The Noise of the ER—and the Need for Quiet

Emergency medicine is loud. Alarms are ringing, monitors are beeping, patients are crying out, and radios are buzzing. In the middle of all that chaos, it’s easy to focus on action. After all, we’re trained to respond—to move fast, to make decisions, to treat what we see. But over the years, I’ve learned that some of the most important work I do doesn’t come from moving quickly or ordering tests. It comes from slowing down and truly listening.

Listening sounds simple, but in the ER, it’s a discipline. The patient in front of you may only have a few minutes of your time, but they’re carrying a story—pain, fear, confusion. Sometimes the key to diagnosing a heart condition or avoiding a misstep isn’t in the scan or the labs. It’s in what the patient tells you when you give them space to speak. Learning to really listen has taken time, and it’s changed how I practice medicine—and how I live my life.

Listening Beyond the Words

Early in my career, I thought listening just meant hearing symptoms: chest pain, shortness of breath, nausea. But I’ve learned that people don’t always describe what’s wrong in medical terms. They talk about what they’re afraid of. They tell you what it feels like. They may not use textbook language, but they’re still telling you something important.

Listening means paying attention not just to what’s said, but how it’s said. The look on someone’s face, the way they hesitate before answering, or the urgency in their voice often tells you more than any vital sign. I’ve seen stoic men who say they’re “fine” when they’re clearly not, and quiet elderly patients who wait patiently but are on the brink of something serious.

What I’ve found is that when people feel heard, they’re more honest. And when they’re more honest, we give better care. Listening builds trust, even in a high-pressure environment where we’re often strangers in crisis.

Listening to the Team

Listening isn’t just for patients. Over the years, I’ve come to see how critical it is to listen to the team around me. Nurses, techs, paramedics—they see things. They know when something feels off. As a physician, especially in a leadership role, it’s easy to fall into the trap of thinking you have to have all the answers. But some of the best decisions I’ve made came after listening to someone else’s observation or concern.

I’ve worked in busy ERs with incredible teams, and what I’ve learned is this: when everyone feels like their voice matters, the whole system works better. Emergencies don’t leave time for ego. They demand communication, respect, and trust. And trust is built when people know they’ll be heard.

Even outside of codes and trauma bays, I’ve tried to be a physician who listens—to concerns about policies, to frustrations after tough shifts, and to those unspoken signals that a colleague might just need a break or a word of encouragement.

Learning from Mistakes

Like anyone, I’ve had moments where I didn’t listen well enough. Times I moved too fast. Times I thought I understood the story before it was fully told. And I’ve learned from those moments—sometimes the hard way. One of the blessings of a long career is the chance to grow. You learn to slow down. You learn to ask one more question. You learn that silence from a patient doesn’t mean everything’s okay.

I remember one patient, years ago, who came in with vague symptoms—tiredness, some nausea. She downplayed everything. I almost discharged her, but something in her tone didn’t sit right. So I sat down again, really listened, and asked her what she thought was going on. That opened the door to a conversation that led to more tests—and a life-saving diagnosis. It reminded me that sometimes the most important thing we can do is stop talking and just listen.

Listening Outside the Hospital

What’s surprised me is how this practice of listening in the ER has changed how I listen outside of it. As a husband, father, and now grandfather, I’ve realized how often we respond without really hearing. Whether it’s a conversation over dinner or a call with a friend, people don’t always want advice or solutions. They just want to feel understood.

Being present—really present—is hard when your mind is used to solving problems every few minutes. But it’s something I’m working on. I think listening is one of the clearest ways we show people we care. And in a world where everyone is rushing and distracted, it’s a gift to offer someone your full attention.

Thirty years in emergency medicine has taught me how to move fast—but it’s also taught me the power of slowing down. In a room full of noise and urgency, taking a moment to truly listen can change everything. It can lead to better outcomes, deeper trust, and more meaningful connections.

I’m still learning. Every shift, every patient, every conversation teaches me something new. But if I could offer one piece of advice to younger doctors, or anyone for that matter, it would be this: listen well. It may be the most important skill we have—not just in medicine, but in life.