Why EM over surgery?

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EclecticMind

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Right now I am just doing a lot of soul searching in hopes of finding my "purpose" in the field of medicine. I began medical school thinking that I wanted to be a surgeon b/c I had spent some time "shadowing" a fellow-trained trauma surgeon at a teaching hospital and thought that his job was awesome! However, after being in medical school I have become much more aware of the cons to a career in surgery... most importantly the effect it would have on my family life, social life, personal life, etc. Lately I have become open to the possibility of maybe doing EM. I worked as a full-time EMT-I for 4 years before entering medical school, and loved every second of it... ESPECIALLY trauma. The reason that I didn't ever really consider a career in EM much before is b/c my experience as an EMT gave me the impression that EM docs are the lowest on the totem pole so to speak. It just always seemed to me that the other docs (even the FP's) never showed any respect for EM docs whatsoever. I just didn't like the idea of spending all of these years to become a doctor to end up in a specialty where I was overtly disrespected by my colleagues. However, I must also add that my experience was predominantly developed in a relatively rural setting, which may have been a disillusioning factor I realize.

But nonetheless, I would be interested in knowing why you have choosen a career in EM over surgery... or in general. Thanks for your time.
 
Where are you in med school? Have you done an EM rotation yet?

If not, try for a setting different than the rural EDs you saw in your EMT days. Rotate at someplace more community-based and urban. Let the group know where you're located and/or where you could rotate, and you can get some suggestions.

At the place I work, EM is the shiznit. A big part of the hospital's identity and public relations comes from being a Level One center with a fancy trauma room and a good EM program. Many, many other departments also kick booty, but I don't think our EPs are the bottom of the totem pole. (If they are, they don't seem to give a crap about that kind of prestige... and that might be the leading characteristic of an EM person.)
 
Come on guys, tell this young student why you think EM is better than surgery?

This thread got many more responses in the Surgery forum...I thought you EM people would have much more to say about why you think your field is better. Many people seem to think the big advantage to your job is the hours/time off, but there must be some better reasons why you all choose EM over surgery I hope?
 
It's a matter of personality, personal preference, and priorities (how's that for alliteration?). I think you need to do several things to make this decision:

1) See what EM is like in a setting similar to the one you'd be practicing in. We do tend to get more flak than most other specialties, but it's clearly higher prestige than many specialties. I'll not name which are more or less prestigious so as to avoid flame wars.

2) Do some soul searching. Figure out what kind of personality you have and what preferences you like in your work. See how that fits in with your choices of specialty.

3) Spend some time with physicians in the specialties you're interested in. Rural ER docs who probably aren't residency-trained in EM don't count. If you like trauma surgeons, you'll probably like emergency physicians. Of all the surgeons I've known, the ones I get along with best by far have been the trauma surgeons. Trauma and EM share a lot of common characteristics.

4) Figure out what exactly you want out of your life. What kind of life do you want? Family, kids? What is important to you and what are your goals?

Despite fourthyear's call for us to tell him why EM is "better", I think the OP would do best to figure out what would be best for him (or her, I don't know the gender). There is no "best" specialty, just one that's best for you
 
EM and General Surgery are very different. The title explains it all:

EM is Emergency MEDICINE (They do some procedures, but they are not surgeons).

GS is General SURGERY (Are the ones who handle MAJOR surgery/trauma).

Comparing EM to GS, is like comparing FP to OBGYN.

Let me ask you this, If some unconsious dude comes in with a major head trauma, who do you think will handle him/her?

A) EM

B) General Surgery

C) None of the above

My answer....C). Remember, we live in reality were there are many hungry lawyers out there.

I think someone here has been watching too much TV.
 
Actually, the first people to handle him will be EM. Then N-surg.

I picked EM because:

a) I liked being the first person to see a patient and to figure out what ails them. Contrary to popular opinion, we diagnose (correctly) most patients in the ER, treat most of them, and send most of them home. We do follow up on patients to see if we were right, and if we weren't most PCP's will let us know what the final dx was.

b) I liked all my third year rotations but I hated outpatient clinic and call. ED is sort of like clinic but I'm not waiting for people to show up and I'm not adjusting bp meds a little here or a little there. If I need to treat BP it's not going to be with something they're going to go home on.

c) When I pictured myself as a "doctor" is was the kind that would know what to do when you're sitting at a concert and someone yells out "We need a doctor!" EM is it, and the only specialty IMHO that fits this description.

d) I didn't get a big kick out of the OR. Sure it's neat to cut stuff out but it seemed pretty cookbook to me. Follow steps XYZ and you're done. I think the surgeons would agree that with exception to the obvious zebra cases or surgery on the critical patient most of the challenge is in post-op management which, IMHO, is more medicine than surgery.

e) I do like procedures. Is EM as procedure rich as Surg? No, nor any of the other surgical specialties. We do get more than our fair share though and once in private practice the procedure ratio goes up (I am told) as there are fewer in-house specialists to do procedures in the ED.

