Hey
@gamerEMdoc
I've got possibly a silly or even an un-answerable question: what could be some signs or indications that a medical student, like me, should pursue emergency medicine? I don't have an elective available to me anymore, so I've been coming into the local ED (community setting, low-acuity) to do shifts with an attending on my off-days from my actual scheduled rotations, and so far I've done 8 shifts already (weekdays, weekends, a few overnights). I get to see around 4 pts usually, follow-up on labs, and go in and discuss with the pt, etc. I've even done some IVs and helped with bedside ultrasound. I've liked it so far, but recognize my attending is risk-stratifying which patients I can see on my own while he tends to the more emergent cases which is totally understandable. In addition to being a scribe previously at a community ED, level II trauma for about 8 months before medical school, I feel I have somewhat a basic understanding of the specialty when taken altogether. Since I don't have an electives anymore for third-year, my goal has been to do enough shifts until December to equal what an EM elective would have been (so around 20 shifts I am estimating), and then make a decision around then I suppose. But, there has not been some "Aha" moment, or like some encounter that has crystallized or revealed that emergency medicine is right for me. Frankly, I think the reason why I've enjoyed coming to the ED on my off-days or weekends, is that the attending actually lets me do H&Ps and gives autonomy to students, like me, which I have not been experiencing with my other rotations as much. It's also possible that I am romanticizing this idea of falling in love with a specialty -- I'm not sure if I will ever have that feeling with any specialty (I've had the opposite feeling, of absolutely not enjoying certain fields, like surgery and psychiatry). And, it's also possible I may be getting cold feet because if I decide to go all-in for EM I suppose I'll always have some FOMO of the few other specialties that interested me, eg. anesthesiology, IR. Do you ever get that even as an attending, on what your life as a physician would have been like if you pursued such and such? Any recommendations or guidance on how to help me make as informed a decision on this as possible? This is kind of stream-of-conscious post, but I've struggled to come up with a cohesive thought process with deciding on a specialty -- it all seems rushed for a M3 to decide on something fairly significant!
Oh man, great questions here, honestly.
For me, EM didn't come as an "AHA!" moment where I rotated and knew from the first second thats what I should do. I liked EM, more than most of my rotations, but it wasn't overwhelming in one direction. I liked IM, critical care, I liked procedures but hated the OR and the life of being on a surgery service, and I liked most of my inpatient rotations like inpatient Peds along with medicine subspecialties. I also liked OB. So there wasn't one overwhelmingly positive EM experience, combined with negative experiences elsewhere, to truly push me in that direction.
For me, the biggest deciding factor was the undifferentiated patient. I love solving mysteries. i love figuring out cases. And nowhere do you get that to the degree that EM has. Most inpatient cases are already worked up and diagnosed. I went to medical school because in part I loved solving cases, and the ED for me was where I found that the most.
So as for the aspects of the field in terms of weighing what you may like or don't like. Some of these may be positives for some, negatives for others. The more of these that are a "positive" for you, rather than a negative, the more likely you'll enjoy EM as a specialty:
1. Undifferentiated cases. Rarely do patients show up with their diagnosis in hand before you even see them.
2. No idea what is coming in the door next and no control of what you get to see. Which means you will have to be the doctor for people no one else wants to see (peds rape cases, drug seekers, violent drunks, etc)
3. Short-term patient involvement means even if you dont like treating a patient, they are only yours for a short amount of time
4. Lots of resources available; no dealing with insurance preauths, etc
5. 24/7 operation means shift work, night shifts, working holidays, etc. And even if you like working weird shifts, your family may/may not like it.
6. Lots of procedures that are relatively quick
7. It's a true team field. You will work closely with nurses, techs, clerks, etc around the clock.
8. High stress field when you are on
9. Hours worked clinically less than many other fields and its a fairly lucrative field for the number of work hours
10. Constant interruptions while at work; focus and multi-tasking are essential to success
11. No call. Ever.
12. We get to say "clear" before shocking people. Just like on TV. And sometimes it works and the patients wake up. And snatching a life from the jaws of death is a high.
13. People die. All the time. You have to be ok with that.
14. It's a customer service field and you are the front door for the hospital.
15. Metrics. If you are a baseball player, you have to be ok that someone is measuring your BA, RBIs, OPS, WAR, etc. EM is the same. Tons of metrics that corporate medicine invents to try and measure your efficiency and productivity.
That's all I can think of off the top of my head. I'm sure there are plenty more factors I didn't think of.
