EM - Hands on, or no?

[wadels]

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I don't know if this is the right forum or not, but I thought I'd get some better input from current med students than in the Pre-Med forum. Anyway, I was taking the SDN Specialty Selector and got matched pretty highly with EM. However, the detailed section mentioned that Em doctors didn't value working with their hands. So I'm confused, my impression of EM from shadowing was that it was a pretty involved and hands-on specialty. I get that not every single patient is coming with multiple GSWs, but still... Unless but "working with their hands" the questionnaire meant literal scalpel-in-the-hand type work?

Any input would be much appreciated. Thanks guys!

 

[Slack3r]

I don't know if this is the right forum or not, but I thought I'd get some better input from current med students than in the Pre-Med forum. Anyway, I was taking the SDN Specialty Selector and got matched pretty highly with EM. However, the detailed section mentioned that Em doctors didn't value working with their hands. So I'm confused, my impression of EM from shadowing was that it was a pretty involved and hands-on specialty. I get that not every single patient is coming with multiple GSWs, but still... Unless but "working with their hands" the questionnaire meant literal scalpel-in-the-hand type work?

Any input would be much appreciated. Thanks guys!

Of course they work with their hands. How do you think they work the consult phone? 😉

 

[Tipsy McStagger]

Of course they work with their hands. How do you think they work the consult phone? 😉

As your skill set progresses through residency the best are able to transition to hand's free consulting in order to better work the crossword puzzles.

To the OP: sorry I forgot to answer your question. EM physicians do work with their hands, it just depends on what kind of procedures you are interested in. Central lines, intubations, lac repairs, chest tubes, reductions, splints... These are all things done regularly in the ED. If you are interested in more involved procedures you may have to look at something surgical.

 

[kavorca]

I would go by that specialty selector. Don't listen to these people.

 

[Cinclus]

I am about to start EM residency. You do plenty of "hands on" work in in EM. It's not surgery, but you will commonly be doing stuff like laceration repairs, I&D, lumbar puncture, ultrasound, central line placement, intubation, etc. You occasionally get to do fairly invasive stuff, such as placing chest tubes.

 

[kavorca]

Think about these questions they are using to try to separate people. They are less thought out than quizzes to determine which Disney Princess you are. I am a Jasmine btw.

 

[cbrons]

I am about to start EM residency. You do plenty of "hands on" work in in EM. It's not surgery, but you will commonly be doing stuff like laceration repairs, I&D, lumbar puncture, ultrasound, central line placement, intubation, etc. You occasionally get to do fairly invasive stuff, such as placing chest tubes.

Dont forget the rectals and pelvics

 

[Crayola227]

I don't know if this is the right forum or not, but I thought I'd get some better input from current med students than in the Pre-Med forum. Anyway, I was taking the SDN Specialty Selector and got matched pretty highly with EM. However, the detailed section mentioned that Em doctors didn't value working with their hands. So I'm confused, my impression of EM from shadowing was that it was a pretty involved and hands-on specialty. I get that not every single patient is coming with multiple GSWs, but still... Unless but "working with their hands" the questionnaire meant literal scalpel-in-the-hand type work?

Any input would be much appreciated. Thanks guys!

OP, I've talked to two EM physicians in my fam, among others.

EM as a field, you use your hands *plenty* and do a lot of procedures.

However, as time goes on, it becomes more "common place" and "everyday" and less "neat." They just become part of the job, like a plumber using a wrench to undo a bolt. Basically, the idea is that there are other things, better things, that indicate if it is a good specialty match. Using your hands is not unique to EM, so as such it's not really the best reason to go into it as a field. Certainly, if you *hated* being on your feet and *hated* procedures it would not be the field for you, but conversely *loving* those things does not mean EM is a match. Got me?

Think of when you first learned to tie your shoes, or drive, or dice an onion. Some things you do with your hands will seem really cool because of novelty vs the fact it is intrinsically enjoyable and will stay as such over time. On the other hand, two people might take piano lessons and one falls in love and the other it goes the way of dicing onions. I think complexity of the task might be a factor, and what you are accomplishing with it.

My experience many EM docs still have a few fave procedures, whether it's suturing or stapling or I&D abscesses. However in my experience the attendings can take or leave most of them.

It seems like other things are higher on the list of what they value about that field specifically.

 

[Cinclus]

Dont forget the rectals and pelvics

I was talking about hands on not hands in. But those are always a blast, too. 👍

 

[username456789]

Of course it's hands on, just ask Dr. David Newman [formerly] of Mount Sinai.

 

[Law2Doc]

I would go by that specialty selector. Don't listen to these people.

Um, first the specialty selector" is a waste of time -- do not pick a specialty because some survey driven computer algorithm says that's a match. This is a step below asking your high school guidance counselor what you should do.