f) I lilke critical care. The nice thing about the ED is we don't have to see the same patient day after day (maybe for 2 shifts). At all the hospitals I have contacts at residents report the amount of time critical patients are boarded in the ED is increasing. I think here it is around 6 hours. We do drips, lines, codes, etc.

g) I like trauma, but I don't love it. For us in EM it's pretty cook-book and honestly it gets pretty boring after a while. As leukocyte says it is true that most academic centers have a mixture of EM management and Surg management for major trauma. At Wake there is always an ED intern on the trauma team who gets the procedures (or the surg intern on the team depending who is on that day), it is always the EM-2 who does the airway, and the EM-3 runs the trauma when it is his day on. The EM attending is supervising unless the trauma attending decides to come down. Many traumas that come to the hospital aren't "major traumas" until something is found on evaluation that triggers increasing their level. Guess who has been managing them until then - EM. We probably get 2-3x as much "non-major" trauma as trauma codes. Of course the real fun for trauma is in the OR and as far as I'm concerned the surg residents can have that.

Out in the real world where there aren't trauma teams, EP's handle trauma until the surgeon shows up or until the patient is transfered.

Anyway, those are just a few reasons I chose EM. You should really try it out to see if you like it.

C
 
Sessamoid is right, methinks. The Surg vs. EM question is a very personal one. There are clearly people who would like either one much more than the other. Which one you will prefer will depend on what kind of person you are, and what things are important in a career/personal life.

I never struggled with this question, but to offer something for the OP:

I chose EM becasue of flexibility, acute care, and flexibility. It is great to know I can go to work and never know what I'll see. Children, geriatric, men, women, severe trauma, medical emergency, psych patients, or just routine visits. Practicing EM is the closest thing to my pre-medical school concept of what it would be like to actually practice medicine. There is also a great deal of practice variability, working in big city, small town, full time, or part time. There are also fellowships in tox., peds, EMS, ultrasound, sports med, and some budding areas of development like critical care. It keeps things interesting!
 
THe answer to leukocytes riddle I'd give is "all of the above".

At all hospitals I've been at and most I've heard of (all of these affiliated with residency programs), general surgery still admits all major trauma pateints, even if neurosurg or ortho or any other surgical specialties operate on them instead of general surgery. This is because you can never be sure that that head injury is their only isolated injury, and even if it is, trauma surgeons usually act as the critical care specialists to manage the ICU care of the trauma patient (except for some of the spceific orders of the neurosurgeon to manage their part). These specialists then leave the patient to us general surgeons to manage in that non-exciting post-op period (after they're out of the true post-op monitoring and complications phase) to await their placement at some rehab facility that they now need due to their major head injury or pelvic/hip fracture. So, in this sense general surgeons on the trauma team are like the medicine sercie often is, playing babysitter for the specialists. This is one of the few negative aspects to general surgery. Well, it's not all negative because that ICU management is educational in our training, but that waiting for rehab placement really isn't.

Sorry, I know this is the EM forum, so this is a little off-topic, but in order to help the OP make an informed decision about the choice between the two I had to clarify this point.
 
Surgery and EM are really nothing alike. I have always found this dilema interesting. I loved surgery. (well, vascular) but never even really considered it secondary to lifestyle, general surgery residency and the fact that I don't like managing clinic stuff. Surgery is very cool but it was also not diverse enough for me.

In med school, I had planned to go into pediatric rheum. Never even considered ER. However, during third year, I realized I hated peds. I also really enjoyed a little bit of everything I did (except medicine clinic) but none that I wanted to do all the time.

I also wanted a career where I had a good lifestyle. Someone recommended EM and I started looking into it. I did a couple of shifts and was hooked. So what do I love about it?

I love the pace. I like to multitask and have a lot of things happening at once. I love not knowing what is goign to walk through my door. Patients are fresh and not coming with a work up intact. I love the diversity. GYN, medicine, surgery, lacerations, peds, ENT, ortho. everything. It all walks in the door. I like procedures.. a little suturing, chest tubes. A little trauma, although I concur, it gets a little boring.

I like the fact that I still have to use my intuition. No, I don't always know why someone is sick but I can tell if someone needs to come in or not.

The lifestyle is great. There are so many options. I can work rural, urban, international. I can work 3 days a week or 3 days a month. I can change from year to year. I can travel for a month and not have to worry about my clinic.

You really just have to go do some shifts. if you like going to work, then it's probably right for you.

Where I am, EM is the bomb. We have direct admitting privlages and we are very well respected in other departmetns.

You have to be good at workign with lots of other people. Your consults are vital.
 
Agree with roja; EM and surgery are not much alike.

The big, glaring question I'd ask yourself is do you want to be in the operating room and manage pre- and post-operative issues?

I think some of the BS that is shown on TV makes it look like trauma surgery and EM are the same thing. Yes, trauma surgeons or emergency physicians may be involved in the INITAL assessment of the trauma patient, but operative and in-house management of trauma is done by surgeons. And it isn't all guts and glory, let me tell you that.

