How can the essence of effective communication change across widely different industries? To find out, we spoke to Tom Combs, an ER doctor who changed track and is now a critically acclaimed author of medical thrillers.

Visiontime: Your first book, Nerve Damage is an adrenaline-laced medical thriller. As a doctor, did you have to simplify the science for the lay person?

The language of medicine is precise but foreign to most readers. The challenge is to provide both authenticity and understanding. I often revise medical scenes several dozen times. Medically accurate terms are used when required but I work to include description and context that makes understanding easy.

Making it easy for readers to understand the medical realities involved is essential. I’ve been very gratified that both non-medical people and the medically expert (e.g. nurses/docs), have found the medical aspects of my stories compelling. I also credit my editor’s (Jodie Renner) non-medical background as one of her many valuable traits. She provides a great check on clarity.

Visiontime: You’ve spent many years as an ER doctor, what role does effective communication play in running a tight ship?

In every patient encounter communication is essential to diagnosis, treatment, and outcome. The exchange between a patient and their physician (or nurse) most often determines if an accurate diagnosis will be made. Additionally the tools of medicine can do great harm. The communication between health professionals must be precise. Misunderstanding can kill. An ER visit that occurred almost 30 years ago at a hospital I trained at provided an unforgettable lesson on the importance of communication.

An intern (doctor in first year of training beyond medical school) saw a young woman with a small localized skin infection. She had no fever, didn’t feel ill but it was sore (essentially like a large pimple located on her thigh).

The intern told the senior doctor in the ER about the patient. He asked if the patient had any past medical history. The intern said “no”. The senior doctor asked if she had any allergies. The intern said, “no”. They went to see the patient who had a small red, tender lump on her thigh. Tecnically called a furuncle it is essentially a large pimple. The senior doctor recommended an appropriate antibiotic, advised to use warm compresses, and return if fever sets in or if her overall condition worsened.

The recommended care sounds appropriate and would be expected.

Except the intern hadn’t actually remembered to ask the young woman about her past medical history. For some misguided reason he did not admit it when asked by the senior doctor.

The patient did have a significant medical history. She had a malignancy and had just received chemotherapy several days before. Her immune status was profoundly compromised. This tiny infection represented a major life threat.

She returned a day later in shock with overwhelming infection.  At that time the error in communication was discovered.

From the first time I heard about this event until today, every time it comes to mind, I get sick to my stomach.

Communication in the ER is essential. It is a matter of life or death.

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.