Something that irritates me, you too?

[AmoryBlaine]

So I know quite a few med students at my school who say that they are bound for EM. One of the reasons they often cite is "I'm ADD" or "I get bored easily" or "I don't have an attention span."

Now I'm only an M2, but I would like to think that "not having an attention span" or "getting bored easily" would be a HUGE liability in an ED just as it would in most fields of medicine and is not a very good basis on which to build a desire to do EM.

Thoughts?

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[GeneralVeers]

Most people who make it as far as med school, probably don't have ADD severe enough to cause them problems.

Most E.D. residents (myself included) use the ADD as an excuse for why we get bored after 5 hours of medicine rounding.

 

[BKN]

So I know quite a few med students at my school who say that they are bound for EM. One of the reasons they often cite is "I'm ADD" or "I get bored easily" or "I don't have an attention span."

Now I'm only an M2, but I would like to think that "not having an attention span" or "getting bored easily" would be a HUGE liability in an ED just as it would in most fields of medicine and is not a very good basis on which to build a desire to do EM.

Thoughts?

As the General says, not likely. I have had a couple of folks claim they had ADD, when what they really had was ADDiction and loved that legal ritalin. It didn't go well.

 

[vtucci]

Speaking for myself, I was diagnosed earlier this year with ADD as an M1 (and an older one at that- almost 30, although they thought I had it when I was around 5 and my mother refused to put me on ritalin) and it was triggered by the volume of material in my anatomy and physio block- I had honors in almost everything before that.

I think people you mentioned are not articulating their reasons properly. Yes, I have ADD and I do get bored easily but that is not why I want to be an ED physician. I am drawn to EM for the variety of medical complaints- you get to be a jack of all trades (and master of none), when you are off, you are off, plus there is the excitement of not knowing what is going to walk through the door. As to your concern that it is a liability to have ADD, I find that I am much more focused and in the zone when I am dealing with a lot of things at the same time than if I was dealing with only one over a longer period of time. A number of my classmates can not even imagine going into EM because they do not like chaos. They want rigid structure. You need to know your personality and which field suits you best-- I suppose that is why we get to test out so many of them in our third year.

I also think that you have to be of a certain personality to really enjoy EM. I like to carry alot of patients at the same time. I am an EMT and have volunteered in one NYC hospital where we would see 5 patients in 15 minutes-- that was my baseline before coming to med school. At some EDs though, there are 5 patients per shift.

One of the best descriptions I heard at last year's EM Conference in Washington DC from the Residency Director at UMaryland was that one of the best indicators for whether you will be a good EM physician was whether you waited tables. A lot of my colleagues thought that was a crazy analogy but after having been a waitress for 16+ years during high school, college, law school and as a post-bac, I think he is right. You need to be able to juggle alot of demanding people at the same time. Some people will hate this and others will thrive on it. Plus it doesn't hurt if you are just naturally outgoing.

 

[AmoryBlaine]

Vtucci,

Sorry if I offended. I wasn't really talking about the diagnosed medical condition of Attention Deficit Disorder but more in general about people who use the term loosely to describe themselves.

I like the waiter analogy. Actually I was 100% against EM until I was directing a bunch of people on a project and a doc complimented me on my performance. I said, "thanks, I like working at the edge of chaos," and he said, "really? you must be destineed for emergency medicine." I thought, "hmmmmmmm."

 

[EctopicFetus]

As General Veers said people just use this as a joke. Once you do medicine rounds that last for 5 hours you will understand. Generally people who like EM cant stand spending 30 mins a day talking about each and every patient. It is just a different mentality.

Being in EM requires a ton of knowledge and always being on your feet. 3rd and 4th yrs will lead you the right way.

It is funny because in many fields the personality of people is what draws them there. No matter what you hear, there is clearly a "personality" in all fields. Most Surgeons are nothing like EM docs and most Peds docs are nothing like Ob/Gyn people.

 

[vtucci]

Vtucci,

Sorry if I offended. I wasn't really talking about the diagnosed medical condition of Attention Deficit Disorder but more in general about people who use the term loosely to describe themselves.

I like the waiter analogy. Actually I was 100% against EM until I was directing a bunch of people on a project and a doc complimented me on my performance. I said, "thanks, I like working at the edge of chaos," and he said, "really? you must be destineed for emergency medicine." I thought, "hmmmmmmm."

Don't worry Amory. No offense taken. I agree that people use the term too loosely and it is a bad representation for why people go into the field. Interestingly, I have heard a number of other specialists (including psych and internal med) refer to ED docs as the ones with ADD.

