physician leadership

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