don't take this the wrong way, but...

[PostCall]

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how do you put up with the ER? seriously. i don't mean that as an insult because more power to you that you can voluntarily go into it for residency and then work at it for a career. but i did a month rotation in the ER and couldn't wait to get the heck out of there every single day. most days i had to force myself to even show up. mainly cuz of the people. every other person there was some low-life drug seeker/malingerer/ex-convict/future convict/or just out to game the system in some way. sure there were people there for legit reasons but there were so many there that weren't. oh and the rudeness and blatent disrespect i won't even get into cuz you all surely know about it. how can u do this for an entire career? what possible benefit do u find in it? is it mostly because it pays relatively well and once you are off shift you're relieved of all responsibility?

 

[WilcoWorld]

Noblesse oblige.

Oh yeah, and most of us are crazy.

 

[GeneralVeers]

I would ask how you put up with Family Medicine, OB/GYN, General Surgery or whatever speciality it is that you do.

Unless you're into Derm or anesthesia, I would wager that our lifestyle is better than what you are doing.

 

[PostCall]

Unless you're into Derm or anesthesia, I would wager that our lifestyle is better than what you are doing.

so it's all (or mostly) about the lifestyle then? even if you work 8 or 12-hour shifts that's still 8 or 12 hours of having to deal with those types of people i mentioned in the first post. do you enjoy dealing with people like that, or is it more u put up with it cuz of the lifestyle...like a tradeoff of sorts?

 

[docB]

so it's all (or mostly) about the lifestyle then? even if you work 8 or 12-hour shifts that's still 8 or 12 hours of having to deal with those types of people i mentioned in the first post. do you enjoy dealing with people like that, or is it more u put up with it cuz of the lifestyle...like a tradeoff of sorts?

That's a good point. For us we are willing to except (bitch about endlessly but accept😀) the trolls. For many the trolls are a deal breaker no matter what the benefits.

 

[Seville]

how do you put up with the ER? seriously. i don't mean that as an insult because more power to you that you can voluntarily go into it for residency and then work at it for a career. but i did a month rotation in the ER and couldn't wait to get the heck out of there every single day. most days i had to force myself to even show up. mainly cuz of the people. every other person there was some low-life drug seeker/malingerer/ex-convict/future convict/or just out to game the system in some way. sure there were people there for legit reasons but there were so many there that weren't. oh and the rudeness and blatent disrespect i won't even get into cuz you all surely know about it. how can u do this for an entire career? what possible benefit do u find in it? is it mostly because it pays relatively well and once you are off shift you're relieved of all responsibility?

I always find it a bit bizarre when I read these sorts of posts. If you hate the ED so much and hated your rotation, then why even come into an EM forum? I mean, I wasn't a fan of my surgery rotation but I don't think I've ever even been on the surgery forum here. Same goes for IM, OB/Gyn, you name it. I mean, did you hate it that much that you really just MUST know what drives us to do it?

 

[PostCall]

I always find it a bit bizarre when I read these sorts of posts. If you hate the ED so much and hated your rotation, then why even come into an EM forum? I mean, I wasn't a fan of my surgery rotation but I don't think I've ever even been on the surgery forum here. Same goes for IM, OB/Gyn, you name it. I mean, did you hate it that much that you really just MUST know what drives us to do it?

as i said don't take it the wrong way as i don't mean to put u on the defensive. i am curious why u do it when what i exprienced during my rotation, which would be considered a standard ER with a residency program, was mostly negative. there are other threads on this forum by ER residents/attendings venting about how difficult ER patients are to deal with, the lack of respect from not only patients but also other doctors, etc...but EM remains a top specialty choice. so there must be a catch where people will deal with all the negatives. so far what i'm getting is that catch is the money/lifestyle.

 

[kungfufishing]

I'm not all that bothered by the dirtbags. I don't like them, don't really dislike them, just sort of indifferent. For better or worse, I rarely attach much value judgement to patients, good or bad. Of course I see patients I genuinely like or dislike, but I tend to view most of them as a more transactional relationship - ask question, hopefully get answer, ask more questions, make medicine, who's next?

 

[Doctor Bob]

so there must be a catch where people will deal with all the negatives. so far what i'm getting is that catch is the money/lifestyle.

