Medicine and backup quarterbacks

Tuesday, September 16, 2008

For the past few years, Matt Cassel and Aaron Rodgers have shared the same fate. They were back up quarterbacks who came to practice each day and worked just in case their services might be needed. Before last week, there was little need for those services as they sat on the bench watching two of the game’s great quarterbacks play on the field. But injuries, retirement and trades happen and the skills that were honed or perhaps rusted on the sideline were ready to be used.

Medicine is no different. Doctors and nurses learn a variety of skills and procedures, knowing that they may seldom be used in the course of their careers. Yet they practice them over and over, ritualistically, so that if the time comes, the actions become automatic, as if they had been performed on a daily basis. The team concept exists in medicine as well. In the operating room and emergency department, roles are assigned so that the team functions efficiently. A doctor is in charge of making certain that the patient is breathing, another is the surgeon. One nurse may be in charge of procedures while another takes care of injecting medications. And just like in football, everybody needs to do their job properly for the play to work.

Life-saving opportunities happen all the time in the hospital, but for most physicians in an office practice, it is a rare time when an emergency falls into the front door. For that reason, standardized courses exist to teach guidelines for resuscitating hearts (Advanced Cardiac Life Support), injuries (Advanced Trauma Life Support) and kids (Pediatric Advanced Life Support). Their purpose isn’t to make cardiologists, trauma surgeons and pediatricians out of family physicians, rather they teach the initial resuscitation techniques so that the patient can survive to get definitive care. The courses provide the playbook as the game starts.

Imagine though, that you’ve taken the course and can readily describe a life saving procedure. Imagine that you’ve seen it performed in the past by somebody else but you’ve never actually done it yourself. Once or twice in a career, a physician may be faced with the need to do something they have never done before. The options are limited. Do nothing and the patient dies; do something for the first time and the outcome may not be different.

The basics of emergency care begin with the ABCs: Airway, Breathing and Circulation. If the airway is blocked and the patient can’t breath, bad things can happen quickly. Sometimes the only option is to cut into the neck and place a breathing tube directly into the trachea. This may occur with trauma or an allergic reaction where the mouth and throat are damaged and obstructed causing air flow to be blocked. A cricothyroidotomy or tracheostomy are not procedures that most docs do on a daily basis, or on a monthly basis or on a yearly basis or ever. Yet when this procedure has to be done to open an airway, it has to be done…now. No airway, no patient.

Medicine and sports share many things. To get good, you have to practice and study. To stay good, you have to maintain your skills and that takes a lot more practice and study. And no matter how good practice goes, your worth is measured when the game counts, whether that happens in the hospital or Lambeau Field.

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