SGEM Xtra: Holding Out for a Hero – Lessons from The Dark Knight

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Date: December 11th, 2022

Dr. Dennis Ren

Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine physician at Children’s National in Washington, DC. You may also know him as the host of this season’s SGEM Peds.

This is an SGEM Xtra for the holidays. We have done previous shows on what we have learned from Star Trek and Top Gun. It is hard to believe that we have not done an SGEM Xtra about what Batman has taught us about medicine and life.

The release of Season#9 of the SGEM as a PDF book seemed like an excellent opportunity to discuss Batman. This is because the book has a DC comic theme. Some people might find that a bit dark. However, this edition arrives at a time of uncertainty. We have been navigating our way through a pandemic, understaffing, emergency department closures, boarding crises, astronomical wait times sometimes barely keep our heads above water and struggling to do everything we can to care for the patients who depend on us.

Despite the challenges we face, I hope the SGEM has been a beacon in the darkness, a bat signal, to remind us that the application of the principles of evidence-based medicine is more important than ever. We discussed this early in the pandemic with Dr. Simon Carley from St. Emlyn’s.

Before we start talking nerdy about Batman, I think it is important we give a shout out to Dr. Tayler Young. She is a first year Family Medicine resident at Queen’s University. Her interests are quality improvement and Free Open Access to Medical Education (FOAMed). Tayler did Season#8 book with an Avengers theme.

SGEM Season#9 contains the an introduction by Dr. Chris Carpenter. He takes us back to 1934 and the start of DC comics. Batman first appears in 1939. The first page for each chapter has the clinical question, the SGEM bottom line and introduces the guest skeptic. Next comes the case presentation and some background material. This is followed by the PICO with each letter looking like the superman symbol. Each episode has the authors’ conclusions and the appropriate quality checklist to probe the study for its validity. The key results are listed. The Talk Nerdy To Me section has a Green Lantern theme. This is followed by the clinical application, what do I tell the patients and a case resolution section. Each chapter ends with any other FOAMed resources, twitter poll results and the Paper in a Picture infographic by Kirsty Challen

You can listen to the SGEM podcast and hear Tayler discuss the layout of SGEM Season#9. You can also download all the previous SGEM books clicking on this LINK.

Batman and How it Relates to Medicine and Life

We discuss eleven ways that Batman relates to emergency medicine and life. You can listen to the entire discussion on the SGEM podcast available on iTunes.

1. Emergency Medicine is Batman

If I were to pick one superhero that embodies the practice of emergency medicine, it must be Batman. He is a detective, a tactician, strategist. He is truly a jack of all trades. He has knowledge of criminal justice, psychology, forensics, chemistry, just to name a few.

Sounds very similar to emergency medicine where we act as primary care providers, pediatricians, intensivists, cardiologists, neurologists, psychiatrists, often during one shift.

Batman also has a lot of cool gadgets just like we have many tools in our arsenal when practicing emergency medicine. I think some of us might even carry a fanny pack (utility belt) on shift.

2. Vulnerability

One of the things that sets Batman apart from other superheroes is that ultimately, he is human. He can get fatigued. He can be hurt. This quality makes me appreciate him more.

Dr. Tim Graham shared his powerful story of burnout on SGEM Xtra: Everybody Hurts, Sometimes. We have witnessed people working in emergency medicine perform heroic acts every day, but it’s important take a moment to check in on each other. The pressure and stress can build up and it is ok not to be ok, to be vulnerable.

I am fortunate to work at an institution where colleagues commonly check on one another after a difficult patient encounter or bad outcome. I have also had colleagues and friends check on me when I have been going through difficult personal circumstances. This supportive community does not only have to be at your own institution but can extend through social media. Let’s normalize looking out for one another.

