Harvard Macy Institute - Blog - The Power of Interprofessional Education

The pager on my hip beeped at 1:22 am with a call from the ICU. The nurse on the other end asked if I would please come down and pronounce a patient who had passed away. “I’ll be right there,” I responded, put down the admission note I was writing, and set off toward the ICU. This was my first inpatient medicine rotation as an intern, so I was embracing this task with a mix of overconfidence and not knowing what I didn’t know. I was also trying not to disturb my senior resident who was either addressing some important tasks or sleeping. Hitting the wall plate to open the double doors to the ICU, a nurse behind a desk pointed in the direction of one of the patient rooms. As I approached the room, I realized that I didn’t actually know how to pronounce a patient and had never been taught how to do so in medical school.

In those first few months of residency, my security blanket was a small stack of books that I carried everywhere I went…books like The Massachusetts General Hospital Handbook of Internal Medicine, The Washington Manual, and The Sanford Guide to Antimicrobial Therapy. There were a few others whose names I don’t remember, and all of these made my small stack of books quite sizeable and a source of humor for some of the senior residents. I assumed they must have committed all of this information to memory and didn’t need to carry around any books, but I still found them comforting.

Armed with this wealth of information, I went to one of the desks in the ICU, sat down, and started to flip through the books to find out how to pronounce someone dead. As I read through the indexes and tables of content, I began to realize that this particular topic might have been overlooked by the authors of these books, but I took to speed reading in the hopes that I might still find the instructions I needed. When that failed to yield the necessary information, I got up from the desk and subconsciously decided to do what every intern does at some point: fake it till I make it.

Approaching the intended room and seeing the lifeless body in the hospital bed, two thoughts immediately raced through my mind. The first was “thank goodness there is no family in the room because I have no idea what I’m doing.” (Please don’t try to claim you never had that thought as a resident.) The second thought I had was more ridiculous and probably rooted in watching shows like MASH and People’s Court growing up. The brilliant idea I had was that I probably needed a Bible to put my right hand on to make this pronouncement official. Makes sense, right? With this requirement in mind and no doubt to buy myself a few more minutes to think, I turned around and headed back to the desk where I had been sitting with my now useless pile of books.

Now, a bit of context is probably required for all of you thinking that I should have just Googled this topic, looked it up on my smartphone, or used an app. The problem with your solution is that is this story takes place in 1998. Google wouldn’t be founded for a few more months and wouldn’t be widely used for quite some time after that. Smartphones had not yet been developed. Cell phones were only used for calling and primitive texting, and I didn’t even own one yet. So, the app option was out. I sat at the desk staring at the computer monitor in front of me, which at the time was useful only for pulling up lab results and looking up the most basic information on the internet. A lot has changed, and with the technology available at the time, I was basically wishing for a miracle.

At this point in the story, I was getting desperate and started opening drawers in the hope that I would find a written protocol for how to properly conduct a pronouncement, a book that might include this topic, or even that Bible that I thought necessary. As I rifled through the drawers and became more frantic, I realized that I wasn’t going to find what I needed. Just then, a hero in scrubs appeared behind me, put her hand on my shoulder, and said “Sweetie, is there something I can help you with? You look kind of pale.”

With the glistening of tears of relief in my eyes I replied, “Yes, there is. I was called to pronounce a patient and don’t have any idea what to do. They didn’t teach me this in medical school.” This amazing ICU nurse with more experience than I had years on this planet chuckled slightly in the kindest way possible and said, “I figured. You looked like you could use some help.” She then sat down next to me and talked me through the necessary steps. She had already done more than I could ever repay, yet she had the wisdom and compassion to walk into the patient’s room with me to make sure I knew what to do and was not alone during one of these most sacred moments in medicine. As we left the patient’s room, she walked me back to the desk and made sure I knew what to write in the patient’s chart. At the time I wondered how she knew I might need help with this as well. In retrospect, I realize that she had no doubt helped a lot of other interns before me.

Post-script

I tell this story every year to our interns during their orientation with us because there are so many lessons to be learned here. No one knows it all, especially a new resident who is just beginning the next phase of his or her training. The attending who seems like he has figured it all out probably hasn’t, and s/he was once in your shoes. Caring for patients requires teamwork, and we should never feel alone. In this challenging career in medicine, it should always be okay to ask for help. Nurses have so much to offer physicians during their training and beyond, and they are a wonderful source of knowledge, experience, and wisdom. We would be wise to involve them more intentionally in medical school education.

I often wish I could go back and adequately express my gratitude to this particular nurse. Though I cannot do that, I feel that I honor her by telling this story of her kindness, compassion, and dedication to patient care and medical education. There are other lessons in this story and in similar stories we all could tell. I welcome you to share them with our medical community.

Relevant References

Bridges, DR, Davidson RA, Odegard PS, Maki IV, and Tomkowiak J. 2011. Interprofessional collaboration: three best practice models of interprofessional education, Medical Education Online, 16:1,6035, DOI: 10.3402/meo.v16i0.6035.
Hunt LM, Fisher AK, King I, et al. Primary care collaborative practice in quality improvement: description of an interprofessional curriculum. Am J Health Syst Pharm. 2018; Oct 3 [Epub ahead of print] doi: 10.2146/ajhp170103.
Safabakhsh L, Irajpour A, Yamani N. Designing and developing a continuing interprofessional education model. Adv Med Educ Pract. 2018;9:459-467. Published 2018 Jun 25. doi:10.2147/AMEP.S159844
Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD000072. DOI: 10.1002/14651858.CD000072.pub2.

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Theodore X O'Connell

Ted O’Connell, MD [Leading Innovations in Heath Care & Education, ’18] is a Founding Residency Program Director at Kaiser Permanente Napa-Solano and Associate Clinical Professor in the Department of Family and Community Medicine at the University of California, San Francisco. Ted is the co-founder of ExamCircle and Editor-in-Chief of Elsevier’s Clinical Key MedEd. Ted’s areas of professional interest include faculty development, medical education, and medical writing. Ted can be followed on Twitter, LinkedIn, Facebook, Instagram, or at his website: tedxoconnell.com.