For me, the catch is that although I have to deal with their whining for 15 minutes or so, I don't have to see them again and again in the office and get woken up at 3am with a call about them. And I don't ever have to find out the cause of their interminable abdominal pain... I just have to show that it isn't life threatening.

But it's mainly an intangible. I like the ED environment. You don't. And that's ok. There's no real good answer as to why the ED environment is right for me... it's just a gestalt feeling. I know pathologists and radiologists who love sitting in rooms alone and staring into a microscope or viewbox. Five minutes of that drives me batsh*t crazy. And no amount of explaining why they love it on their part is going to change that for me.

The money isn't a factor for me (everyone gets paid pretty much the same in the military). And neither is the lifestyle... if you absolutely hate what you do, then you'll spend the time you are at work loathing your life, and a bunch of your time outside of work dreading your return.

 

[Rendar5]

Every field has positives, negatives, and interesting twists that really matter to different degress with different people.

The negatives you mention do exist, but they don't really bother me that much. Does constantly checking and repleting potassium bug the **** out of me? yes, but I doubt it bugs medicine residents that much. Does standing on my feet for 8 hours straight during an operation make me miserable to no end? hell yes, but I doubt it bugs a surgery resident that much. Does hearing someone whine about their life annoy me to the point that I tune it out, smile, and walk out the room? yep, but psych residents are ok dealing with that negative aspect of the field.

On the other hand, I like shift work, I like dealing with acute life threatening diseases, I like dealing with crashing patients, I like seeing pediatrics, adult, geriatric, internal medicine, surgical, ob/gyn, ent, urologic, etc, etc, etc cases. The only other specialty that deals with every single field is family medicine and I don't really like outpatient medicine. Those are all positives for me that probably don't matter as much to anyone else.

So EM is obviously a field you hate becuase the positives don't matter to you and the negatives are all your pet peeves. Find a field where the positives matter a lot, and the negatives are no skin off your back.

 

[willow18]

Put aside the 10-20% malingerers, put even aside the 'exciting' parts of a trauma/crashing patient, in what other field do you get to essentially play medical detective with a new case every 10 minutes? Oh, and leave it for other people to clean up the 'mess' after you've decided what/where the mess is. Some cops enjoy the action of the arrest, some enjoy just solving the case. Now, I know I'm not gonna be able to keep a patient in the ED for 10 days to be able to publish an exotic case report in NEJM, but that's the tradeoff for not having to balance potassium and play social worker for five months between those exotic cases. And I don't know where you were, but the crap I had to put up with on my medicine rotations were faaaar worse than what I encountered in the ED, from the drug seekers who were on service for one reason or another for weeks to the diabetic who has no intention of controlling his sugar, to the CHF'er who refuses to stop loading up on Campbells, sodium-rich chunky. In the ED I decide she has a CHF exacer and up she goes; I don't have to debate with her the merits of Campbells chunky for the umpteenth time. Of course in the outpatient setting you see all the people seeking letters to get out of work/rent, or get more money from the government or people trying to get disabled passes and so forth. Nevermind all the perfectly healthy people coming for non-evidence based "checkups" (if only they knew all the evidence behind that finger up their bum); gahhhh, I didn't go into medicine to see healthy people. That's my view on it for now. We'll see how it pans out.

 

[dmitrinyr]

Every field has positives, negatives, and interesting twists that really matter to different degress with different people.

The negatives you mention do exist, but they don't really bother me that much. Does constantly checking and repleting potassium bug the **** out of me? yes, but I doubt it bugs medicine residents that much. Does standing on my feet for 8 hours straight during an operation make me miserable to no end? hell yes, but I doubt it bugs a surgery resident that much. Does hearing someone whine about their life annoy me to the point that I tune it out, smile, and walk out the room? yep, but psych residents are ok dealing with that negative aspect of the field.

On the other hand, I like shift work, I like dealing with acute life threatening diseases, I like dealing with crashing patients, I like seeing pediatrics, adult, geriatric, internal medicine, surgical, ob/gyn, ent, urologic, etc, etc, etc cases. The only other specialty that deals with every single field is family medicine and I don't really like outpatient medicine. Those are all positives for me that probably don't matter as much to anyone else.

So EM is obviously a field you hate becuase the positives don't matter to you and the negatives are all your pet peeves. Find a field where the positives matter a lot, and the negatives are no skin off your back.

