John Hinds coined the term #resusWANKER at his amazing SMACC lecture on thoracotomy. I created this lecture on resusWANKERS in dedication to John and gave it at the Teaching Course in NYC with Rob Rogers. I gave it a second time at the Royal College of Emergency Medicine meeting in Manchester. This recording came from the third and final iteration in Glasgow, Scotland. I'd love to hear what you think–please comment below:
the seven resusWANKERS:
1. Wrong-but-Strongers (Dunning Kruger Effects)
- J Pers Soc Psychol 1999;77(6):1121
- Are We All Less Risky and More Skillful than our Fellow Drivers? (DOI: 10.1016/0001-6918(81)90005-6)
- Dunning When Knowledge Knows No Bounds- Self-Perceived Expertise Predicts Claims of Impossible Knowledge
2. Name Badge Believers (Specialty Name Bias)
3. Water Torturers (Decision Fatigue)
- PNAS 108(17):6889
4. EKG Thrusters (Slips/Sterile Cockpit)
- Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study (Anesthesia and Analgesia 2016, 122 (2): 512-25)
- Noise Levels in Surgical ICUs Are Consistently Above Recommended Standards. (DOI: 10.1097/CCM.0000000000001378)
- Task Interruptions and Error Rate
5. Leadership Encroachers
6. Slothful and Avoidant
7. Just Plain Dicks
Now watch the lecture…
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Scott Weingart
An ED Intensivist from NY. No conflicts of interest (coi).
Top stuff, charismatic and insightful.
Cognitive load and decision fatigue for us squeezed middle-grades is a major problem in the E.D. With little consultant shop-floor presence, career middle-grades bear the brunt of the front-line minute-to-minute decisions. Pressure to see numbers as well as support increasingly spoon-fed juniors is a difficult balance to maintain. Especially if you are seen as approachable and sensible, you tend to be favoured over other colleagues, increasing your cognitive load.
My pet hate is the “ECG pushers” who give you not one but TWO ECG’s for the same patient. Not only are you expected to pick the best, like they’re competitors in a best in show beauty pageant; you then have to sign off and make decisions based on the clinical story, all the while trying to complete your task in hand. I now get them to pick which one they want me to sign and throw out the other in a dramatic, petulant toddler fashion. It is very satisfying.
Any other tips on decreasing decision fatigue, especially in a limited staffing environment?
Take care,
Sandy Nelson, Specialty Doctor, EM in sunny Northern Ireland
Loved the lecture! One note re food at clinical workstations: Federal regulations actually do NOT prohibit clinical staff from eating at the workstation. Hospital administrators have abused/misinterpreted an OSHA statute about infection control to make this a blanket rule in clinical areas.
Here’s the text of the actual rule: “Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on countertops or benchtops where blood or other potentially infectious materials are present.”
So as long as you don’t keep blood/urine etc at your workstation, you’re free to eat there from a OSHA’s perspective. Here’s a letter from OSHA explicitly saying this:
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=25506
In residency, I printed copies of this letter and handed them to administrators giving me grief about food. I proudly eat and drink throughout my shift at my workstation.
hey buddy, great to hear from you! yep, well aware of the letter–admins actually use its contents as justification, stating that since all areas of the ED are exposed to tubes/specimens/etc. that this is actually condoning rather than condemning the ban. Would need to actually tape border the area and declare it as a no labs zone to satisfy the JC inspectors (which is prob. what we will wind up doing in my current unit).
Hello Scott, my name is Carlo Alberici, I’m a Prehospital Resuscitationist and I’m also a member of the Italian Society for Emergency Medicine (SIMEU – Società Italiana di Medicina di Emergenza-Urgenza). Let me begin by complimenting you on your lecture on ResusWankers (I too am a fan of the late John Hinds and I loved his SMACC lecture concerning “wankers”). In fact, during my shifts I frequently encounter these people as you would call them “S Hitters”. At first they may seem annoying but looking back at every emergency intervention they do help me reflect on how I approached each situation and how I handled it and most importantly how I could improve myself and my team for the next time. I would like to share a personal experience during a shift I had in the field. My ambulance team was called to intervene for a ACS patient with chest pains not subsiding with sublingual nitrates. Upon our arrival we documented a STEMI in act. We applied protocol therapy including a thrombolytic agent (after discussing the patient situation with the chief cardiologist on duty) and stabilized the patient for transport to the main critical care hospital by helicopter (unfortunately the… Read more »
thanks so much for sharing that Carlo!!!
Fantastic presentation, and a fitting tribute to John Hinds.
I especially loved what you said about giving aggressive care to the sickest patients, which is something I often come up against as the one of the most junior members of the team.
My name is Chileshe Mabula and I am a JRMO (Junior Resident Medical Officer, equivalent to a first year intern), in Chipata, Eastern Zambia. I’m interested in your thoughts about keeping Operating Theatres “sterile” (I know surgeons aren’t your favourites :). Do you feel it’s detrimental to play music or chat in that setting . . .should there be a training level below or above which extraneous elements should be disallowed, or just be points during procedures when everything should be shut down except the task at hand?
Thank you for all your amazing work, and contributions to FOAMEd.
So there is huge debate in the surg/anesth world on this very topic. My take–music is assoc with entering flow state in folks, and you def. would love to have your surgeon in flow. I think leaving the music off until the pt is induced, all set, and good to go makes sense. At that point, turn it on based on the surgeon’s preference. If something goes wrong, kill the music.
[…] EmCrit: How Not to be a #ResusWanker […]
Just loved the Resus Wanker episode. So easy t relate to. It seems the presence of these people is worldwide. Hi from Sydney Oz
Thanks Scott,
Loved this talk as ever.
When will W-Anchor T-shirts / Resus Wanker posters & checklists going to be available for purchase?
Myself I guess I score about 3/7 on a good day but exposed to all 7 wankers most shifts.
I’m sure John would had loved whole talk. RIP
Regards
Ed Egan FACEM
Emergency Physician
Murwillumbah & Royal Tweed Hospitals
Flight Doctor, NNSW Retrieval Service
thanks buddy!
Great lecture. I don’t think it will be possible to hear it in my country – probably to many #resus wankers.
I’ve sent a link to my friends. I thought a lot about what you have said and that’s true – thanks for sharing. 🙂
Absolutely brilliant talk. I think this talk may define your career, Scott.
J.Kim
EM
Thanks, buddy!
Hi Scott, love your work, big fan!
Just wondered, do you have any advice to avoid falling into the “Wrong but Strong” trap? It’s frightening that it happens to everyone, yet we are not warned about the phenomenon before hitting the wards. It’s a big thing that scares me personally (that I could be doing it) and of course, you don’t know what you don’t know – it would seem prevention and awareness is better than cure??
Love to hear your thoughts.
Thanks!!
Natalie, NZ based UK Grad, currently moving between ED and Rural Medicine, and also a bit of General Practice thrown into the mix. Fun and games!