If you knew then what you know now...

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

CowgirlCali

Member
10+ Year Member
Joined
Dec 23, 2010
Messages
8
Reaction score
0
For everyone in EM, if you could, is there any advice/tips you would give your younger self?

I've finally completed my G.E and now I'm working on my major courses while serving in the military and I know EM is what I want to do as a career. I've researched this career down to the bone, however I've found the best advice and information comes from the people who actually work in this field day in and day out. With that said:

1. What are the pros and cons to you in this field?
2. Do you have a specialty?
3. Best advice you've ever received?
4. Things you wish you knew when you were just starting out?
5. If you had a chance to start over, would you still pick EM?
6. How do you manage your family life?

Answering any of these questions would be most appreciated! :thumbup:
Thank you!

Members don't see this ad.
 
1. What are the pros and cons to you in this field?
Pro: Variety and helping people acutely.
Con: You get to see the lowest of the lows - the dbags of sociey.

2. Do you have a specialty?
I thought I was an EM doc?
3. Best advice you've ever received?
Do good patient care and the medicolegal stuff will fall in place.
4. Things you wish you knew when you were just starting out?
That my opinion of society would dramatically change by going into EM... and for the WORSE!
5. If you had a chance to start over, would you still pick EM?
I'm happy with EM, it's where I fit. Would I choose something else? It's always a possibility since I like so many specialties. Ask me in 15 years when I'm in the middle of being an attending.
6. How do you manage your family life?
I chose a program that didn't work me to the bone in terms of hours worked - I manage fine.
 
Members don't see this ad :)
For everyone in EM, if you could, is there any advice/tips you would give your younger self?

I've finally completed my G.E and now I'm working on my major courses while serving in the military and I know EM is what I want to do as a career. I've researched this career down to the bone, however I've found the best advice and information comes from the people who actually work in this field day in and day out. With that said:

1. What are the pros and cons to you in this field?
I will try not to repeat things but another con is shift work. You arent an endocrinologist who works 9-5. It is tough on your body to work days, evenings, nights and everything in between. I personally do all nights by choice which honestly makes it better for me. The other thing to consider is that if you want to make some extra money you can pick up a shift or 2. Not many other well paying jobs have something like this.
2. Do you have a specialty?
3. Best advice you've ever received? Emulate those you respect and take only the best from everyone you work with and train under. There are lots of flaws in docs. Whether it is crappy bedside manner, being a dbag etc. I try to take the best from those who trained me and try to do that myself.
4. Things you wish you knew when you were just starting out?
5. If you had a chance to start over, would you still pick EM?Yep. Best field by far.
6. How do you manage your family life?My wife is awesome and i try to maximize my time outside of work by doing mostly 12's and spend time with my kids and wife when i am not at work. I work for a relatively small private group which makes things better.

Answering any of these questions would be most appreciated! :thumbup:
Thank you!
See above answers in bold
 
1. What are the pros and cons to you in this field? pros: being able to be able to see anything, do anything, and do it fast. it really takes someone special to be able to walk into a room, see someone's septic, and have them to the ICU in under 30 minutes. Also, leaving work at work. I come home, and I don't work. I get to spend my time with my wife and kids.
Cons: shift work. yeah, I only work 7a-4, 9a-6, or 3-midnight, but it still sucks. I come home at midnight, and sleep in the guest room so I don't wake my wife up. And when I do the 3-midnight shifts, i usually don't see my wife for a few days because she's a practicing pediatrician who has day hours...so when I'm home, she's working and vice versa.


3. Best advice you've ever received? You'll never EVER know everything about medicine, so don't try faking that you do. And, do what's best for your patient, not for the billing. And, read, read, read

4. Things you wish you knew when you were just starting out? how much patients will manipulate you to get high

5. If you had a chance to start over, would you still pick EM? absolutely 1 million times over

6. How do you manage your family life? easy- when i'm home, i'm home. i spend every minute I can with my wife and kids.
 
http://www.agraphia.net/10-things-that-make-a-great-emergency-doc/

I agree with everything said in this post. It's a rough specialty but if you fit the personality it's the best thing you'll ever do. I love it.

