EM Doc?

[doing]

What kind of characteristics would you say would make a good EM doc? For example personality, intellectual strengths, and so forth...

What about characteristics that describe a not so good EM doc?

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[docB]

The ability to keep a straight face.

 

[southerndoc]

The ability to keep a straight face.

Even that can be broken sometimes...

When I was doing a cardiology rotation recently, we were consulted on an elderly man who "passed out" and then wrecked, according to his wife (who had early-stage Alzheimer's). The wife said the guy had 2 syncopal episodes the day before this event. Did they bother to call their doc? Noooo... Did it occur to her that he shouldn't drive? Noooo. We got consulted because the guy was having very frequent PVC's and runs of 5-6 PVC's, so the concern was he developed VT and that triggered his syncopal episodes.

So I'm talking with the man's daughter and son-in-law. They inform me that a guy following behind them noticed the man swerving back and forth in the minutes before the accident.

I look over to the wife and ask "Did you notice him swerving before the accident?"

She replies: "No more than usual!"

At that point I just lost it. I busted out laughing without hesitation. The cardiologist whom I was with walked into the room mid-way during talking with them. He caught all this and he busted out laughing. The daughter and son-in-law were both laughing. For some reason, the woman never realized how funny it was. She maintained a straight face the entire time.

Guess you would have to be there to fully appreciate how funny it was.

 

[roja]

Sooooooo true.. keeping a straight face is important.


Also, ability to multitask and think fast. If you don't believe it, watch a medicine resident working a shift in the ED. Patients do NOT move. p.a.i.n.f.u.l.

 

[Seaglass]

and runs of 5-6 PVC's

Oh, like V-tach.

 

[Daiphon]

being able to indulge one's latent ADHD tendencies without falling prey to the comorbid latent OCD tendencies that medical schools seem to select for.

oh, and i think the ability to "BUFF and TURF" might come in handy someday...

my $.02,
-t

 

[DrQuinn]

having a thick skin, being able to multitask, and ability to laugh and joke in stressful situations. Also, IMHO, the ability to not take emotions at work home with you. You'll tear yourself up. One would need a strong stress-relief activity, or just the personality to "not let things get to you" <--- although this can lead to problems down the road.

Q, DO

 

[beanbean]

You also need to be in somewhat decent physical shape and have fast feet. To keep things moving at a decent pace, you need to move at a very quick pace. If you are working in a large ED this can translate to quite a few miles per shift. Its a bonus to get exercise will working!

You also need to really appreciate the unique weirdness of people and have a sense of humor about it. Doing a shift in the ED is like that old game show "lets make a deal". Which curtain do you choose to reveal your prize? Sometimes you pick the curtain with the brand new car; other times you get the smelly goat. That goat just might be pretty interesting, but you need to look beyond the smell.

 

[southerndoc]

Oh, like V-tach.

Yea, well this cardiologist didn't like students and residents calling 5-6 PVC's as VT unless they were accelerated. These PVC's actually weren't accelerated (rate of about 100).

I say tomato, you say tomahto. Classic example of this.

 

[Seaglass]

potahto.

Oh, wait. That post is too short. Potahhhhhhhhhhhto.

C

 

[kungfufishing]

if only smelly goats in the ED would swallow just about anything and go away happy like their barnyard counterparts....

 

[ERMudPhud]

What kind of characteristics would you say would make a good EM doc? For example personality, intellectual strengths, and so forth...

What about characteristics that describe a not so good EM doc?

I can't wait to see kinetic's response to this. Come on kinetic you know you're out there. Its only a matter of time before you find this thread

 

[beyond all hope]

Making decisions based on very little information, using a combination of experience, clinical skills and gut instinct. You have to know sick vs not sick, everything else is just details.

You should be able to see patient rolling in on a stretcher, and with their vitals, CC and PMHx and a spot physical exam tell whether they will be discharged, admitted to floor, ICU or morgue. You should also be writing orders now. Door to dispo in <2 minutes. Of course, you will have a few complex patients where you don't know that answer immediately, but I'd say 80% of my patients fall in this category.

This skill, when used correctly, gives you sufficient time to think about your 10-20% of patients who are either complex or sick.

Quick decisions take courage and confidence, and is why EM docs are often referred to as cowboys. Many times we are WRONG, but that doesn't mean we can afford to slow down. Other services love to laugh at how stupid we are because our initial diagnoses are often wrong. Making diagnoses is not my job.