There is a lot of institutional variance, as we do not have an emergency medicine residency so our trauma ER is completely run by surgery residents/surgeons. So I see everything from the sprained ankle to the self-inflicted GSW to the head from the time it rolls in the door.

EM sees a variety pack of things all day long and doesn't deal with the management once the patients are on the floor.

As for other things, hands-down EM is a much better lifestyle. They run hard for the ~12+ hour shifts but then they are usually free of the god-awful sound of the pager when they go home. I'm in surgery and in the last ~14 months, I have been on q3 call more than 90% of the time and on some months have had absolutely NO time for a life or outside interests.

If you love the OR more than anything else in your life, surgery may be the right choice for you. If you like emergency medicine and enjoy outside interests, I couldn't fault a person at all for choosing EM.
 
I'm an EM intern doing a month of general surgery this month. It is nice to know this is the toughest month of our intern year and once I am done I can leave the endless paging and floor scut behind me. The two sugery interns I am with are very envious of the rest of my schedule. They love going to the OR so the paging and managing the patients is worth it to them, but I couldn't do it for 5 years.

-P
 
Thank you all for your elaborate responses... they have been verly enlightening for me. Looking back, I must admit that although I wasn't necessarily conscious of it at the time, I was attracted to the "prestige" of being a surgeon... mainly b/c when I did work with the trauma surgeon I mentioned, it just seemed like the entire hospital "bowed down" to the surgical team. But after MUCH soul-searching, I have realized that there are things in life that are more important to me than walking around a hospital with my head in the air and proud knowing that I was a surgeon.

I realize now that there are many more things that I would be "proud" of as an EM doc as I would be as a surgeon. I also realize that as I make this decision for my career, I should go back to my roots and begin where it all started... and that was definitely in the arena of emergency medicine. It hooked me from the start... and that's probably the biggest reason why I'm in medical school (3rd yr) and have the opportunity to even be able to choose what kind of doctor I want to be.

Again, your responses were fanatastic! I sincerely do thank each of you for taking the time to inspire me. Best of luck!
 
I' going through this dilemma myself. It seems to me the similarities are in the ability to treat someone quickly and they get better because of the way you intervened. I do agree with the cook-book nature of some surgery but couldn't the same be said for intox pt, r/o MI, and traumas in the ED?
 
100904 said:
I' going through this dilemma myself. It seems to me the similarities are in the ability to treat someone quickly and they get better because of the way you intervened. I do agree with the cook-book nature of some surgery but couldn't the same be said for intox pt, r/o MI, and traumas in the ED?
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I briefly considered trauma surgery. Trauma surgeons and ER docs both can do everything in the trauma bay prior to the OR, although some surgeons don't want to admit this, of course, the surgeon handles everything OR and post op, which is a whole new world. In medical school, I really enjoyed the science of surgery, but I didn't enjoy carrying it out---being in the OR for hours, suturing. I have the attention span of a gnat. ER docs make heavy decisions based on limited information and trauma surgeons do this TOO, but as time goes on, the surgeon is offered more information and at least in the OR, being a surgeon probably requires a meticulousness that isn't in the personality of most ER docs.

All specialties in medicine get cookbook. No matter how "cool" what you're doing is, everyone eventually gets a little bored with the common stuff. However, I usually see something at least everyday that strays from the path and humbles any notion of that.

The big difference between EM and other types of medicine is (1) you're making decisions off limited information and trying to simultaneously determine a treatment and a disposition and (2) the DDX is the reverse of most other specialties. In medical school, you're taught to take a presentation and make a list from most likely down to the zebras. In EM, you're taught to make a list of all the things that could present like this from highest lethality on down.

Hope this helps.

mike
 
My two cents-
I too was an EMT for several years before med school, and became close friends with some attendings while working as a tech in a busy community hospital. I'm a fourth year, and spent considerable time doubting EM, thinking that there must be another field I would be just as jazzed about, maybe interventional radiology, cardiology, even surgery. But I, like you, had to go back to my roots, and after my EM rotation, I realized there is simply no other place for me, but that's me. Frankly, I'm happy there are folks out there that want to do other things.
Surgery is great, it's focused and you get to make a definitive intervention in many cases. No field should be disparaged by any other because guess what? In the end we all need each other. The question of respect is funny, because in the last week I've had an IM intern tell me I was a sell-out, and an orthopod tell me he was 'sorry' I had chosen this field in the middle of a TKA. I told him that was okay, I'm not (while holding the retractor, of couse..).
As EM is the new kid on the block, we will have prove both the necessity of such a specialty and practice in an effort to be comfortable handling a wide range of emergent and urgent problems. This will be a continual process. I firmly believe there is a right way to do it and a wrong way, and I hope the best EM docs will be able to take a patient as far as they are able to before handing them off for definitive surgicial intervention or appropriate follow up, etc.
Having said that, there are endless opportunities to criticize EM by other specialties. No one will be second guessed as much, no one else will practice in an open fishbowl. But who has the opportunity to take any one who comes through the door and attempt to do whatever is in their best interest?
No one.
Ultimately, we all have to make that decision, and it's not easy. Best of luck and respect to all-the practice of medicine will be difficult enough for all of us without the egotistical joggling for the 'best rep'
 
Great thread!

