Stop, look, and listen 

By Eric Last, DO, Zucker School of Medicine & Department of Writing Studies, Hofstra University

I’ve always been fascinated by trains. It’s a genetic enchantment passed to me by my dad. The romance of the railroads, the broad and sweeping curves, and the majestic vistas of passing scenery seen through spacious glass all appeal to my imagination. Powerful engines moving vast quantities of goods through the country seem to embody the American spirit, while at the same time is a reminder of the cruel conquests of the American West. And commuter trains bringing workers to and from the city are an ingrained part of life in my community, like so many others.  

I remember my first railroad trip of consequence, to Washington D.C. from New York City. Hauled behind two mammoth GG-1 electric engines, the train made its way to the U.S. capital passing through cities and countryside. I also remember the news reports of Robert F. Kennedy’s funeral train taking the same route; the rails like a giant trail of steel tears through the heart of America.  

“Stop, Look, and Listen” 

But there’s also danger of maiming injury and death that can come from these mechanical beasts. The usual sites of such catastrophic intersections are railroad crossings, where the steel rails traverse asphalt. Protected by bells, flashing lights, and large signage, the crossings nonetheless are still the scenes of carnage caused either by awful accident or rank stupidity and hubris. Often, the victims didn’t heed the three-part railroad crossing warning to “Stop, Look, and Listen.” 

I thought about that warning earlier this week, in the context of an interminable training session for our new EHR. Throughout the class, the enthusiastic trainers extolled the wonders of their software, lauding features that automatically save work, and import records from outside sources. Some of their greatest enthusiasm was for the “hard stop”—the octagonal red icon, emblazoned “STOP” that appears when a critical piece of information is omitted. Don’t even try to proceed without completing that required entry—you’ll be saved from yourself and prohibited from moving on. 

My mind returned to the grade crossing. Where is the “hard stop” that ensures that we stop, look, and listen to the patient who is the subject of all our clicking? If we’re preoccupied with our technology, seeing more patients in less time, and not enhancing the time we have with the patient in front of us, then we’ve relegated ourselves to being data entry technicians and abandoned being clinicians. 

I’m convinced that patients want, and deserve, so much more than that from us. To remind us to stop, look, and listen, we should: 

1. Remember why the patient is with us: to find help, advice, reassurance, direction, and connection. 

2. Remember why we’re with the patient: to use our knowledge and humanity to help the patient achieve their goals. 

3. Use non-clinical discussions to affirm our relationship: ask about their last birthday party, vacation, their child’s school play, or the shared angst caused by our sports teams.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.