Resident tries to help other doctors, put patients at ease

By Carolyn Wait

chh@heraldsun.com; 918-1035

CHAPEL HILL -- Patients fill the exam rooms and line the halls of the UNC Hospitals Emergency Department, or E.R., as most people call it. It's about 3 a.m. on a Friday morning. Ben Leacock, a third-year chief resident in emergency medicine, hasn't taken a break yet, even though it's halfway through the night shift.

A timid medical student asks Leacock to sign a form proving that she covered certain topics during her emergency medicine rotation. Leacock has patients to see and paperwork to finish, but he doesn't dismiss this opportunity to teach.

He settles into his chair at the crowded nurses' station.

"Let's at least learn something," he says to the student.

The hum of voices and mechanical beeping continues around them, but Leacock speaks as if nothing else is happening. The student nods intently as he guides her through the complex decision-making process of an E.R. doctor: tests to run, procedures to do, drugs to choose.

This is how learning happens in the E.R. -- one doctor shares his experience with another.

The constant education suits Leacock, who considered teaching before pursuing biology and then medicine. He turns almost any conversation into a lesson.

When a young clerk asks Leacock to clarify an order written in his illegible doctor's scrawl, he not only deciphers the text but explains the order. The clerk leaves knowing more than just a string of letters -- he knows exactly what to do for the patient.

Yet Leacock doesn't come off as a know-it-all. With his matter-of-fact tone and simple explanations, he seems more like a knowledgeable friend.

Leacock's approachable teaching style is important with patients, too.

"We do a lot of education here," says Dr. Janet Young, assistant professor of emergency medicine at UNC. Most patients have little health knowledge, so E.R. doctors must explain what symptoms, tests and diagnoses mean.

During this recent night shift, Leacock sees a patient complaining of a cold he's had for a week. Leacock examines the man with genuine concern. As he walks away from the patient, he rolls his eyes in frustration and amusement. "This man is fine," he mouths. But he dutifully consults with Young, the attending physician on duty. They decide that a chest x-ray is not medically necessary.

Leacock discusses their opinion with the patient, who agrees that he doesn't need an x-ray. He leaves with Tylenol and instructions to return if his symptoms worsen.

"People just don't know which way to go on their own health," Leacock says later. "Half of what we do is reassure people."

Not everyone in the E.R. just needs reassurance. The National Center for Health Statistics estimates that only 12.1 percent of E.R. patients are non-urgent. (NCHS defines "non-urgent" as not requiring care within two hours.)

Non-urgent cases aren't turned away, though. UNC Department of Emergency Medicine Chair Emeritus Dr. Judith Tintinalli explained in an e-mail message that an "emergency" is "what a patient thinks cannot wait."

Leacock can usually empathize with his patients, regardless of what brings them in. As the father of two young children, he often relates to parents as someone who has also had a sick child. And as someone always looking for answers, he understands his patients' desire for them.

Leacock went into medicine hoping to find the reasons why doctors do what they do. During medical school, he sought additional information on the history of medicine. He now leads a research discussion group at UNC.

Increasingly, he realizes that there are few absolute truths in medicine. Each case has its own complexities, and he never has complete information, whether on a patient's history or how well a drug really works.

Yet many people think that E.R. doctors are "more than gods," Young says. People think that E.R. doctors can save lives and diagnose obscure illnesses as easily as doctors on television.

Patients with vague symptoms are the most difficult for Leacock. He's seen patients who drive hours to get to UNC, hoping for a diagnosis that explains their aches and pains. Leacock feels awful for them, especially when they have a long wait. Often, all he can do is run tests to make sure it's safe to send the patient home.

Leacock prefers working with patients who need immediate help. If someone stops breathing, for example, he knows what he needs to do. And if he's successful, he can take pride in having saved a life.

But those patients are relatively rare. According to NCHS, only 5.1 percent of patients require immediate care, and even their needs aren't always obvious. Most times, Leacock must act quickly with limited information while appearing to be more than a god, as Young says patients expect.

It's now early morning. Leacock sees a man who has come in because his feeding tube has fallen out of his stomach. Leacock's hands -- hands that worked as a carpenter for three and half years before medical school -- are gentle but agile and confident. But he meets resistance. The opening in the man's stomach has already started to close.

He remains calm after three failed attempts. He decides to use a narrower feeding tube as a temporary fix. The patient and his wife seem concerned, but Leacock explains that a specialist will have to insert a wider tube. He tells them what to do until they can get to the specialist.

He leaves them, reassured with this knowledge, to see his next student.