I almost feel at home here 😉 . I, too, am a 3rd-year - I just finished a gen surg rotation, and surprised myself by absolutely loving it. The hospital I did it at, though, has no ER residency.

I, too, came from an EMS background, and came to med school focussed on EM. Now, at this point, I'm waiting until this October when I do my 4th year EM rotation to decide for sure, but if the reality of being a provider in an ER doesn't jive with my preconcieved notions, I know I could be happy in surgery.

Lifestyle? Yeah, it's definitely a factor (I'm 37, too) but certainly not the overwhelming one... finding something I'll love doing for the rest of my working life is more important.
 
Hey, a blast from the past. Cool thread.

Another thing to mention is personality, or more accurately, persona. There's a vibe and a climate to different specialties that can enhance or support a person's medical skills. I have a friend who's an ortho surgeon. Great guy, witty, very laid-back. Shadowing him over two days (one OR and one clinic day), I was really struck by how serious and earnest everything has to be, to achieve that professional staff doctor state of being.

Contrast this with the behaviors and styles of my friends and co-workers in the ED, where gentle sarcasm is a valuable teaching tool, and being a tight-ass is counterproductive to the consistent and effective delivery of optimal care. Maybe it's because you could be asked to do just about anything in your skill-set at just about any moment, and staying well-balanced and loose is valued highly.

It seems like a day in surgery where nothing unexpected has happened is a really good day; a day in the ED where nothing unexpected has happened is a day that just ain't over yet. Maybe one good way to decide would be considering which environment is more comfortable for how you like to work.
 
Here is my answer and my perspective. Before entering med school I worked as a physician assistant for 7 years. one year in trauma/surgery, 3 years in critical care medicine, and 3 years in emergency medicine. i also moonlighted in neurosurgery once a month over that time period. I was lucky enough to do alot of cool stuff. There were many reasons I went back to med school but one of the major ones was because I loved EM and finally found a discipline that fit with me. Remember Surgery and EM have differences and similarities. Knowing what they are and how they fit with you is the hard part. Do whatever gives you that "burn", or makes you want to go to work each day.
1. Truama surgery does get quite boring after the adrenaline wears off. I saw everything (thoracotomies and laparotomies in the ER (not just in the OR), etc) and I got to perform chest tubes and central lines in the admitting area, and after about year all I felt I was mostly doing was ordering CT scans and babysitting. After the adrenaline was gone (it is just like a drug that you get tolerant too) it is cookbook (not that is a bad thing) because you are providing a great service to the community. Rarely do patients go to the OR and to me that is were the challenge is in trauma "surgery".
2. The challenges of the OR are unique and special and most surgeons will tell you that this were they feel at home and cant wait to get back too. Managing patients outside the OR can be fun too but surgeons would rather be in the OR. Eventhough I was only assisting during my OR experience and doing the procedure would of been totally different I felt like I was in a cage and couldn't wait to get out of the OR.
3. Their are good and bad surgeons and good and bad ER docs. If you want to be a bad ER doc you can be lazy, not work anything up, and dispo stuff quickly. If you want to be a bad surgeon you can not consult in a timely manner, show poor judgement, and be dispondant towards your patients and physicians. If you want to be a good ER doc you can remain well read on subjects that specialist will eventually handle and show them that you are a good "physician" because you understand their big picture. I have seen many good, intelligent ER docs telling specialists what needs to be done and 9/10 times that is what ends up happening. The more effort you put into learning your trade as an ER doc beyond what is minimally required the more rewarding it is. I use to love chanllenging my suturing skills and got to the point that I would almost never call plastics and all the ER docs except for one (another suturing junky) would give me their laceration cases.
***So why do ER? Fast pace, 40 hour work weeks, no call, variety of cases in both age, type, and acuity. sedation, airway, procedures, undiagnosed patients, cool staff, save lives and get the patient going in the right direction. Take it from someone who has a successful family while in med school. As much as I love medicine it is part of my life not my whole life. ER affords me the opportunity to exercise intensely, be a good father and husband and tackle some hobbies and self-improvement activities. I didnt think surgery would allow for a well balanced life which should never be underestimated. When I am 60 years old (36 now) I know I will look back and not have any regrets. That is all....mark
 
Surgery is the Islamic Jihad of the medical profession. Nobody is more fanatic about what they do and less tolerant of those who don't share the faith.

With that said, surgery and EM share some common characteristics (preparing for the onslaught of protests from both sides):
1) To do well in both, you have to be decisive and think quickly on your feet.
2) You should be able to act (sometimes radically) on relatively little information.
3) Procedures are a feature of both specialties.
4) There is a good bit of critical care in both surgery and in EM.
5) Neither specialty cottons to wandering around pontificating for hours.

