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An Interview with Dr. Charlotte Crosbie

Dr. Charlotte Crosbie, an emergency physician, has been a driving force in encouraging quality improvement in patient care and department improvement processes. Her full-time work at BH will end in April when she moves to Seattle to start a new career journey. We had the opportunity to interview her about her experience and accomplishments at BH.

What do you think are the most important values for an ED physician to have?

“Integrity, honesty and Respect – for your patients, your colleagues and most importantly yourself.  You can’t advocate for patients in the way you need to if you don’t have self-respect.”

What motivated you to move from law to medicine?

“When I was articling, I volunteered at a physical rehabilitation hospital with my dog doing pet therapy. I enjoyed the patient interactions more than the (mostly) computer interactions I had in the legal world.  Technology has changed the practice of law drastically over time.  Once upon a time, you actually met face-to-face with clients – now, even a lot of discoveries are online – and I found I wanted more human interaction than what I was getting in law. Emergency medicine, in particular, is a great choice for that.  I still miss the intellectual parts of the law, though, so I do some medico-legal consulting and can satiate my appetite for that working with law firms where I can dig into standard of care and causation issues.  The great thing about emergency medicine is that it allows flexibility to do other things we enjoy on the side.”

How does your previous experience in law improve the care provided to patients?

“I think having our flex doc review the LWBS charts was really pushed through because of my understanding of the law and our obligations even to patients who leave the department without being seen.  We’ve been able to call back patients who would have otherwise deteriorated at home because of this.  Personally, though, legal training certainly enables me to hone in on pertinent issues quickly and allows me to have well-informed discussions with patients.  A lot of people think legal training must make a physician paranoid and cause them to practice defensive medicine – but for me, I don’t think that’s true – mostly because I have a specialized understanding of medical malpractice and am aware of what will keep me out of trouble, so I don’t tend to dwell on things.  I think legal training has also affected my documentation, and generally, when you read my charts, you have a pretty good idea of what I was thinking and why.  But I’m also practical, and even law is all about what is reasonable in the circumstances.  So, I think I just transferred these concepts to medicine.  Emergency medicine is full of hidden dangers, and we are expected to miss things – we are only human and can’t prevent every bad outcome. And I’m at peace with that as long as I’ve done what’s reasonable in the circumstances and the patient is on board with the plan.”

As a female role model, what advice do you have for other women in the ER?

“Women are treated differently than our male peers whether the medical world wants to admit this or not. Although I think Burnaby is one of the most collegial places to work – probably in the country – my female colleagues and I have still been treated differently by certain specialists. And as a result, we need to fight harder to stand up for our patients, which can be exhausting.  But my advice is don’t give up because emergency medicine can be a really rewarding job when you persevere.  I think I see women struggle the most when they lack confidence and don’t set boundaries.  And if you don’t respect yourself, this will be even more difficult.  Remember, we all went to medical school and residency, so we all have the training to do the job.  So, my advice here is to a) learn how to say no and b) reach out to female role models around you for mentorship.  Everyone has different strengths and weaknesses, and everyone has a different style.  It might take you a while to find your own style – and it doesn’t have to be the same as everyone else’s – but find someone to help you work on what works for you.

What do you think is the most important skill to bring to work?

“Emergency physicians require a lot of different skills because we are generalists.  But the ability to advocate is my answer here.  Emergency medicine requires constant advocacy for patients because so many physicians and allied health are burnt out and operating over-capacity, so getting the imaging and consults your patients need can be challenging at times.  You must do the best thing for the patient, though, and this sometimes involves an exhausting amount of advocacy. But I’m glad that Burnaby s generally a collegial place that enables us to do this and get the best care for our patients.”

Can you walk me through a BH project or accomplishment that you’re particularly proud of?

“I think I’m most proud of helping recruit several other Emergency docs in the last few years to Burnaby.  Before my time, there was a very consistent group of docs there for a long time, which speaks to what a special workplace it is.  But workplaces need new energy and new ideas in order to grow (our ED was still issuing paper cheques to docs when I started and wasn’t even using the EMR tracker!).  Medicine and patient care are rapidly changing and fresh perspectives help us navigate this.  Burnaby Hospital is such a special place – and was definitely the best decision I made after residency – and I’m so glad that the others I brought on board are also enjoying it and will continue to contribute to our community here.”

Can you share an instance where you had to collaborate with other BH medical staff to achieve a common goal? What was your role, and how did your contributions impact the outcome?

“I’ve had a fair amount of collaboration with our consultants and our nurses on different projects. I’ve had some collaboration with internal medicine with respect to consulting them for our ED patients overnight. Burnaby is a unique environment in such a busy hospital because we try to protect some of our consultants overnight so that they can get some sleep and be able to work the following day.  However, when you’re up all night doing solo coverage of a busy emergency department and your shift is over, you want to leave.  With internal medicine, we developed Teams IM consults so that our Emergency doctors could send secured consults via messaging to our internal colleagues, and this was really helpful in terms of getting the ED doc out on time after their night shift, getting the patient a timely consult, and also letting our colleagues sleep. I’ve also tried to streamline certain consults and pathways with plastics, gynecology, and other specialties for our orientation book. 

I also helped lead the ED Flex doc implementation and defined what that role looked like. There was a lot of collaboration with nursing for this one. Overall, the role is going well, and our nurses seem mostly very happy with it. I also think it’s greatly impacted flow and getting patients the care they need sooner.”

Ultimately, Dr. Crosbie has provided BH with incredibly useful insights, experience, and knowledge that improves patient care. She is a vocal, brave, and courageous female presence in the ER who, through example, empowers other women to be present and speak up. We are thankful for Dr. Crosbie’s contributions to BH and wish her the best in Seattle!