Megan Hickie: Harnessing emotions

WHAT is emotional intelligence, and is it an important trait for junior doctors?

Recently I was called to a deteriorating patient during an after-hours hospital shift. I was covering the ward on my own and hadn’t met the patient before.

As a very new and junior doctor, you can imagine my initial terror when I glanced at an observation chart of sharply decreasing vital signs, and a panicked, suddenly short-of-breath patient. When the nursing staff asked me with alarm how I would like to proceed, I realised with a jolt that there was no one else coming.
    
I had been taught at medical school the steps that needed to be taken — immediate oxygen via non-rebreather mask, electrocardiogram, bloods, arterial blood gas and a mobile chest x-ray. How many times had I parroted that concise little inventory of pass-mark-worthy investigations during exams? But this wasn’t a simulation, this was a real person.

This patient, who reminded me of my own grandmother, and her noisy, laboured breathing, was causing an explosion of anxiety in the pit of my stomach.

“What would you like to do?” the nurse asked for the third time. I was going to have to engage a different part of my brain than that which had been silently taking notes during ward rounds for the past 7 days.

I needed to use some emotional intelligence.

After a slow, deep breath, I moved confidently to the bedside. I held the patient’s hand and explained what might be happening, and what we were going to do. In the calmest voice I could muster, I asked one of the staff to remain with her, and the other if she would deliver the bloods I had just collected, to the lab.

I walked as fast as my feet would carry me to the nearest phone — politely but firmly declining four requests for new medication charts that pounced from nearby rooms as I sped down the hall — and dialled the intensive care unit (ICU). Madly flicking through notes, I tried my best to convey the urgency of the situation, without blurring the details of the case with my own overwhelming desire for assistance.

When I got back to her side, I relayed the plan to my worsening patient; now on a maximum oxygen requirement with no visible improvement in her saturations. “The intensive care doctors are on their way and the test results will be a few minutes longer. Do you have any questions about what is happening?”

She looked up at me desperately through her mask and puffed: “I’m scared”. “Me too”, I thought, but I said nothing, blinking away the stinging feeling in my eyes, and squeezing her hand.

I wonder if there is any course that could have prepared me for that moment, or help me reflect upon it and do better next time. Research published recently by JAMA Otolaryngology–Head & Neck Surgery, involved a series of emotional intelligence (EI) interventions for residents at the University of Kansas Medical Center.

The interventions included taking an emotional quotient inventory (EQ-i) test at the beginning of the year, before undergoing an 8-hour EI training program in managing high-stress simulations, and a full year of mentoring and modelling from faculty leaders in EI. The residents then retook the same EQ-i test at the end of the year.

Interestingly, the study found that the EI interventions raised department mean EQ-i test scores from average to high average, increased patient satisfaction with the department, and was enjoyed by almost 100% of the participating residents.

EI is such a crucial element to working in a hospital environment, and yet the development of skills in breaking bad news, managing a team, prioritising tasks and dealing with autocratic superiors receives so little focus in medical school.

In the era of postgraduate medical degrees, many junior doctors today are interns and residents at a much later age than the generation before us. For this reason, we may bring with us a more solid foundation in EI capabilities from previous professions, parenthood and more broad life experience than the interns of 20 years ago.

However, we still need to learn from our superiors how to deal with emotionally complex situations, which are very much specific to the practice of medicine and the management of patients in hospital.

I know this to be true from the wave of relief I felt when the ICU team did arrive, and so skilfully allayed the fears of my patient — and myself.

Dr Megan Hickie is an intern in internal medicine at the Canberra Hospital. She is the former editor-in-chief of the Medical Student Journal of Australia (MSJA).