Welcome aboard to the EM freight train. I love working at the edge and get antsy if I am spending more than an hour on a patient workup and discusssion-- that has been my experience with our longitudinal clinical experience in the first year. Those of you in other fields, please feel free to correct me if I am wrong. The only time I can recall us spending more than an hour on a patient in the ED was with a gun shot wound. Love it, want more of it!!!

 

[GeneralVeers]

Does anyone else feel increasing anxiety if they have to talk to a patient for more than 2 minutes? I start to get twitchy and begin spacing off. After about 2-3 minutes of the patient recounting a history that's going nowhere, I change from open-ended, to yes/no questions.

Don't worry Amory. No offense taken. I agree that people use the term too loosely and it is a bad representation for why people go into the field. Interestingly, I have heard a number of other specialists (including psych and internal med) refer to ED docs as the ones with ADD.

Welcome aboard to the EM freight train. I love working at the edge and get antsy if I am spending more than an hour on a patient workup and discusssion-- that has been my experience with our longitudinal clinical experience in the first year. Those of you in other fields, please feel free to correct me if I am wrong. The only time I can recall us spending more than an hour on a patient in the ED was with a gun shot wound. Love it, want more of it!!!

 

[Hawkeye Kid]

most Peds docs are nothing like Ob/Gyn people.

good, because i'll only have to spend 9 months with my (future) wife's OB, but i'll have to spend 18 years with my (future) kids' pediatrician. but i kid, i kid.

as usual, EF hit the proverbial nail on its proverbial head. personality makes the specialty. without that match, i probably wouldn't be in EM--no matter how cool it is to wear pajamas to work every day.

 

[EctopicFetus]

Hmm pajamas.. Im on call today for my sub-i and wearing the pjs is something im ready for!

 

[edinOH]

Does anyone else feel increasing anxiety if they have to talk to a patient for more than 2 minutes? I start to get twitchy and begin spacing off. After about 2-3 minutes of the patient recounting a history that's going nowhere, I change from open-ended, to yes/no questions.

Try 30 seconds!

My clinical medicine instructors from my preclinical medschool days would be so disappointed!

Open-ended questions only work with people who understand how to listen and answer the question they were asked. Ultimately I find myself having to pull teeth just to get to the two or three important pieces of data amongst the mountain of useless words being hurled at me under the guise of "history".

Not that I'm bitter or anything...

 

[8744]

I'm not completely sold on the "Open Ended Question" paradigm which is the ideal of primary care. Sure, we need to ask "What brings you to see me today?" but I think some people confuse this with, "Please tell me your life story in excuciating detail including the time when you and Uncle Jeter were sixteen and thought you'd go pick up a couple girls in the next trailer park down."

The standard model for patient interaction that I was taught here at Duke is to ask an open-ended question and then sit in the "eager listening" position for about five minutes nodding emphathetically.

 

[AmoryBlaine]

That's funny Panda.

I remember one day working in a clinic early on I had just dutifully taken an hour long history detailing 6 complaints, a 2 page ROS, political leanings, favorite foods, last toenail clipping, pet's names and ages, and top 3 all-time movies. Started presenting to the doc (a fellow in an IM subspecialty) and he listened patiently, then marched into the room and said politely but firmly to the rambling patient, "you get two problems today, what are they going to be?" A true epiphany moment.

 

[8744]

That's funny Panda.

I remember one day working in a clinic early on I had just dutifully taken an hour long history detailing 6 complaints, a 2 page ROS, political leanings, favorite foods, last toenail clipping, pet's names and ages, and top 3 all-time movies. Started presenting to the doc (a fellow in an IM subspecialty) and he listened patiently, then marched into the room and said politely but firmly to the rambling patient, "you get two problems today, what are they going to be?" A true epiphany moment.

Seriously, though, the problem is that many of our patients have so many health problems that one hardly knows where to start. The first thing is to have the humility to realize that you're not going to solve all of their problems at the current visit. Most patients are reasonable and understand this. Occasionally you will get one whos appears top be searching for the one physican who through one combination of pills will cure them of their CHF, their CAD, their DM, and their COPD.

 

[turtle md]

Does anyone else feel increasing anxiety if they have to talk to a patient for more than 2 minutes? I start to get twitchy and begin spacing off. After about 2-3 minutes of the patient recounting a history that's going nowhere, I change from open-ended, to yes/no questions.

