controversial, but i gotta ask

[AmoryBlaine]

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Ever heard of thrombolytics?

(Although I do agree with the remaining balance of your post.)

I stand corrected. Having yet to leave the ivory tower I don't know what a world w/o 24 hours caths looks like.

(And thank you)

 

[AmoryBlaine]

Whenever I get an obnoxious colleague (or usually just a relatively inexperienced colleague as age and experience seems to dilute the piss and vinegar) who wants to know what, really, we are beyond glorified triage nurses, or wants to whine that we miss diagnoses, yada yada yada, I point out that the one thing we do better than anyone, the real 'bread and butter' in my mind of emergency medicine, boils down to one thing:

We are the masters of resuscitation.

We have the procedural competency and at least the necessary acute medicine knowledge to resuscitate sick kids better than the average pediatrician. Same goes for the ability to resuscitate sick septic patients or a patient with thyroid storm that would not be rivaled by the average internist. Sure, the surgeons can resuscitate someone all right (and will provide the definitive care in the OR in many circumstances) but even most surgeons would struggle to match the depth of our resuscitative skills and knowledge breadth when you consider the vast majority of medical, surgical, pediatric and, frankly, undifferentiated patients.

I have never supposed that we are better than any other specialty. We're just different. But we definitely have our own specific function that no other specialty does and we shouldn't need to be apologists because most of the times when we're not resuscitating we doing a little bit of everything (the backup quarterback analogy was nice).

An excellent point, I might say "stabilization" because it encompasses a bit more than resus but the essential point is the same. I was not trying to suggest that we don't have expertise, just responding to some fairly nasty accusations about our colleagues.

 

[roja]

You're anesthesiologists?

(😉 just teasing)

Fraternizer!

 

[emergiQ]

You're anesthesiologists?

(😉 just teasing)

That thought is gonna fester 🙂

 

[QuikClot]

1. MIs are eventually managed by a cardiologist

Everything is eventually going to be handled by someone else. Eventually the surgery patient is going to be managed by the nursing home, but it doesn't follow from that that the surgeon is second fiddle to the rehab nurse.

Let's take a closer look at the analogy proposed, that EM docs are like "back-up quarterbacks." Does that make any sense? Do you start the game with the second string? No, you start the game with your best player, and they hand it off to the second string. That's why we call the best player the "starter." And that's what the EM doc is -- the starter.

EM docs are the best at EM, and other docs are the best at what they do, so a better football analogy is not first-string and second-string, but people playing different positions. In the ED, you call the play, and then you either pass, hand off, or scramble. Your internists and surgeons are like your running backs and wide receivers.

The "triage nurse" meme is kind of like the running back and the wide receiver sitting down after the game and saying that the quarterback really isn't excellent at anything; he doesn't run as well as the running back, he doesn't score as many touchdowns as the wide receiver. All he does, really, is pass the ball, and ANYBODY could do that (with an unlimited amount of time and no defense pressuring them, anyway.)

The quarterback reads the field and executes the play, quickly and under great pressure. He doesn't have to take the ball into the end zone himself to be successful.

 

[dmunorse]

Everything is eventually going to be handled by someone else. Eventually the surgery patient is going to be managed by the nursing home, but it doesn't follow from that that the surgeon is second fiddle to the rehab nurse.

Let's take a closer look at the analogy proposed, that EM docs are like "second-string quarterbacks." Does that make any sense? Do you start the game with the second string? No, you start the game with your best player, and they hand it off to the second string. That's why we call the best player the "starter." And that's what the EM doc is -- the starter.

EM docs are the best at EM, and other docs are the best at what they do, so a better football analogy is not first-string and second-string, but people playing different positions. In the ED, you call the play, and then you either pass, hand off, or scramble. Your internists and surgeons are like your running backs and wide receivers.

The "triage nurse" meme is kind of like the running back and the wide receiver sitting down after the game and saying that the quarterback really isn't excellent at anything; he doesn't run as well as the running back, he doesn't score as many touchdowns as the wide receiver. All he does, really, is pass the ball, and ANYBODY could do that (with an unlimited amount of time and no defense pressuring them, anyway.)

The quarterback reads the field and executes the play, quickly and under great pressure. He doesn't have to take the ball into the end zone himself to be successful.

I like that analogy. Good work.

 

[AmoryBlaine]

Everything is eventually going to be handled by someone else. Eventually the surgery patient is going to be managed by the nursing home, but it doesn't follow from that that the surgeon is second fiddle to the rehab nurse.

Let's take a closer look at the analogy proposed, that EM docs are like "second-string quarterbacks." Does that make any sense? Do you start the game with the second string? No, you start the game with your best player, and they hand it off to the second string. That's why we call the best player the "starter." And that's what the EM doc is -- the starter.

EM docs are the best at EM, and other docs are the best at what they do, so a better football analogy is not first-string and second-string, but people playing different positions. In the ED, you call the play, and then you either pass, hand off, or scramble. Your internists and surgeons are like your running backs and wide receivers.

The "triage nurse" meme is kind of like the running back and the wide receiver sitting down after the game and saying that the quarterback really isn't excellent at anything; he doesn't run as well as the running back, he doesn't score as many touchdowns as the wide receiver. All he does, really, is pass the ball, and ANYBODY could do that (with an unlimited amount of time and no defense pressuring them, anyway.)

The quarterback reads the field and executes the play, quickly and under great pressure. He doesn't have to take the ball into the end zone himself to be successful.

I didn't actually make the analogy of the second-string quarterback and I don't really agree with it.

 

[QuikClot]

I didn't actually make the analogy of the second-string quarterback and I don't really agree with it.

I do not think ED docs are magical or that they are better than docs in other fields. Rather, I think they are the best at EM, which is a distinctive skill set and requires a distinctive thought process. I don't think any specialty is best judged by what procedure or complaint they manage better than anyone else, rather, each specialty has its own population with their distinctive challenges and a practice with its own working conditions with which they do most of their training, and more importantly, their practice. With experience navigating your home ground becomes intuitive (as distinct from magical), and this is equally true of a surgeon or an EM doc or an FM doc.

The reason to have "specialist generalists" like FMs, EMs, peds, hospitialists and intensivists is not so the amount of knowledge that is important is less, but so that the physician can have the "home field advantage" in terms of training and exposure to the types of patients that present and the kinds of problems that arise.

We seem to be dangerously close to agreeing with one another.