Remember the Professionalism APGAR during times of stress

What does it mean to be a professional? And how do we maintain our professionalism at a time when things such as stress, burnout, and caregiver fatigue threaten our motivation? As an anesthesiologist, the ability to remain professional in many scenarios is something I constantly strive for. Aside from how it affects my relationships with the interdisciplinary OR team, professionalism is an important attribute given that my job requires patients in vulnerable positions to almost instantly trust me with their lives.

In medical school, we learn early that one of the best ways to remember important information is to attach an acronym or a catchy phrase to complex concepts. One example is the APGAR scoring system for assessment of infant well-being. I learned to remember the constituents of the score by applying descriptive terms to the name: Appearance, Pulse, Grimace, Activity, and Respirations. These same five letters can also be used to remember important components of professionalism:

A – Appearance. Anyone who has been coached on public speaking knows the edict, “dress a notch above your audience.” However, in a workplace where pajamas (aka scrubs) are acceptable dress, this can be challenging. Consider donning the white coat whenever possible (and clean). Is there any blood on your scrubs? Ink scribbles? Also consider your accessories. Avoid chewing gum or eating/drinking anything in front of patients, who for various reasons have often been restricted from doing so themselves. And in this age of Internet and social media, we must remember that appearance is not just physical!

P – Presentation. How do you introduce yourself? It is important to strike a balance between formal and familiar. Initial use of last names is most appropriate, while asking the patient what they would like to be called makes things more personal. The way you present medical information MUST be tailored to their level of sophistication. Using “big words” might be automatic when you’re stressed and hurried, but patients can be left with a disjointed understanding.

G – Gravity. Concerning professionalism, one of my mentors always said, “Acknowledge the gravity of the situation.” If your patient is presenting for a surgical procedure, this is a big day for him/her. Maybe your patient is seeing you in clinic for a problem that is central to their lives, one you may view as rote because you have treated it so many times before. Patients see a physician for a service that they themselves are not capable of performing, and thus that service is very important to them.

A – Audience. Who else is in the room? NEVER make assumptions … The worst way to start off a relationship with your patient is to accidentally refer to her husband as her father! Is the other party in the room a primary caregiver or decision-maker, or are they playing on their cellphone waiting to head to Starbucks? That being said, privacy is central to any professional relationship. If you must ask sensitive questions or perform a revealing examination, consider the Audience! You can ask the patient if he/she wants them to stay, or you can graciously ask them to leave. For anesthesiologists, this comes in handy when asking about substance abuse history, sensitive medical history, or even performing a difficult IV.

R – Relativism. In medicine, we have an automatic means of connecting with our patients … we are all human, and nothing can change that. We have the capacity for empathy in whatever situations our patients might experience; the key is to recognize that connection and use it to relate to them! No matter how rich or poor, educated or unsophisticated, we have all gone through traumas or addictions or bad times.

I’ll bet you think you would score perfectly on my Professionalism APGAR, but truly, no one is consistently professional all the time (just like babies never score 10/10). May you remember it during your most challenging moments in the dance between doctor and patient.

Dawn Baker is an anesthesiologist who blogs at PracticeBalance.

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  • StephenModesto

    …Thanks…l will copy/paste this clever and insightful acronym. As genereal principles, each category seems truistic, but collectively the group provides a very well styled social strategy.

  • Robert Luedecke

    Dr. Baker, thank you for an outstanding article. As a fellow anesthesiologist I especially identify with the need to have patients trust us with their lives after only spending a brief time with them. After having surgery myself, I know it is extremely important to show patients that we truly care about them and will make this as easy as possible for them. I believe an added benefit of this trust is that my job will be easier and the patient will have fewer complications if they are more at ease. Maybe someone can do a study to see if this can be measured in lower nausea rates and less airway reactivity. Keep up the good work!

    • http://www.practicebalance.com/ PracticeBalance

      Thanks so much for your comment! I too have had recent surgery, which affects how I think about the day-to-day perioperative actions I take with my patients. My blog has a post about being a patient; check it out if you’re interested. I like your idea of n/v and reactivity as “patient satisfaction” metrics, since it’s difficult to measure satisfaction immediately postop.

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