I particularly like this one:

"10) You should be proud of what you do.
The unwashed masses are cast against the shores of the department and you take all comers. You don’t ask insurance status. You don’t ask if they can pay. No, you treat meningitis, fatal arrhythmias, broken bones, and bring people back from the brink. Why? Because it’s the right thing to do."
 
4. Things you wish you knew when you were just starting out? how much patients will manipulate you to get high
[/B]

This is the worst part of my job. I HATE drug-seekers and the game.

Edwin Leap wrote a great article that is only not hilarious because it is so true.

http://journals.lww.com/em-news/Ful...Opinion__Jim_Bob_s_Terrible_Confession.7.aspx

I saw a family/daughter combo in Walmart the other day that used to be real frequent fliers. I stopped and talked to them for a while. They were glowing, actually grooming themselves and looked really happy. Teen-age dropout mom just gave birth and hit the jack-pot of entitlement. They are moving into a house for the first time, got medicaid, food-stamps, all as a reward for having unprotected sex, then choosing not to give the child up for adoption. This was literally the goal for the daughter, their financial salvation. Absolutely no thoughts of actually working for either party, or ever making themselves useful human beings.
 
Last edited by a moderator:
This is the worst part of my job. I HATE drug-seekers and the game.

Edwin Leap wrote a great article that is only not hilarious because it is so true.

http://journals.lww.com/em-news/Ful...Opinion__Jim_Bob_s_Terrible_Confession.7.aspx

I saw a family/daughter combo in Walmart the other day that used to be real frequent fliers. I stopped and talked to them for a while. They were glowing, actually grooming themselves and looked really happy. Teen-age dropout mom just gave birth and hit the jack-pot of entitlement. They are moving into a house for the first time, got medicaid, food-stamps, all as a reward for having unprotected sex, then choosing not to give the child up for adoption. This was literally the goal for the daughter, their financial salvation. Absolutely no thoughts of actually working for either party, or ever making themselves useful human beings.


The absolute worst, saddest case I've seen of this lately was a family from one of the outlying areas near where I work.

So, Mom (and apparently daughter) came to the ED on a saturday. Mom comes via EMS for 'seizures', daughter and family in tow. So on questioning mom, she hadn't been taking her narcs and benzos because the PCP stopped perscribing them and she was going through withdrawl from benzos and narcs. To her credit, she legitimately was having seizures (witnessed by myself and staff), where she'd become apneic and cyanotic, and was post-ictal. So, while we're working mom up, daughter sneaks out to the triage area and gets seen for "toothache". Mom got admitted to the hospital, so I figured it was the end of that.

Next day I roll into the hospital for a 3-midnight shift, and see the same last name on the board with chief complaint of "seizure". Turns out it was the daughter, who was having withdrawl seizures on the floor while visiting mom. She went down from standing, struck her head, and ended up having a temporal fx through her external meatus, with an epidural hematoma, all from her withdrawl seizures. Turns out the day before, someone rx'd her dilaudid for a toothache.

Go figure.
 
Why we as a society reward people for having children (when they are unemployed) is beyond me. If you have a child while you are already on government assistance, or unemployed, that child should be taken away from you, as you clearly have no means to support it. There should be no financial incentive for people to pop out kids.

I put a legal hold on a narc-seeker who'd been to our hospital every day for the past week wanting Dilaudid, sometimes even calling EMS to bring her. Not only did I put a legal hold on her (unable to care for herself) but called CPS on her 3-month old child, whom she was leaving at home to seek narcotics at the ED.
 
Why we as a society reward people for having children (when they are unemployed) is beyond me. .

Who cares if they are employed?

I don't care if the father is Gates, I don't think we should reward people for having children!

I am hesistant to get all politicatal, but I think folks will understand since I am furthering a GVeers post (who is often very political).

What's with the glorificatino of reporduction? Or, even if you want to glorify it, why should it be worth money?

Feeling argumentatively political,

HH
 
Addressing Birdstrike's CONS:

When you’re off, you’re not really off.
True, the recovery can be difficult. This "burnout" is especially true for people who work a lot of shifts. If you're tired, work less. You'll still make more than a lot of FP or IM out there. You can trade/bunch your days and have a longer time off. Take a vacation, sleep on flight.
Also, when you're off...you're not really off is especially true for other specialties as well (except FM, maybe). They take calls from home, they answer to consultations, they are not off either! they have pagers at home, we don't. So, my days off is better than their days off, hands down.

