The Patient Care Totem Pole

This piece applies to all trauma professionals. Actually, it applies to anyone who has the privilege of providing patient care. It has to do with this:

A totem pole is a sculpture that usually depicts a hierarchy of people or concepts. In patient care of any type, there are individuals who are closely involved in patient care (first responders, first year residents/registrars, nurses) and there are those who are a bit further removed (supervisors, nurse managers, attending physicians/consultants). The first group are those usually thought to be nearer the bottom of the totem pole, the latter closer to the top.

But the thing is, those nearer the bottom have valuable experience and insight into what is happening to their patient clinically. And they usually know what needs to be done if the patient is in trouble. Unfortunately, they may have to get authorization (orders) from others higher on the totem pole, or have those individuals actually see the patient, to deal with a problem.

Too often, I hear that a patient problem has developed and, as expected, their nurse calls the next level up the totem pole for instructions (intern/first year registrar). That person doesn’t give them the desired response, or refuses to come see the patient. The nurse frets and tries to do the best he or she can given the circumstances. They wait a bit. They call again. Still no joy. 

Many times, there is an undesirable patient outcome when this happens. There’s a lot of pressure to avoid calling the chief resident or attending physician. But this reluctance cannot be allowed to happen! Remember, the whole reason we are here is to make sure our patients have the best outcomes possible! This is far more important than not ruffling the feathers of the higher-ups.

Bottom line: If you have a patient who has a problem, you probably know what needs to be done to fix it. If you have to call someone to get orders to do it, they should either issue the order or provide a good explanation as to why they want to do something else. If they don’t, go up the next level of the totem pole immediately to get it. Don’t be shy about going quickly to the top. Remember, your patient and their well-being are counting on you! And by the way, the image at the bottom of a totem pole is thought to be the most important. It’s the largest (because the base of a tree is bigger) and it’s at eye level where everyone can see it.

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