That you would be attracted to both, especially considering your EMS background, is not surprising. Prehospital personnel are often in situations similar to those above.

Reasons to choose EM over surgery:
1) Greater variety. Most disease is not cured surgically. As an EP, you will see every variety of disease and injury in every stage of its progression.
2) The ability to manage ANYthing that comes through the door. I'd rather have an EP treating my mother's chest pain than a surgeon.
3) The ability to multitask to the greatest degree.
4) Lifestyle. A minor concern to those who truly love what they do.
5) Culture. As you've probably figured out, surgery has a culture that can be malignant. Surgeons tend to have derogatory things to say about physicians in most other specialties, and even about each other. Behavior in the OR that might not get anyone to bat an eye would get you fired from most other specialties. EM docs tend to be a pretty fun group overall, laid back, and collegial.
6) Shorter time to get in the air. As a surgeon, you have to pay your dues for a LONG time before you are in the practice and have sufficient control over your life.

Reasons to choose surgery over EM:
1) Disease that CAN be cured surgically usually can ONLY be cured surgically.
2) Patients actually get better.
3) The ability to give one issue your complete attention and focus.
4) If you love operations more complex than a chest tube or multilayer laceration repair, the OR is the only place to be.
5) You get to follow up on your patients over a period of time but don't have to manage every little problem.
6) You frequently get to see the resolution of the patient's condition.
7) Prestige. To the "white tower" physicians who like to march around in their long white coats feeling good about themselves, it matters. Heirarchy is very important in surgery, and usually is based on what PGY you are. The rest of us just treat patients.

EM docs are not:
"Glorified triage nurses" as the surgeons say.
"Those bastards downstairs who ruined an otherwise great night on call because they are afraid to discharge anyone" as the internists say.
"The *****s who have no idea how to page the general resident on call instead of bothering me" as the ENTs/urologists/cardiologists say.

Most non-EM docs hate the ER. For one thing, it usually represents more work for them. As a resident you're not getting paid extra for doing more work, so this is not so rewarding. For another, if you don't really know what's going on in the ER and how it works, it is loud, chaotic, and crowded. Non-EM docs may prefer to retreat to their call room or OR or office or some nice quiet place like that to think about the patient. Forget the garbage that other docs say about the ER. Few of them understand or get to experience the ER as an EP does. For the same reason, I gritted my teeth anytime someone called me an "ambulance driver" when I was a paramedic.

This decision is quite personal as others have said. If you LOVE being in the OR and can't wait to get in there every day and are willing to put up with the crap you have to wade through to get there, then go surgery. If you are excited when the pager goes off to come down to the ER, are intrigued by all the activity around you when you're there, then strongly consider ER.

'zilla
 
Just browsing this thread, I don't think anyone's addressed medical missions opportunities--this was something that factored into my decision to enter EM.

On an individual level, I would say a surgeon is the most valuable doc for a medical missions effort mostly because of the "ability to cure" factor. As a provider, an EM doc probably isn't too much more useful than your FP, IM, or Peds doc.

On the other hand, EM docs have a big leg up on all other civilian docs as far as disaster management and DMAT. A surgeon would have to go way out of their way to acquire this background and training.

For me, if I ever had the calling to do more than short-term medical missions, I would have seriously considered going into surgery. I'm much more switched on by the prospect of getting onboard with a DMAT, so EM fits a lot better.
 
I would say that surgeons don't hate the EMP and niether do general internists. residents hate it because to them, it means more work. To a private surgeon, a private MD the EMP represents someone who will work up thier emergent patient. And also will become a referral source.

Our orthopods LOVE the ED residents. and that is not just because we get drunk with them. Its because thier attendings KNOW that a good bit of thier income comes from our referrals.

(And I saw the other side of this. My dad is an orthopod. a HUGE part of his practice was built threw the ED.)

I have never really understood the people who went into medicine for 'prestige'. You are really just begging to have your world knocked out of you if you completely identify your whole self being based on your career choice. This is NOT what medicine is about and if that is what you are chasing, you will never be content. (there will always be SOME surgeon/cardiologist/whatever that is better and more prestigious than you)

Pick the field where you loved going into work everyday. Period. All the rest is BS.
 
roja said:
Our orthopods LOVE the ED residents. and that is not just because we get drunk with them. Its because thier attendings KNOW that a good bit of thier income comes from our referrals.
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I have a theory. It goes Ortho:EM :: Harold:Kumar.
roja said:
I have never really understood the people who went into medicine for 'prestige'. You are really just begging to have your world knocked out of you if you completely identify your whole self being based on your career choice.
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Truer words were ne'er spoken. Those who want adulation should take an acting class, play in a garage band, or do stand-up comedy sometime during MSIII and MSIV years, to get it out of their system. Anyone who thinks residency is going to be about people telling them how awesome they are is cruising at high speed down the Major Freakin' Disappointment Memorial Tollway (exact change only please).
 
Feb,
I just gotta say that I 😍 your posts.

