Communication: From the ER to the Writer's Desk

Currently resting, rather than retired, Jane Atkinson is a PR and communication consultant based in London. She co-founded the communication and PR firm Atkinson Courage whose clients included IBM, United Distilleries, and the late Diana, Princess of Wales, to whom Atkinson also served as personal media advisor.

Visiontime: Made or born a Londoner?

I moved to London forty years ago. I grew up in various parts of England. When I got together with my husband forty-two years ago, we moved out to London as a couple for work and the excitement of living in the city. If I wasn’t living in London, I would probably be based around the Balearic Islands on my boat, or living in Barcelona.

Visiontime: Do you have a secret spot around London where you go to reflect, rejuvenate, decompress or just be invisible?

I am lucky to live in Chiswick. There is a lot of green space here, but my favorite is is the Chiswick House and Gardens park, west of the river Thames. When the sun shines, you can wander there and lose yourself. There is a big lake in the middle with a quaint little bride that you can go on top, or you can just sit by the water and meditate. There is a lone-standing Ionic temple with a nearby pond, and a beautiful greenhouse with benches nearby where you can either sit down or even lay down. If you have a dog, you can go for amazing walks through the woods. And there is an exceptional café right in the middle as well. Because Chiswick is a very residential part of London, you’ll be hard-pressed to find any tourists here. It’s uniquely local, which is quite a rarity in a cosmopolitan city like London.

Visiontime:  You just gave us an example of the perils of stalled communication in the ER.  How about when good communication saves the day?

Thankfully the “save the day” events are more common. Sometimes patients’ behaviors have had a hand in getting themselves ill. Without their sharing the information diagnosis can be impossible.

Patients who have used drugs (especially IV use), patients who are suicidal, and patients who have been abused often do not readily reveal it. Being open and non-judgmental encourages the patient to share the truth thereby allowing the diagnosis or intervention that is needed. Many times a great nurse has alerted me to a distressing medical, home, or social situation that must be addressed. There are many people involved in care-giving (medics, nurses, techs, social workers, family, and friends)—being receptive to getting their input is huge.

Many times such input has helped “save the day”.

Visiontime: What if personal issues get in the way, is it possible for people who don’t like each other to work in the ER and do a good job?

Thankfully the overwhelming numbers of healthcare providers are professionals and even if their personalities are lacking they care about good outcomes for their patients.

That being said – ill-will, rudeness, abusive behavior, and lack of respect are absolutely dangers to good patient care. Illness and trauma are ruthless and there is no “editing” or “do-overs” for mistakes. If ill-will is allowed to impact effective communication it can compromise care.

Your previous questions underline this (e.g. imagine if the senior doctor had humiliated the intern for a previous failure to ask about patient history—what influence might that have?)

Visiontime: Is effective communication taught in the ER, for example, the famous time out before surgery, or is it expected to evolve on the job?

Emergency medicine is one of the newest of all major specialties (first program created1972). I was lucky enough to train in two of the best programs in the U.S. (HCMC, Mpls/ Univ of Cincinnati, Ohio). I believe the nature of my specialty has demanded a focus on communication. We are both the front lines of critical care and the safety net for our society’s most needy. Despite what some sources might suggest, no one is ever turned away from an emergency department – ever. We treat everyone who presents. As part of that mission we communicate with everyone—if we do not, people suffer. I’m proud to have joined the ranks of police, fire/rescue, EMTs, paramedics, nurses, and all the other great folks dedicate to providing emergency care.

Visiontime: You went from an ER doctor to a medical thriller novelist, other than the subject matter, what do you bring communication-wise to your new profession?

I think my decades of life in the world of busy, high-acuity ERs has sensitized me—increased my empathy. We humans are vulnerable. In a moment any of us, or our loved ones, can be struck down by accident or injury.  Mental health issues are very common and devastating.

My stories involve more than the medical world, but it is an element I believe is uniquely intense yet universal. The blast-furnace of emotion and human drama in emergency and critical care medicine touches us all at one time or another. Illness, injury, and life-or-death struggles are often the most significant events in the lives of patients, their families, and caregivers. Fundamentally it’s not about science—it’s about people.

My experience in treating people in dire straits makes me intimately involved in their lives.  The ER is the destination for those who face life or death drama. Being a part of those struggles has increased my passion for life. I’ve experienced an incredible range of the tragic and spectacular and writing allows me to share and wonder.

Some suggest that reading fiction is a way to “escape”. I believe it is a pathway to excitement, empathy, and increased awareness of the incredible potential of life. My writing is an attempt to provide for others the special gift that great stories have provided me.

Visiontime: As a doctor and a writer, from what perspective do you consume popular fiction set within a medical context like the show ER, Dr. House, and medical thriller novels? Can you fully immerse yourself in them, or are you too involved and see everything from a critical eye?

I could never watch the TV show ER. When it premeired my wife had it on and the doctor leading the resuscitation was yelling at everyone, “COME ON, PEOPLE. LET’S GO! LET’S GO!”  I would have thrown him out of the ER.

Leading an ER team you need to have your act together. You need to recognize and respect how critical every member of the team’s role is. Bellowing at them would not help them do their best. People are influenced by the physician they are working with.

The other aspect for some of the shows is that I had too much exposure to the tragic side of emergency care and was averse to seeing more of it.