You are either an employee or a “de-facto” employee of a group or hospital
So what, that's the way it is. Plenty of IM are hospitalist and are employed by the hospital. Plenty of surgeons are employed by a group. Why should this bother you so much, it should affect you that much on your job performance.
The EM career choice is in demand. That goes for the job demand as well. At least you don't have to build a bussiness and root yourself in a community that you may not like. If you don't like the school system that your children are in, get up and move, the next day is the same as any other day.
I don't know how often someone get kicked out of a group (no empirical data here), but I bet it's not often. Again, this goes for other specialties as well. There's always an internal struggle between docs for more patients. IM docs bad mouth each other on the floor all day. We had a cardiologist recently left his group of 5 years over money. Now, he's starting over and he's suing the group over the patient base. That's part of medicine.

The adrenaline rush gets old.

So are appy, cholecystectomy, DKA, asthma, cellulitis, pneumonia, fractures, fractures, and fractures. Everything gets old.
heck, even trauma surgery gets old. Every other day, someone fall off a 10 ft ladder, same cook book medicine like every other specialty.

Working a small set-number of shifts per month is getting harder and harder to do
Not sure how to address this one. Maybe true for some people. But I think for the majority of us, it's not a big deal. I guess it depends on how you spend your free time too. Fishing, skiing, gambling, or gardening? something to look forward to during your days off. Most people don't have difficulty getting out of bed if they have a goal to accomplish that day.


Despite the hero factor, you won’t get paid like one, or be appreciated like one.
hahaha, how much are heroes supposed to be paid?
In term of appreciation, if it's important to you, it's there if you want to feel it. I think most ER docs don't feel appreciated because they don't take the time to spend / discharge the patients. Especially at places with residency, attending tends to let the residents run the floor. But if you spend a lot of time with the patients instead of going through the nurse for everything, both the patient and the nurse will appreciate you. Of course, the more you do this, the less money you make cause it takes time away from you seeing more patients. But, it's there.

You’re treated with unfathomable contempt and disrespect at times.
Yes, true for all specialties, but MOST for EM. That's life. Life is not fair.
I don't hate it when a drug seeker cursing while walking out of the ED. I actually feel accomplished. That's one drug seeker that didn't outsmart me and ended up with no narcotics that day, no wonder why he's pissed.

BTW, i'm only addressing this because I don't want some impressionable 3rd year med student to be swayed away from EM if they haven't truly experience it. There is a really good thread (now is a sticky above) about the 12 things we hate/love about the ED. It's a must read for everyone that are considering EM as a career choice.
 
For everyone in EM, if you could, is there any advice/tips you would give your younger self?

I've finally completed my G.E and now I'm working on my major courses while serving in the military and I know EM is what I want to do as a career. I've researched this career down to the bone, however I've found the best advice and information comes from the people who actually work in this field day in and day out. With that said:

1. What are the pros and cons to you in this field?
2. Do you have a specialty?
3. Best advice you've ever received?
4. Things you wish you knew when you were just starting out?
5. If you had a chance to start over, would you still pick EM?
6. How do you manage your family life?

Answering any of these questions would be most appreciated! :thumbup:
Thank you!


Are you a medic? Become one. Then go to P.A. school through the military. Do a 1 year EM fellowship in the military. Leave military service at 38 years old with an officer's pension/tricare and some great career options. Or, you can get out of training as an EP at ~ 38 years old with tons of debt and no pension. Your choice.
 
Members don't see this ad :)
Along the drug-seekers theme… A significant percentage of the population has at least one of the following characteristics (some have all), addiction, dishonesty, malingering, mental illness, and plain stupidity. This mix of attributes makes many of your histories and physicals utterly useless. On one extreme, you have the regular guy, with vague belly pain, minimal tenderness over the right lower quadrant and no rebound tenderness, normal vitals, who refuses pain medicine and ends up having an appy. On the other extreme, you have the screaming in pain, guarding to palpation, came in by ambulance who has absolutely nothing.