Occasionally they make me snort coffee out my nose, but it's all good. :laugh:
 
Actually the ED is nothing more than triage, thats all. And at times a medical student would do a much better job than the Attending. I'm a 2nd year surgery resident and I can not express my disrespect of the ED. They are a danger to their patients and are COMPLETELY clueless about abd pain, bleeding ect.. Few Examples

1. We were on staff call last week, 31 consults for abd pain. Half get sent home emmediatly, not one goes to surgery

2. I saw a patient who pulled on his perm cath last friday, The ED decided to flush the catheter (which was locked with 20,000 U Heparin for each line) so he starts bleeding more, get a PTT >250 from a LINE draw and give 10mg of Protamine. No pressure was held, Only a loose absite dressing was used lol - SO many mistakes here, MINDBLOWING

3. Get a call, "we have an appy down here". Exam shows a large incarcerated abd hernia. They didn't do an exam or do not know how to.

I could go on and on. I make it a point to my medical students. The "only thing you can trust what the ED tells you is the Room number." FP are way more competent than any ED doc.
 
gerickson03m said:
Actually the ED is nothing more than triage, thats all. And at times a medical student would do a much better job than the Attending. I'm a 2nd year surgery resident and I can not express my disrespect of the ED. They are a danger to their patients and are COMPLETELY clueless about abd pain, bleeding ect.. Few Examples

1. We were on staff call last week, 31 consults for abd pain. Half get sent home emmediatly, not one goes to surgery

2. I saw a patient who pulled on his perm cath last friday, The ED decided to flush the catheter (which was locked with 20,000 U Heparin for each line) so he starts bleeding more, get a PTT >250 from a LINE draw and give 10mg of Protamine. No pressure was held, Only a loose absite dressing was used lol - SO many mistakes here, MINDBLOWING

3. Get a call, "we have an appy down here". Exam shows a large incarcerated abd hernia. They didn't do an exam or do not know how to.

I could go on and on. I make it a point to my medical students. The "only thing you can trust what the ED tells you is the Room number." FP are way more competent than any ED doc.
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:idea:


😴
 
Actually the ED is nothing more than triage, thats all. And at times a medical student would do a much better job than the Attending. I'm a 2nd year surgery resident and I can not express my disrespect of the ED. They are a danger to their patients and are COMPLETELY clueless about abd pain, bleeding ect.. Few Examples

What an dingus. Could you generalize a little more? The ER docs I work with are brilliant diagnosticians. They are nailing calls on the head from some Joe schmoe who can't even give them a convincing last name, much less a medical history.

1. We were on staff call last week, 31 consults for abd pain. Half get sent home immediatly, not one goes to surgery./

Boo-hoo. Poor little surgeon had to work without operating! +pity+
Maybe you don't understand how we are trained in the ED. Zebras come first, just in case. If we can't adequately rule out bad stuff, then they get a consult. We don't have the time or resources to sit on a bunch of patients all day to see if something develops. Granted some ER docs are a little quick with their consult trigger finger, but it just may be because the are more experienced and have had a similar case jump up and bite them on the ass a few times. ( See the thread, I Feel Rotten on this forum.) I think we would all agree- better safe than sorry when our patients are concerned. Or maybe we don't all agree.

2. I saw a patient who pulled on his perm cath last friday, The ED decided to flush the catheter (which was locked with 20,000 U Heparin for each line) so he starts bleeding more, get a PTT >250 from a LINE draw and give 10mg of Protamine. No pressure was held, Only a loose absite dressing was used lol - SO many mistakes here, MINDBLOWING

3. Get a call, "we have an appy down here". Exam shows a large incarcerated abd hernia. They didn't do an exam or do not know how to.

That may or may not suck, depending on your accurate recall of events.

I could go on and on. I make it a point to my medical students. The "only thing you can trust what the ED tells you is the Room number." FP are way more competent than any ED doc.


Don't forget- we usually have all the takeout places phone numbers by heart, too! :horns:


I will remember the next time your family member comes into the ED having a massive MI to call off the ER docs and have them page the brilliant 2nd year surgery resident stat. I'm sure they are pros at life saving interventions. :laugh:

Bottom line is, there are good docs and bad docs in every field... wait...here comes an epiphany....EVEN SURGERY!!!! (*gasp*) I'm sure some of my more experienced brothers on this board could give you numerous examples of the idiot surgeon who was in a rage that they got consulted for the obviously benign abdomen, that perfed 3 hours after discharge. :wow: Hell- I have quite a few, and I'm still in school!

Take your sorry, overworked, trolling ass off of our forum and go make stupid comments somewhere else. Have a great day! Drive safe! You never know what kind of idiot could be waiting to run your trauma if you don't! :meanie:
 
I'm sorry, what was that? I was too busy watching "When Surgery Tools Get Left Behind" on Discovery Health channel.

USAF MD hit it on the head. Most ER docs I've met are terrific at diagnosis. What ER docs do not have, in contrast to the admitting teams, is the opportunity to observe the illness progress. It would seem that gerickson03m's hindsight works just fine. How lucky that he (or she) has that luxury.

