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Tip O'Neill was (for those of you that don't remember) was Speaker of the House of Representatives for many years, while a Member of Congress from Massachusetts. He said once, "All politics are local".
I was talking this evening with my PD, and said, too, that "All EM is local". It doesn't matter how good a tertiary care hospital your place is - people may come 200 or 300 miles for surgery or cardiology, but all your true EM business is local. Rochester, Minnesota and Durham, North Carolina are NOT vast, busy cities like NYC and Philly and LA. That's why it is incumbent on EM programs to give a little more, to make it a little better than the rest, since, in the hospitals, if you notice, name places are in the middle of nowhere, or, when they're downtown, when they can't get away, the subspecialties are on higher and higher floors - further and further from the ED. The EM perspective - now, broad strokes, rule out the worst first - is antithetical to the focused, detail-oriented IM workup, or the surgical "when in doubt, cut it out" mentality. This puts EM at odds with other branches of medicine.
So do it better than the next guy. Bring your best game, every day. Think a little more. Try something new. Be a leader by doing. Make your program the place to be, in and of itself, instead of just "that place on the corner" - the last stop because it's there or nowhere. Because all EM is local.
I was talking this evening with my PD, and said, too, that "All EM is local". It doesn't matter how good a tertiary care hospital your place is - people may come 200 or 300 miles for surgery or cardiology, but all your true EM business is local. Rochester, Minnesota and Durham, North Carolina are NOT vast, busy cities like NYC and Philly and LA. That's why it is incumbent on EM programs to give a little more, to make it a little better than the rest, since, in the hospitals, if you notice, name places are in the middle of nowhere, or, when they're downtown, when they can't get away, the subspecialties are on higher and higher floors - further and further from the ED. The EM perspective - now, broad strokes, rule out the worst first - is antithetical to the focused, detail-oriented IM workup, or the surgical "when in doubt, cut it out" mentality. This puts EM at odds with other branches of medicine.
So do it better than the next guy. Bring your best game, every day. Think a little more. Try something new. Be a leader by doing. Make your program the place to be, in and of itself, instead of just "that place on the corner" - the last stop because it's there or nowhere. Because all EM is local.