I recall one schizophrenic patient that frequented the ER of my residency. He had a very flat affect and tended to come to the ER and to the out-patient clinics on a very frequent basis, often complaining of things like "toe pain". I once saw him for the main complaint of "Blindness". I asked him if he was currently blind, he said, "No, only when I do this" and he closed his eyes real tight. I saw him for the complaint of abdominal pain/chest pain. He had left upper quadrant tenderness. I looked at the previous 8 visits to out-patient clinics/ER for chest pain in the past year and noted that he hadn't had a troponin drawn with any visit (He was 37 years old, didn't smoke, had no hypertension, and no family history of CAD). Trop was over 3, with a normal EKG. 3 days later, he is status post quadruple CABG.

Combine this unreliable history/physical exam with a nightmare of medicolegal climate and heavy patient satisfaction combined with at times extreme time constraints, and pressure to "move the meat", we have become increasingly dependent on imaging studies/laboratory testing to pick up all emergencies.

This is contrary to the old adage that 95% of diagnosis comes from history and physical that your professor will try to beat into you during your "history and physical class". This is often taught by old-timers in your medical school, who practiced in a different time. The attendings of our attendings made a lot of diagnoses that were probably wrong, but it didn't matter because the they couldn't do a darn thing about so many diagnoses. "You are having a heart attack! That is not good. Here is an aspirin. You need less stress in your life. Good luck with that." Think about the advances in cardiothoracic surgery, with bypass, aortic repair, and valve repair. Think about the advances in neurosurgery, with aneurysmal clipping and coiling. It wasn't imperative that doctors make so many serious diagnoses 50 years ago. People died, and that was life. People don't accept the "crap happens" excuse anymore.

Also think of the now innumerable pharmacologic treatments that are now available that weren't to physicians 50 years ago.

Interesting article about this:

http://www.time.com/time/magazine/article/0,9171,872488,00.html

Writing of pharmaceutical chemists in Clinical Pharmacology and Therapeutics, Dr. Modell asked: "Will they realize that there are too many drugs for the patient, for the physician, and, surprisingly enough, for the pharmaceutical industry?" No fewer than 150,000 preparations are now in use, of which 90% did not exist 25 years ago, and 75% did not exist ten years ago. About 15,000 new mixtures and dosages hit the market each year, while about 12,000 die off.
 
Last edited by a moderator:
"I don't know how often someone get kicked out of a group (no empirical data here), but I bet it's not often."

December07- I was referring EM groups losing their contract with a hospital and the group getting kicked out. This happens frequently. I was not referring to any specific physician getting thrown out of his own group.

I see, thanks for clarifying that point.
 
"I don't know how often someone get kicked out of a group (no empirical data here), but I bet it's not often."

December07- I was referring EM groups losing their contract with a hospital and the group getting kicked out. This happens frequently. I was not referring to any specific physician getting thrown out of his own group.

That is always the threat held over our heads by the hospital when they are making another unreasonable demand. Essentially we are the hospital's bitches and have been delegated a whole host of ridiculous responsibilities, ranging from writing admission orders to discharging patients in less than 147 minutes.
 
Just some points of contention:


Pros:

The adrenaline rush can be cool at times.

Like everything, with enough exposure it becomes mundane.


You are a “real doctor”. Despite the many consultants who will try to make you think they are superior, you are the only one who can see ANYTHING. The only one with the courage. You are the only one with the courage to walk in that room and take on any patient, any challenge. You’re not a neurosurgeon who says, “I only do spines, not brains”. Or the plastic surgeon who says, “I do eyelids, but not tear ducts.” You do brains, spines, car accidents, heart attacks, adults, kids, normal people, crazy people, surgical patients, non-surgical patients, everything. You at least see the patient, do what you can, a do what’s right.

I think the last line pretty much sums it up. You realize what the problem might be, stabilize if necessary, and transfer to the appropriate service for further evaluation and treatment. You're not really *doing* all that much.


This is probably the coolest thing about the specialty. I think most of the ER bashing you see and hear from other specialties is that deep down it kills them to know they gave this up.

Ok, not really ...

It covers up a huge insecurity that a lot of “specialists” have. Deep down they know that when the s—t hits the fan, and the secretary at their office collapses and goes into cardiac arrest and they’re shaking in their boots, they’re going to call 911-that’s you. If someone collapses on an airplane at 37,000 feet and they call for a doctor you’ll know what to do.

So will anyone else who has had BLS/ACLS. I don't see what your point is. ICU docs do it all the time. Medicine docs do it all the time. Hell, I'm a psych intern and even I have run codes. If it ends up being some unusual cause that doesn't respond to the normal algorithm of ACLS, you probably won't figure it out anyway.