My thoughts exactly. Still, the reality of the current system is that even if you find something that you are absolutely passionate about and want to do for a career, it doesn't necessarily mean that you will end up doing it. I wasn't lucky enough to get an EM spot in this year's match (again) and so I'm going back to the land of "correcting potassiums and endless rounding" in hopes of someday working in the ED. As the above quote states, pick a field that will make you happy most of the time (no one is always happy with their work). I think at the end of the day, money is not the dealbreaker. I would like EM even if EM attendings were payed FM money. The fact is, for most people, if you hate your work then no amount of money will make you love it. On the other hand, if you love your work, no amount of negativity will make you reconsider your career choice.

 

[deleted6669]

there are fewer "dirtbags" in suburban depts and rural depts, although "dirtbags" get some of the coolest trauma and medical problems..... I work a full spectrum of departments from level 1 to community to rural to solo coverage and the variety of em is one of the things that really draws me to the field. I can't see dealing with only the same 10-15 disease processes 90% of the time like most subspecialists do.

 

[astrolux]

I've found that there are difficult patients no matter where you go. One of the benefits about EM is those who choose it as a profession are typically fun to be around. I am attracted to EM for a number of reasons, not the least of which is the fact that the people I've enjoyed working with the most are in the ED.

 

[Cerberus]

I enjoy seeing all segments of society - from the dirtbag who just got his face cut open by "his bitch" to the gangbanger to the little old lady from the nursing home. I just find it interesting. Plus, when you get a dirtbag in the ER, you can usually get rid of them in a few hours or less, it's not like I have to see them in my office every few months or round on them everyday.

 

[Jeff698]

I think much of this depends on your attitude. I had to teach myself how not to take trollism personally and ruin the rest of my day. Not that I'm always successful in this but it does help alot.

I'm in a pretty nice hospital and, honestly, most of my patients are normal folks. I do what I suspect docs in other specialties do: focus on what I like and get through what I don't.

Take care,
Jeff

 

[Pinner Doc]

I like EM because I like working up a patient from scratch. That, and showing up to work not knowing what is going to walk through the doors that day.

 

[docB]

I always find it a bit bizarre when I read these sorts of posts. If you hate the ED so much and hated your rotation, then why even come into an EM forum? I mean, I wasn't a fan of my surgery rotation but I don't think I've ever even been on the surgery forum here. Same goes for IM, OB/Gyn, you name it. I mean, did you hate it that much that you really just MUST know what drives us to do it?

as i said don't take it the wrong way as i don't mean to put u on the defensive. i am curious why u do it when what i exprienced during my rotation, which would be considered a standard ER with a residency program, was mostly negative. there are other threads on this forum by ER residents/attendings venting about how difficult ER patients are to deal with, the lack of respect from not only patients but also other doctors, etc...but EM remains a top specialty choice. so there must be a catch where people will deal with all the negatives. so far what i'm getting is that catch is the money/lifestyle.

I can see why the question might ruffle some feathers but for internet standards it was asked in a pretty civil way. In other words this question didn't strike me as trolling or flaming but more as a real question with a little venting on the side. And that's ok. That's why I tried to give a real answer.

For the OP I think there's more to it than just the lifestyle. We are people who are just happiest in the environment of the ED. I could never do clinic or peer at films or through a microscope all day. I have the greatest respect for those fields but I know I just could never do it. That's why you almost never see people trying to make up their minds between EM and Path. You really just have different personality types.

People that go into EM for the lifestyle but don't really like EM wind up unhappy.

 

[EM OR BUST]

where do you think we admit these "dirtbags"? I would rather spend a few hrs with them in the ed, then days on the floor with them.

 

[Venko]

I can see why the question might ruffle some feathers but for internet standards it was asked in a pretty civil way. In other words this question didn't strike me as trolling or flaming but more as a real question with a little venting on the side. And that's ok. That's why I tried to give a real answer.

For the OP I think there's more to it than just the lifestyle. We are people who are just happiest in the environment of the ED. I could never do clinic or peer at films or through a microscope all day. I have the greatest respect for those fields but I know I just could never do it. That's why you almost never see people trying to make up their minds between EM and Path. You really just have different personality types.

People that go into EM for the lifestyle but don't really like EM wind up unhappy.

I entirely agree!