If you are someone who needs more time to decide what you want at the restaurant, you probably shouldn't be an ER doc.

All of the other things: multitasking, thick skin, sense of humor, physical fitness and endurance, are also very true.

Also a great love of free time...

 

[aliraja]

If you are someone who needs more time to decide what you want at the restaurant, you probably shouldn't be an ER doc.

That's actually a really good point! I hadn't really thought much about it until now, but have you folks noticed that you're always the first to put down your menu at a restaurant? I thought it was mostly because I'm always hungry... but maybe it's because we just make decisions fast. Huh. Who knew?

 

[basementbeastie]

not just order food, but scarf it down fast too (too fast according to my wife as i wait...and wait, for her to finish that little piece of fish).

 

[spyderdoc]

You also need to be in somewhat decent physical shape and have fast feet. To keep things moving at a decent pace, you need to move at a very quick pace. If you are working in a large ED this can translate to quite a few miles per shift. Its a bonus to get exercise will working!


During residency, I wore a pedometer for a few weeks. I walked anywhere from 3.5-5.5 miles during my 8 hr shifts....Pretty impressive...

 

[spyderdoc]

Part of thinking fast, you MUST have a good Bull****ometer. You have to know who is BSing you for narcs, and especially a worknote. How many of us have done a million dollar workup to find nothing, say goodbye to the patient, then hear them say..."oh, by the way, can I get a work note?" This is where the ability to appear calm and keep a straight face kick in...

 

[docB]

You've got to have a large bladder.

 

[Apollyon]

You've got to have a large bladder.

The "number 1" priority...don't leak this information.

 

[DrQuinn]

That's actually a really good point! I hadn't really thought much about it until now, but have you folks noticed that you're always the first to put down your menu at a restaurant? I thought it was mostly because I'm always hungry... but maybe it's because we just make decisions fast. Huh. Who knew?

wow. You are sooooooooo right! I never thought about it. It irks me when people can't make up their mind. *sigh* Atleast now I have an excuse. That's such a funny thought, aliraja.

Q, DO

 

[v-tach]

Oh, like V-tach.

Depends on your definition of v-tach...from what I understand some people call any run of 3 or more PVC's (but under 30 seconds and not causing hemodynamic compromise) non-sustained v-tach; for others the threshold is something like 6 or more.

 

[v-tach]

Yea, well this cardiologist didn't like students and residents calling 5-6 PVC's as VT unless they were accelerated. These PVC's actually weren't accelerated (rate of about 100).

I say tomato, you say tomahto. Classic example of this.

So then if anything, it would be a run of AIVR in that case, right?

 

[The White Coat Investor]

You also need to be in somewhat decent physical shape and have fast feet. To keep things moving at a decent pace, you need to move at a very quick pace. If you are working in a large ED this can translate to quite a few miles per shift. Its a bonus to get exercise will working!

You also need to really appreciate the unique weirdness of people and have a sense of humor about it. Doing a shift in the ED is like that old game show "lets make a deal". Which curtain do you choose to reveal your prize? Sometimes you pick the curtain with the brand new car; other times you get the smelly goat. That goat just might be pretty interesting, but you need to look beyond the smell.

I had four consecutive smelly goats last night. My favorite was the guy with ESRD who tells me he needs his meds refilled. "What meds do you take," I ask? "I don't know," he says. "Well, who's your doctor, I ask?" He says, "I don't know." Six hours later I learn that he knows the name of a pharmacy he once picked meds up at. AArgh!

 

[The White Coat Investor]

Part of thinking fast, you MUST have a good Bull****ometer. You have to know who is BSing you for narcs, and especially a worknote. How many of us have done a million dollar workup to find nothing, say goodbye to the patient, then hear them say..."oh, by the way, can I get a work note?" This is where the ability to appear calm and keep a straight face kick in...

Maybe I'm just the candyman, but if you want to come to the ED and your $1000 problem is: "I want a worknote," I'll give it to you every time. If you bring a chief complaint I can raise it from a level 3 visit to a level 5 visit! (Of course, one might argue, those looking for work notes may be less likely to actually provide reimbursement.)

 

[leviathan]

potahto.

Oh, wait. That post is too short. Potahhhhhhhhhhhto.

C