EM definitely uses their hands -- they do the initial physical exam, put in lines and tubes, do LPs, suture up superficial lacerations, get pelvic and rectal swabs, do disimpactions, etc. But some get a bad rap because their focus is sometimes more about disposition than treatment, so the lazier ones are often accused of being a bit quick with the consult phone. But don't pick a specialty with the selector. Go spend a few afternoons/evenings of your spare time shadowing in an ED and see for yourself what it's all about.

 

[Tenk]

Of course it's hands on, just ask Dr. David Newman [formerly] of Mount Sinai.

Too soon.

 

[wadels]

Guys, thanks for all of your responses; they were really informative. I have actually shadowed in the ER in a few hospitals and loved it. It was my experience that the doctors were pretty hands-on with the stuff that everyone mentioned (sutures, intubations, etc.). I had recently stumbled across the specialty selector and decided to take it for fun. I got "matched pretty high" with EM, but I was just confused about that one little part of the detailed explanation.

 

[TooMuchResearch]

It's about 5% talking to patients, 10% procedures, and 85% hands on the computer.

 

[alpinism]

It's about 5% talking to patients, 10% procedures, and 85% hands on the computer.

And this is why I have no intention of practicing full time in the US after residency. Takes the joy out of medicine.

To be fair almost every specialty is >50% hands on the computer nowadays.

 

[Mad Jack]

OP, I've talked to two EM physicians in my fam, among others.

EM as a field, you use your hands *plenty* and do a lot of procedures.

However, as time goes on, it becomes more "common place" and "everyday" and less "neat." They just become part of the job, like a plumber using a wrench to undo a bolt. Basically, the idea is that there are other things, better things, that indicate if it is a good specialty match. Using your hands is not unique to EM, so as such it's not really the best reason to go into it as a field. Certainly, if you *hated* being on your feet and *hated* procedures it would not be the field for you, but conversely *loving* those things does not mean EM is a match. Got me?

Think of when you first learned to tie your shoes, or drive, or dice an onion. Some things you do with your hands will seem really cool because of novelty vs the fact it is intrinsically enjoyable and will stay as such over time. On the other hand, two people might take piano lessons and one falls in love and the other it goes the way of dicing onions. I think complexity of the task might be a factor, and what you are accomplishing with it.

My experience many EM docs still have a few fave procedures, whether it's suturing or stapling or I&D abscesses. However in my experience the attendings can take or leave most of them.

It seems like other things are higher on the list of what they value about that field specifically.

And a lot of the time it goes from "everyday" to "annoying." Suturing a lac as a fresh intern and suturing a lac at the tail end of your shift when you just want to go home to your family are totally different things. My prior career really made me realize I'm not procedure oriented, as literally every procedure I had to do was "so cool" when I started out and "a ****ing annoying chore" five years later. Some people are all about procedures though and things like rounding and patient management make them die on the inside. Unfortunately I just don't think there is enough time before people apply to residency to figure out whether they're truly of the "thinker" or "doer" variety (and of course every specialty is a mix of both, but you know what I mean).

 

[sloop]

But some get a bad rap because their focus is sometimes more about disposition than treatment, so the lazier ones are often accused of being a bit quick with the consult phone. But don't pick a specialty with the selector. Go spend a few afternoons/evenings of your spare time shadowing in an ED and see for yourself what it's all about.

Just to play devil's advocate here: I will say that almost all inpatient medical work is fundamentally more about disposition than treatment. The bottom line of anybody working in a hospital, whether on a psych ward or a surgery floor or the E.D. is "does this patient need to be here?" The issue is that, for most services, if the answer is no there's usually only one place the patient can go. When the "here" is the E.D., there are many possible places the patient could go once they no longer need to be in the E.D.—only one of those places is out the door.

Primary concern about "treatment" of the patient is almost necessarily monopolized by outpatient or elective procedural work. It is here where the incentives are such that the goal really is "optimally treat this condition" rather than "good enough, now follow up outpatient."

 

[Law2Doc]

Just to play devil's advocate here: I will say that almost all inpatient medical work is fundamentally more about disposition than treatment. The bottom line of anybody working in a hospital, whether on a psych ward or a surgery floor or the E.D. is "does this patient need to be here?" The issue is that, for most services, if the answer is no there's usually only one place the patient can go. When the "here" is the E.D., there are many possible places the patient could go once they no longer need to be in the E.D.—only one of those places is out the door.

Primary concern about "treatment" of the patient is almost necessarily monopolized by outpatient or elective procedural work. It is here where the incentives are such that the goal really is "optimally treat this condition" rather than "good enough, now follow up outpatient."

While it is true that all hospital teams should have an end game in mind as to how to get the patient out of the hospital, either to home, rehab or wherever, the focus on disposition is much more immediate and exaggerated in the ED, where they might spend 10-15 minutes examining the patient and deciding -- this person needs a surgeon, or that person should go home.