First, the question is a good one. For people who don't enjoy the environment, it can seem like what type of person would, and its a fair question. I don't find this question offensive in the least, but rather invigorating to know I made the right choice in my own life.

Emergency medicine is a field with tremendous variety. The description that PostCall gave is characteristic of emergency medicine in some places, but not all. Our emergency department has a very small percentage of patients trying to "game" the physician, or of patients who abuse illicit substances. The variety allows for many different types of physicians to find rewarding and exciting practices.

I love the pace of Emergency medicine, and the concept of being able to care for anyone, anywhere, anytime. I love that I get to interact with nearly every other type of physician and practitioner in the hospital and speak their language about patient care. I get such a personal thrill from saving a life, and I mean directly, saving someone from imminent death (I understand that all physicians and healthcare workers contribute life saving care, but this is different). The excitement of managing what outsiders would perceive as chaos for a shift and then going home knowing that you dont have to round or write progress notes or do preventative medicine as a primary focus when you get back is awesome.

I love that the main journal of EM is filled with a variety of topics including MI, PE, blast injury, epidemiology, snake bites, barometric injury, post operative complications....anything and everything! I could keep going on, but really, PostCall, this field rocks!

Its way more than the lifestyle for me...I highly recommend it for those who are looking to be an expert in resuscitative care and understanding who is sick and who is not sick, and who have short attention spans!

Cheers,
TL

 

[Fletcher]

Yeah- I hear ya- we do deal with a lot of BS, but we also get to do/see a lot of crazy cool stuff. Part of the reason it appears as if people don't respect us is because they are jealous of our amazingly awesome lives- shift schedule- who can compare? We do the fun part of the job- initial assessment puzzle solving diagnosis and punt them to everyone else to finish up.

Many of us considered OB, or Surgery, because we love the procedures but couldn't stand the call. To be honest the OB's deal with chronic abdominal pain unknown etiology as well as the surgeons dealing with prolonged post-surgical pain- the blessed difference that we have is that we don't see them every time they have pain and we're not responsible for the chronic management of their pain- only the acute- I'll take that any day.

FP/IM/Peds people like the long term follow-ups for the chronic management, and hate the chaiotic environment of the ED. I have no interest in the chronic management of hypertension nor do I have interest in dealing with the same crazy and obsessed parents on a regular basis.

Personally I love my job- enjoy going into work every day- and am satisfied with a days work at the end- what more could you want?

 

[Rendar5]

Yeah- I hear ya- we do deal with a lot of BS, but we also get to do/see a lot of crazy cool stuff. Part of the reason it appears as if people don't respect us is because they are jealous of our amazingly awesome lives- shift schedule- who can compare?

While I agree with the rest, I think it's a bit dangerous to presume that lack of respect = jealousy. It's more that it = 20/20 hindsight (with increased time for the disease process to present itself and for most of the facts to be ordered and processed), changing presentation by the time they hit the floor, and our creating work for them, in addition to other factors.

 

[Jeff698]

If if makes anyone feel any better, the ever-present retrospectoscope is aimed at lots of, if not most, doctors. As an example, my hospitalist was bemoaning this to me last night. He was saying that whatever he did would be considered wrong the next morning.

Welcome to the club, I said.

Take care,
Jeff

 

[ER-ER-Oh]

Ok, my two cents: I simply love the pace, and the strange people who happen in. I used to have a business repairing ships. It was like war every day, with crazy deadlines, and rain, and snow, and loudmouthed clients, and nutty people.

It's the same in the ED. Every day is difficult. It's either simply difficult to manage the flow, and/or difficult cases. I work at a Level 1 trauma center, and am the Director of a small rural ED in our system. There are times when the patient population tries to drag me under. But just when I'm about to whine about it, BOOM!, something happens, a GSW, a bad accident, a crashing bradycardic, and I'm revitalized. Whether it's working with the residents, the PA's, the nurses, I'm one of those guys who just finds the redeeming qualities in everyone, and makes fun of them, including the patients. I'm an actor, a doctor, a nut, and an artist, and I show it all to everyone. Some patients hate me because I call them on their stupid ****. Others love me because I tell it to them straight. Either way, it's the connection with those around you, and embracing the craziness of the ED, that makes it worth it for me. You simply can't make this **** up, really. And it all sounds great when you're talking to a chick in a bar.