I want to discuss a case 'we got wrong' with an attending w/o looking like I'm Monday Morning QB'ing

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Count me in as surprised by the ppl who aren't draining PTAs. I trained in a large academic center w/ ENT residents and still never was allowed to call them without at least attempting drainage. In the community, I have yet to transfer someone for urgent ENT consultation for this.


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It completely depends on your facility. In my training only one attending would do these. The other 95% would consult ENT. When I did my first community gig we didn't have ENT on call so I was stuck draining them myself. Now I do have ENT again but I'll attempt aspiration first anyway. I never did enough of these to be comfortable sticking knives in there, so you do what you're taught and comfortable with. No reason to learn new techniques on the fly without someone to actually show/teach you
 
Was at a good talk by Scott Weingart who made the distinction between Emergency Medicine and the reality of the specialty which should actually be called Emergency Department Medicine.

"The stuff I wanted to do in medical school was a career path that I was told repeatedly cannot exist by all of my mentors in EM. I just wanted a specialty where I took care of sick patients when they're at their sickest. I always thought that was what EM was supposed to be, but it was made abundantly clear to me by my advisors that that's not what EM is at all. That EM is really providing primary care to people at any hour, when they're in need, and that the resuscitation portion was actually a small part of that career path. That never made sense to me. When you listen to the words of Peter Rosen, who was a mentor I only got to meet recently, so he was a mentor in absentia, but when you hear him talk about why he helped to found the field of EM, it was because he wanted to take care of sick patients, and he thought we were the best field to do it. Somehow, I think EM has lost its way. It's become a field where we care more about customer satisfaction and patient turnaround than taking care of sick patients."

https://www.acep.org/content.aspx?id=96602
 
"The stuff I wanted to do in medical school was a career path that I was told repeatedly cannot exist by all of my mentors in EM. I just wanted a specialty where I took care of sick patients when they're at their sickest. I always thought that was what EM was supposed to be, but it was made abundantly clear to me by my advisors that that's not what EM is at all. That EM is really providing primary care to people at any hour, when they're in need, and that the resuscitation portion was actually a small part of that career path. That never made sense to me. When you listen to the words of Peter Rosen, who was a mentor I only got to meet recently, so he was a mentor in absentia, but when you hear him talk about why he helped to found the field of EM, it was because he wanted to take care of sick patients, and he thought we were the best field to do it. Somehow, I think EM has lost its way. It's become a field where we care more about customer satisfaction and patient turnaround than taking care of sick patients."

https://www.acep.org/content.aspx?id=96602

We should not be selling the version of EM Rosen described to Weingart. It's not real.

What it is, is hyper-speed weekend/holiday/3am primary care, with less control, more focus on customer service, more liability, with a sprinkling of critical care on top, and no time to do it. Can be really fun at times, but often is simply overwhelming and emotionally & physically exhausting.
 
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