And it's so nice to hear that you are sure to tell the medical students how little you think of the ER docs. I'm sure that the students think so well of you for it. They must think to themselves, "gee, there's a really sharp junior resident who thinks nothing of the docs who work in an environment he knows nothing about. Here's someone who is more than willing to spout off about his contempt for other physicians he doesn't even know. I want to be just like him." 😍 And surgery residencies wonder why they have trouble filling.

I wonder if gerickson03m holds the same contempt for the nursing staff. Do you happen to get paged to random numbers or for tylenol orders all night long? Newsflash: they know how to give tylenol. They're doing that to make you miserable.

As we were talking earlier about culture, the ER docs that I've worked with are hesitant to publicly disparage other physicians from any specialty. This is not because they believe they are looking up at the medical community from the bottom, but because they respect the varied training and experience of their colleagues.


'zilla
 
gerickson03m said:
Actually the ED is nothing more than triage, thats all. And at times a medical student would do a much better job than the Attending. I'm a 2nd year surgery resident and I can not express my disrespect of the ED. They are a danger to their patients and are COMPLETELY clueless about abd pain, bleeding ect.. Few Examples

1. We were on staff call last week, 31 consults for abd pain. Half get sent home emmediatly, not one goes to surgery

2. I saw a patient who pulled on his perm cath last friday, The ED decided to flush the catheter (which was locked with 20,000 U Heparin for each line) so he starts bleeding more, get a PTT >250 from a LINE draw and give 10mg of Protamine. No pressure was held, Only a loose absite dressing was used lol - SO many mistakes here, MINDBLOWING

3. Get a call, "we have an appy down here". Exam shows a large incarcerated abd hernia. They didn't do an exam or do not know how to.

I could go on and on. I make it a point to my medical students. The "only thing you can trust what the ED tells you is the Room number." FP are way more competent than any ED doc.
Click to expand...

Here we go again. This was a thoughtful and generally benign discussion of how people torn between surgery and EM made up their minds (not a problem I ever had) and then the trolls(tools?) showed up. We ought to just take the ER sucks threads, lump them all together, and make them a sticky. Or maybe a seperate forum moderated by kinetic, neutropenia boy, and gerickson. That way when a bitter, overworked, underloved resident from some other service wanders in here they won't feel the need to recreate the whole rant. At one point I posted my list of favorite, surgery, IM, anesthesia,ortho and ENT screwups just to show that everyone makes mistakes and that just like you bail us out sometimes, we sometimes save your bacon too. I'm just too tired to do it again.

Posts like this make me glad I don't work in an academic center anymore where I have to interact with people like this. You know there is a reason your surgical training is going to last 5-7 years, because you don't know nearly as much as you think you do yet.
 
😍 Gerickson. 😍 ..... You are so right on man!!!!!!!!!!!!!!!! Wow I am so happy someone finally spoke up to tell the truth about EM. Now please do us all a favor and be sure to keep telling all of your medical students!!!! 👍
😛



🙂



😀

Reason 1 for above post) Any medical student who would think twice about a second year surgery resident's bitter EM bashing ,let alone weigh said bashing when choosing their future specialty, is not someone who should go into EM anyway. They must value that residents opinion almost as much as he does himself and therefor are obviously made for the years of seniority tush kissing and crap swallowing that is a surgical residency.
Reason 2: Despite this guys valiant efforts to spread the truth, EM remains way to competitive for my comfort level. Maybe if he gets his word out a bit more I can shorten my rank list next year.
:laugh:


P.S. Sorry I fed the troll. Im in the middle of my gen surg rotation and I couldn't help myself.
 
threepeas said:
***So why do ER? Fast pace, 40 hour work weeks, no call, variety of cases in both age, type, and acuity. sedation, airway, procedures, undiagnosed patients, cool staff, save lives and get the patient going in the right direction. Take it from someone who has a successful family while in med school. As much as I love medicine it is part of my life not my whole life. ER affords me the opportunity to exercise intensely, be a good father and husband and tackle some hobbies and self-improvement activities. I didnt think surgery would allow for a well balanced life which should never be underestimated. When I am 60 years old (36 now) I know I will look back and not have any regrets. That is all....mark
Click to expand...


40 hrs? really??? So I cn actually have a life? What about residency?

Agape
 
sunnyjohn said:
40 hrs? really??? So I cn actually have a life? What about residency?

Agape
Click to expand...
yes, for full-time benefits you had to work 1600 hours per week which is about 32hrs/week. everyone wanted atleast 40 and some moonlighted to get 50. when i left the docs were making $110/hour, + about 10% of gross in bonus, + 10% of gross was being contributed to 401K. not a bad deal. this was 1 hour out of washington dc.
 