3. Batman Won’t Give Up

“Maybe that’s what Batman is about. Not winning, but failing, and getting back up. Knowing he’ll fail, fail a thousand times, but still won’t give up.” (Batman-Zero Year)

I don’t know about you, but I can’t imagine shouldering the responsibility and burden of being Batman. He is doing his day job of running Wayne Enterprises and no matter how great or poorly his day or how much he got hurt or injured in the previous night, Batman always suits up and goes out on patrol. You just must admire that discipline and tenacity.

Our emergency medicine colleagues also exhibit this “won’t give up” attitude. They keep showing up despite the craziness of the past shift, past week, or even the past few years.

4. Turning Failures to Triumph

Is it surprising that this theme has popped up again? Chris Carpenter and I spoke about this on the SGEM Top Gun episode. Sometimes despite our efforts, we can still “fail”. If you define failing as patients having bad outcomes or dying.

It sort of reminds me of Star Trek the Next Generation and Captain Jean-Luc Picard. He said “it is possible to commit no mistakes and still lose. That is not a weakness. That is life.”

That is also emergency medicine. It is possible to do everything right and a patient can still have an adverse event or even die. This “failure” can be turned into opportunities for us to learn and get even better at what we do. Constantly striving to improve what we do. Ultimately everyone will die but what do we learn and how can we grow from these situations?

5. Hard Work, No Complacency

Because Batman has no innate superhero abilities, he is constantly training to maintain his skills just like we are in emergency medicine.

The SGEM encourages everyone to keep reading, keep thinking critically, keep questioning, and keep adapting so patients get the best care based on the best evidence.

6. The Bat Family

I think some people mistake Batman for being a strong, silent, brooding loner type. Some of that is true, but he is not alone. He has the support of the entire Bat family with Alfred, Robin, Jim Gordon. But he also has the entire Justice League to help him when it comes to saving the world.

We want to acknowledge all the people we get to work with in the emergency department (nurses, cleaning staff, respiratory therapists, PAs, NPs, switchboard operators, consultants, lab technologists, diagnostic imaging, etc). It is truly wonderful when everyone comes together as part of Team Patient.

We also want to acknowledge all the family and loved ones that accompanied us and supported us through medical training and our careers. We appreciate your patience and understanding when we’ve disappeared for months on end while studying for a certification exam or missed important life events. Without you all, we would not be able to do what we do.

7. We are Defined by Our Actions

What has defined emergency medicine is to be the one specialty that is for anyone, for anything at any time. We are the light in the house of medicine that never goes out. Like a light house we offer safe harbour in stormy weather. It is these actions of being available for patients in their time of need that defines who we are in emergency medicine.

8. One Person Can Make a Difference

Batman always reminds me that one person can make a difference. There are many things for which we do not have much control over. But we can always choose to be kind and take a moment to recognize that everyone has a story. How we choose to approach a challenging situation or patient may leave a lasting impression. I learned about this from my kindness mentor Dr. Brian Goldman.

Kindness Mentor Dr. Goldman with BatDoc

9. Everyone is Batman

A hero truly can be anyone. The best part about Batman is that we can all strive to be Batman, or BatPerson or BatDoc.

10. Batman as a Symbol

“As a man; I am flesh and blood; I can be ignored, I can be destroyed. But as a symbol, I can be incorruptible. I can be everlasting.”

I want to take a moment and acknowledge all the amazing work that Ken has done with the SGEM. I am incredibly grateful for his mentorship. To me, Ken represents the importance of skepticism and critical thinking in applying the principles of evidence-based medicine to provide the best care for patients. More importantly, I think Ken embodies a kindness of spirit that I hope to emulate. I am sure I am not the only one that feels this way. So, thank you, Ken, and the SGEM for being that symbol for us.

11. Hope

For our last point, we want to again acknowledge that things are tough in healthcare right now. However, one of the greatest things that has come out of these times is the wonderful #FOAMed community that has developed around SGEM. We want to thank you for tuning in every week to listen, learn, and share your stories and expertise.

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So, patients get the best care, based upon the best evidence.