also helps to let them know how things work in the ed and set boundaries and limits of what's appropriate to negotiate and what's not up for discussion Setting expectations with patients may help reassure them as well. Patients with allergic reactions without a clear new exposure, vague neurologic complaints with a negative workup, and even a mrSa abscess prompt me to let them know how commonly I see these things, and the anxiety on their faces melts away as they realize they probably don' t have some awful, terrible, fatal diagnosis. And we can let patients know that frequently we don't figure out the cause of belly pain with normal labs and imaging, and that's pretty common as OUR COLLEAGUES I think out of habit, I frequently go up to nurses after I've seen a patient of theirs and summarize my plan with them, "Oh man, I have no idea what's wrong with this guy, so we'll get some basic labs, or"I really dont like this EKG. Im going to have cards see him, but can you make sure he's got a good IV? I may need to do a Ct angio on him. It makes sure were on the same page, and frequently the nurses will drop in little extra bits of helpful information they've heard while theyre rooming the patient Different residents need different sets of expectations sometimes. I want the interns to give me a formal, thorough presentation, but the seniors can give me a briefer one. I think even giving them simple feedback by saying,"You need to do a full neuro exam on patients with headache teaches them how you evaluate a chief complaint and what they should expect to do on every patient with that complaint Finally, any good " how to talk to consultants discussion is really all about setting expectations with them. Being very clear that"I want you to see he patient and drop a note makes sure everyone knows this is not a curbside question, and asking the consultant what time you can expect him in the eD lets him know you want him there promptly OURSELVES On those post-holiday Tuesdays, walking into a shift knowing you're going to work hard may make your day a little less painful. Or running your board and realizing that you can probably make a disposition decision on everyone in the department may give you the sense of achievement you need to finish that shift when you're getting crushed Part of why we went into emergency medicine is probably because we like the unexpected. Who and what is going to walk through the door next? Will this patient decompensate? Is this guy going to lose his airway in CT? W prepare for the unexpected all the time. By preparing for expectations, too, we can make our emergency departments an even smoother, more predictablealso helps to let them know how things work in the ED and set boundaries and limits of what’s appropriate to negotiate and what’s not up for discussion. Setting expectations with patients may help reassure them as well. Patients with allergic reactions without a clear new exposure, vague neurologic complaints with a negative workup, and even a MRSA abscess prompt me to let them know how commonly I see these things, and the anxiety on their faces melts away as they realize they probably don’t have some awful, terrible, fatal diagnosis. And we can let patients know that frequently we don’t figure out6 the cause of belly pain with normal labs and imaging, and that’s pretty common as well. OUR COLLEAGUES I think out of habit, I frequently go up to nurses after I’ve seen a patient of theirs and summarize my plan with them, “Oh man, I have no idea what’s wrong with this guy, so we’ll get some basic labs,” or “I really don’t like this EKG. I’m going to have cards see him, but can you make sure he’s got a good IV? I may need to do a CT angio on him.” It makes sure we’re on the same page, and frequently the nurses will drop in little extra bits of helpful information they’ve heard while they’re rooming the patient. Different residents need different sets of expectations sometimes. I want the interns to give me a formal, thorough presentation, but the seniors can give me a briefer one. I think even giving them simple feedback by saying, “You need to do a full neuro exam on patients with headache,” teaches them how you evaluate a chief complaint and what they should expect to do on every patient with that complaint. Finally, any good “how to talk to consultants” discussion is really all about setting expectations with them. Being very clear that “I want you to see the patient and drop a note” makes sure everyone knows this is not a curbside question, and asking the consultant what time you can expect him in the ED lets him know you want him there promptly. OURSELVES On those post-holiday6 Tuesdays, walking into a shift knowing you’re going to work hard may make your day a little less painful. Or running your board and realizing that you can probably make a disposition decision on everyone in the department may give you the sense of achievement you need to finish that shift when you’re getting crushed. Part of why we went into emergency medicine is probably because we like the unexpected. Who and what is going to walk through the door next? Will this patient decompensate? Is this guy going to lose his airway in CT? We prepare for the unexpected all the time. By preparing for expectations, too, we can make our emergency departments an even smoother, more predictable