You’re everyone’s hero even if they don’t say it. You won’t have to say, “Yes I’m a doctor, but I only do rectums”. Also, there is nothing cooler than bringing a young person through a life-threatening situation and saving a life.

It’s the most secure profession on the planet. Recession, depression, peace, war, people will always get sick. And if not, they’ll still go to the ER, trust me. People love the ER. More visits yearly than Disneyworld. You’d think they’re giving away free stuff (oh, wait, they are)

Whatever makes you feel better. I think most specialists (psych included) talk so much **** about EM because our consults usually have half-assed workups prior to being called. Yes, you are a doctor! Maybe you should act like one before calling a consultant and do a proper evaluation instead of simply recognizing which service you should call first.


/rant
 
Just some points of contention:

Whatever makes you feel better. I think most specialists (psych included) talk so much **** about EM because our consults usually have half-assed workups prior to being called. Yes, you are a doctor! Maybe you should act like one before calling a consultant and do a proper evaluation instead of simply recognizing which service you should call first.


/rant

Fair enough. I would also argue that it is not uncommon for many specialists to have a bias against EM that they bring into the ED, regardless of who is working there or how competent/full their work-ups may be. I personally think that most of the people outside the ED "don't get" the specialty because medicine is practiced differently there. It is perhaps the only place where you are often taught how to diagnose and treat simultaneously. This flies in the face of all medical education prior to the inception of EM, when the mantra was 1) Do H&P 2) Gather labs 3) Once all labs are back, formulate diagnosis. That is a very effective strategy obviously, because it has worked for centuries. Unfortunately it doesn't work as effectively in the ED, but when you only spend a fraction of your time there, it is hard to appreciate that. Just food for thought.

Also, I don't "talk ****" about any specialty because that means you are judging people you've never met.
 
Just some points of contention:
Yes, you are a doctor! Maybe you should act like one before calling a consultant and do a proper evaluation instead of simply recognizing which service you should call first.[/B]


/rant

A psych intern reminding us that we (EM physicians in general I am guessing) are doctors.. Thats great stuff. I haven't had such a chuckle in days...:)
 
Whatever makes you feel better. I think most specialists (psych included) talk so much **** about EM because our consults usually have half-assed workups prior to being called. Yes, you are a doctor! Maybe you should act like one before calling a consultant and do a proper evaluation instead of simply recognizing which service you should call first.
/rant

Hmm....so angry - I wonder if it's your subconsciousness telling you that you really wanted to be an EM doc….? ;)
From my, be it limited, experience a patient can’t even sneeze on the phych service without getting a medicine consult, two sneezes very well might get you a transfer to the unit… which is not a bad thing. To state the obvious, there are good reasons different specialties exist – they all do things the ‘other specialist’ doesn’t want to deal with and vice versa.
Seriously, I am just curious why someone would take all this time and effort to poo-poo a specialty they are not involved with in any way…? :confused: The ever popular ignorance/arrogance combo, I suppose….
 
What psych interns don't get is the frustrating grid-lock that tends to happen in the ER. There is a bottleneck that happens when somebody needs to be admitted that is frustrating and must be relieved ASAP. If I have an ICU admission (the patient is tubed) I might not know what exactly is going on (pneumonia, versus PE, versus pulmonary edema from NSTEMI or CHF), but I know I need an ICU bed to open up, potentially a nurse to get called in from home to take care of that patient, etc. If we aren't going to get an ICU bed, than our nurses in the ER need to know ASAP so they can call someone in from home to give that patient the 1:1 care that needs to happen.

What is the result? I call early on admissions, whether psych, medical, surgical, or ICU. 5% of the time, the disposition changes, and I realize I might have asked the wrong doctor to admit, or the exact diagnosis changes. But 95% of the time, I have a bed 1-2 hours earlier and that patient is gone from the ER and we are moving waiting room patients through the now usable space. It behooves admitting doctors like this troll to drag their feet so that their staff doesn't have to work hard and the admitting doctor can continue their internet surfing and delay seeing a new patient.

How many times have you heard ER nurses try to call report again and again because the floor nurses are "busy"? As if the ER nurses aren't.
 
Top