Primarily because the the pattern of arrogance by surgeons is so distasteful that i would quite possibly implode. When they (the surgical residents) come down to the ED, I want to laugh...they simply want nothing to do with the ED and they try to leave as soon as possible. The longer they stay, the more irritated they become. Every one is constipated...no one has appendicitis...no one gets pain medicine...NO FEMORAL LINES...you didn't get an upright abdomen?...Did you do a pelvic...did you do a rectal...did you do the entire workup so that I have nothing to do but call my attending and assist during the surgery because if it really came down to it I could not differential diagnose independently to save my life...Oh the arrogance.
 
I guess it's only fair to mention that not all Surgery people are total tools. At the brand-name center(tm) where I work, some Surgery residents seem cool. Maybe as they gain respect for the stuff the ED is doing, they get mellower and more "in the loop."

I saw one guy the other night who seemed like he was willingly hanging out with us. Our staff doc was like, "are you sure you want to re-pack that guy's cyst? We can do that," and the Surgery res said, "nah, I'm here anyway, and you have a lot going on. Thanks though."

So, it happens that way too.
 
Now, we all know that not all surgeons are pathological histrionics. Unfortunately, the ones that do taint it for all those that aren't. They just happen to be more vocal, completely idiotic and thus garner more attention.

In general, our surgeons are awesome. We have some that I absolutely LOVE to work with. One of them is a second year and she never ever bitches about consults, even when I preface it as 'this is a bad consult my attending is making me get'. She is regarded as one of the BEST surgeons in our program, from attendings down. So, our good surgeons, they know that the vast majority of ED docs (and residents) only consult when necessary adn that as residents realize that despite thier surgery program directors desire for the surgical residents to see 'all undifferentiated abdominal pains' that there is no way in hell we are torturing them with all[i/] of them.

Now, just as there are a**hole surgical attendings/residents, there are some pathological ED people as well. We have one attending that is so freaking condescending to ALL consults, I cringe every time he opens his mouth when a consult is around. (I pray they just talk to me over the phone) "Well, you know, really when you do a whipple you should be careful of yadda yadda yadda" or some other such bull**** nonsense... What the hell does he know about whipples? *sigh*

Let's all just kiss and make up. 😀
 
EclecticMind said:
Right now I am just doing a lot of soul searching in hopes of finding my "purpose" in the field of medicine. I began medical school thinking that I wanted to be a surgeon b/c I had spent some time "shadowing" a fellow-trained trauma surgeon at a teaching hospital and thought that his job was awesome! However, after being in medical school I have become much more aware of the cons to a career in surgery... most importantly the effect it would have on my family life, social life, personal life, etc. Lately I have become open to the possibility of maybe doing EM. I worked as a full-time EMT-I for 4 years before entering medical school, and loved every second of it... ESPECIALLY trauma. The reason that I didn't ever really consider a career in EM much before is b/c my experience as an EMT gave me the impression that EM docs are the lowest on the totem pole so to speak. It just always seemed to me that the other docs (even the FP's) never showed any respect for EM docs whatsoever. I just didn't like the idea of spending all of these years to become a doctor to end up in a specialty where I was overtly disrespected by my colleagues. However, I must also add that my experience was predominantly developed in a relatively rural setting, which may have been a disillusioning factor I realize.

But nonetheless, I would be interested in knowing why you have choosen a career in EM over surgery... or in general. Thanks for your time.
Click to expand...

Here are some more thoughts to add to my previous response.
I think one of the most unique and challenging aspects of EM is handling the undifferentiated patient. I appreciated the challenge and fun of this after working in the ICU as a PA for 3 years. I was learning how to handle the sickest patients and put out ICU fires but the patients 9/10 came through the doors with a diagnosis. After a few years of this I realized I was losing the important subtle HPI/PE and diagnostic skills that I knew were important to being a good physician. I went and worked in the ER and over some time I realized how much fun and how challenging it was to work up a patient that no one had worked up before. Also, there were some times that the patient had a diagnosis from their internist/FP that we were able to take a fresh look at and ended up discovering something new that led to a different diagnosis and treatment plan.
Second, the EM allows you the opportunity to relieve suffering in such a way that cant be done in the clinic or on the floors. You can use just about any drug in the ER to relieve pain and anxiety. You can take someone's acute gastroenteritis symptoms away and enjoy watching them finally getting some sleep after hours and hours of vomiting, etc. Some one with SOB can get treatments or if necessary intubation that can put them in a restful non-anxious state. Even though parents of children can be challenging you see them in ER at there worst and if you can fix or diagnosis the kid correctly you can watch a worrisome parent become comforted. So there are these and many more opportunities you can have an immediated impact on a patient and family in the ER
Last, I think a very important aspect of medicine to consider the type of patient relationships you want. the procedures can get old so I think the physicians that truly stay happy in their field are those that enjoy their patient interactions and maintain compassion for them. I describe ER interactions as short and sweet. After things settle down with a patient I have always had time to get to know them a little bit. I think patient and family education is important and have always made time when necessary to incorporate this. Some patients say that despite their short time in the ER they sometimes get the most information. This is of course is provider dependent but it can be done even in the ER. That is all...best wishes !!!
mark
 
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