The only open-ended question I ask is "What brings you into the Emergency Department TODAY." Then I direct the conversation and try to solicit particulars in which I am interested.

 

[GeneralVeers]

The only open-ended question I ask is "What brings you into the Emergency Department TODAY." Then I direct the conversation and try to solicit particulars in which I am interested.

Exactly what I do! I ask that question, give them about 1 minute to answer then go for the focused history questions.

If they still can't give my an pertinent details, I skip the history and either try to find a relative or go to the physical exam. If that's not helpful, then I'm forced to do the workup based on the nursing note.


My favourite is still hispanic ladies with abdominal pain. When I ask them where it hurts, they make a circular motion on their stomach and say "total".

 

[monkeyarms]

yes, it sounds as if my table waiting experience really will serve me well in the ED. maybe i should push this angle on interviews next year.

"good evening sir, may i ask what brings you here tonight?"

"why your fine selections of narcotics, of course!"

"mmm, indeed. would you care to see our cocktail menu or proceed directly to main courses? our feature tonight is an herb roasted dilaudid served with a fentanyl cream sauce and a side of steamed percocets."

"that sounds nice.....but cream sauce makes me nauseated and i'm allergic to percocets. can i just get a double serving of the dilaudid iv and a bottle of oxycontin to go?"

"um, actually sir we don't serve that here"

"this is outrageous! i demand to speak to your manager!"

 

[DW3843]

yes, it sounds as if my table waiting experience really will serve me well in the ED. maybe i should push this angle on interviews next year.

"good evening sir, may i ask what brings you here tonight?"

"why your fine selections of narcotics, of course!"

"mmm, indeed. would you care to see our cocktail menu or proceed directly to main courses? our feature tonight is an herb roasted dilaudid served with a fentanyl cream sauce and a side of steamed percocets."

"that sounds nice.....but cream sauce makes me nauseated and i'm allergic to percocets. can i just get a double serving of the dilaudid iv and a bottle of oxycontin to go?"

"um, actually sir we don't serve that here"

"this is outrageous! i demand to speak to your manager!"

hahahahahahahaha

 

[turtle md]

yes, it sounds as if my table waiting experience really will serve me well in the ED. maybe i should push this angle on interviews next year.

"good evening sir, may i ask what brings you here tonight?"

"why your fine selections of narcotics, of course!"

"mmm, indeed. would you care to see our cocktail menu or proceed directly to main courses? our feature tonight is an herb roasted dilaudid served with a fentanyl cream sauce and a side of steamed percocets."

"that sounds nice.....but cream sauce makes me nauseated and i'm allergic to percocets. can i just get a double serving of the dilaudid iv and a bottle of oxycontin to go?"

"um, actually sir we don't serve that here"

"this is outrageous! i demand to speak to your manager!"

Ah, life in the ED ...

 

[Febrifuge]

When I started my post-bac last summer, my classmates and I were talking about the monstrous workload, and the term "ADD" got tossed around. When one person (who is now a good friend, and will be a fantastic doc) tried to gently chastise me for using the term loosely, all I had to say was that before I came out here, a psych MD was ready to put me on Strattera "just to see what happens." I refused, but we'll see. I actually like my chaotic brain, and it does the job well... so far.

I never have fewer than three Web browser windows open at once, and on more than one occasion I've been speaking with someone who knows I'm headed to a career in medicine, but doesn't know I'm an ER tech, and they've said, "ah; you're going to be in EM." So yes. It's personality, fo' sho'.

 

[kungfufishing]

I cant believe you took the demerol with phenergan salsa off the menu! Looks like I may have to become a regular customer somewhere else...

 

[deleted6669]

one of my attendings puts it another way:
"em providers are control freaks, it's all about making order from chaos"

I too frequently juggle 8+ pts at a time and I have a specific goal for each one, what will happen next, what can wait, etc

 

[southerndoc]

I too frequently juggle 8+ pts at a time and I have a specific goal for each one, what will happen next, what can wait, etc

That is exactly the reason I like emergency medicine. Nothing is more exciting than juggling 8 patients with active issues. It's not like carrying 8-12 patients on a floor.

As commented to me on my last ICU call, emergency physicians are "awesome" at resuscitating patients. I worked a patient out of asystole when the primary team was nowhere to be found (don't ask). The nurse told me "ED residents always do a great job with resuscitations. If the primary team had worked the code, the patient would be heading to the basement right now." I took that as a compliment since this nurse is hardcore and rarely gives out compliments.