Seven C's That Can Help on Your Next ED Shift

PHILADELPHIA -- Want to make better use of your brain on your next emergency department (ED) shift? Follow these seven C's, psychologist Helena Boschi, PhD, MSc, said Monday at the annual meeting of the American College of Emergency Physicians.

The reason these hacks are needed is that the brain has two major design problems, said Boschi, who is based in London. First, the brain is designed to avoid death, not to embrace life. As a result, "the brain hooks to bad news.... Negative information sticks like glue."

Secondly, the brain tends to make decisions based on very little information, she continued. "We don't have the brain power or time to deal with everything; our brains are designed to stop us from paying too much attention" to too many things. And when we're stressed, we tend to seek out familiar patterns and actions. "The more uncertain you feel, the faster you seek closure."

Boschi's seven C's include:

Comfort with uncertainty. "Accept that this will always be tough," even though emergency physicians will argue that they're better than many other people at dealing with uncertainty. "Break your routine; discuss uncertainty between you and your patients. You need to feel that this is something you're going to have to live with." She urged the audience to stay physically fit, noting that that is the body's biggest defense against cortisol, "because the brain and body are so connected."

Control is not always possible. "We hate being sold to, but we love to buy," said Boschi. "Whenever we're told to do anything, psychologically we push back." When you're treating patients, change the context and focus on what you can do, not on what you can't control.

Carve out space to think. "Just a tiny pause helps the brain to make a better decision," she said. "You can't think when you're busy doing, and snap judgments may lead to the wrong conclusion.... Slow down your thinking and put the brakes on."

Checks and balances are important. Boschi noted the primacy of the "anchoring" effect -- the idea that you make decisions on what you've seen previously. That's why, for example, restaurants might list the most expensive item first, because "the $41 steaks make you order the $36 lamb chops" -- the lamb chops suddenly look cheap compared to the more expensive item, even though you might ordinarily consider that price expensive. Similarly, "physicians may anchor to a previous decision," which is why getting a second opinion may often be a good idea.

Courage can be a virtue. Brains do well when they collaborate with other brains, but they also have a need to fit in, Boschi said. "We'd rather be wrong together than right alone. Show courage by saying, 'I don't know.'"

Challenge your view of the world. "We seek similarity," she said. "Flip your stereotypes.... Take someone else's perspective. You need to be flexible and remember that one size doesn't fit all."

Curiosity is essential. "Engage yourself in your environment," she said. "Be an expert who's interested in everything. See everyone and everything as an opportunity to learn, and keep an open mind."

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