Reflections on rules and flexibility

As the traditional Chinese proverb goes: nothing can be accomplished without norms or standards. Rules are crucial in today's society, but it is equally essential to be flexible without deviating from them. To ensure the quality and normal working order of the hospital, strict rules and regulations need to be followed by both doctors and patients. In the emergency department (ED), where accidents and unpredictable changes occur on a daily basis and lives can be lost without notice, rules and flexibility are all the more significant. About 6 years ago, when I worked as an intern in the ED, as usual, all the patients were waiting in an orderly, if occasionally noisy, line outside the emergency outpatient clinic. Suddenly there was a cacophony from the crowd. Get out of the way! I want to be the first to go to the doctor! Seen from a distance, it looks like a middle-aged woman shouting. As an intern, I had an obligation to maintain medical order. So, I hurried to the middle-aged woman, asked her about her condition. “I'm a regular here,” she said quickly. “I recognize your emergency doctor. I've been here a lot, so I will be first. At the same time, I noticed that the lady was not in a severe acute condition. I stressed to her to follow the hospital rules and not jump the queue. But the woman's emotions seemed to be ignited as she shouted: “I want to be first. You cannot stand in my way.” I had no choice but to argue with her. My supervisor, the ED doctor, showed up just in time to alleviate the confrontation. After asking permission of the waiting patients, he allowed her to see him immediately, telling me that she was in a constant state of anxiety and he would later explain in detail. What a really dispiriting day! I firmly believed I did nothing wrong and, after all, my starting point was to comply with hospital rules and regulations. Then my supervising teacher provided the details detailed on this patient, saying that she had been a successful career woman. Unfortunately, her husband was severely injured in a car accident and was brought to our ED but was not able to be resuscitated and died. Since then, she has been in a state of chronic anxiety, suffering from nervous headaches and often struggling to control her behavior. The ED doctor also suggested that she seek more specialist treatment in the psychiatric unit, but she politely replied that the ED was where her husband's life had finally dissipated. Going to the emergency department for help seemed to be her anxiety relief. My teacher said that as emergency physicians, we will face all kinds of complex and urgent situations every day, and we should first learn to understand and help patients more. He also emphasized that my starting point is the consideration of rules, which is not wrong, but we as doctors should be people-oriented, flexible in the rules, so that patients have compassionate medical treatment. Undoubtedly, it would have been an additional delay to the normal sequence of medical treatment if the teacher had not stopped me and the woman from arguing. The experience profoundly touched my career as a doctor and made me rethink the relationship between rules and flexibility. Rules exist to guarantee the fundamental rights of all patients, and flexibility allows patients to maximize their rights. So, we need to learn to be flexible, to adapt and optimize within the rules, and only then are the needs of the patient truly considered. Yingnan Hu outlined the initial story and, after communicating with Wei Zhang, wrote the first draft. Wei Zhang then revised it and gave guidance and summary. Yingnan Hu finished the final manuscript. This research was funded by Zhejiang Xinmiao Talents Program (2022R410B048). The authors declare no potential conflict of interest.