Is it true that even EM gets monotonous and loses its novelty that was once felt

[UCSFx2017]

EM is heavily romanticized by the media and has its appeal of solving acute illnesses with quick real-time information. To be honest, the media certainly had a tinge of effect on my interest. EM is very to-the-point and builds very short-term yet meaningful patient relationships that I find attractive. Did EM become monotonous and lose its novelty that was once felt as an undergraduate for you? I imagine myself being excited every now and then as an EM physician and was wondering if that fantasized excitement and high would eventually dull itself and that I would eventually become jaded. If my conceptions are true, how do you spice up your days, aside from continued, informal, independent education?

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[dchristismi]

Yes, it does. When you do it every day, it does become routine. And yeah, we all get jaded. Maybe moreso than other specialties.

In fact, it takes quite a bit nowadays for me to get that good adrenaline buzz. Still, you never know what you're going to see next, and you do have to be ready for anything. Because anything, and I mean anything, can stumble in your doors.

But the vast majority of what we do isn't glamorous or exciting.
Most of us live for the sick ones. You couldn't pay me enough to work in a clinic and manage hypertension and diabetes all day.

So you do what everyone else does - have family, hobbies, vacation, etc. You know, life. Career is important, but it's not everything. I mean, how much excitement does the average accountant see daily? Or lawyer? Or engineer? Just because the field attracts adrenaline junkies, doesn't mean we all get our fixes from it.

 

[dotcb]

I'm in my 6th year of EM and I still really like it. To some extent, whatever you do routinely will become monotonous, even EM. Most people eventually find a way to make their career/life interesting and have variety in it. Some move into admin, some teach, do research, get really into their hobbies, families, vacation planning, etc. Compared to some fields, EM really does have a lot of variety in it. For me, working up chest pain or RUQ pain for the 1000th time is not terribly interesting. But for the medical student or resident working with me, it may be their first time working up X complaint. Or for the more advanced resident, I may be able to give them so tips on efficiency or get into a discussion of literature. I may need to look up the answer to a question I'm asked. It keeps things fresh to some extent. I also like where I work - the nurses, colleagues, high acuity, interesting pathology - these things help.

 

[Khaos]

I agree. For the most part it is monotonous. If triage does their job well and puts down an accurate chief complaint, you can order most of the things from the computer and then walk in to get the details. I still enjoy getting the code, trauma, and weird cases. Those are the reasons I went into EM. The STEMI has lost most of the glamor that it used to have when I was a resident. I don't like lacs, chest tubes, and time consuming procedures. I do still like intubations and running codes.

 

[Birdstrike]

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[DrMom]

Anything in life that you do over and over again becomes monotonous at times. Every specialty (and pretty much every other job out there) does a lot of the same things repeatedly, so it's nothing unique to EM.

 

[The White Coat Investor]

The sicker they are, the more routine it becomes. I treat everyone with asystole the same.

Seriously though, some of the more interesting stuff isn't all that sick. If you enjoy people watching, you'll always enjoy EM. It's like a chance to see how the other half lives. The 63 year old on meth last night with a-fib with RVR for instance. I asked him, "What the hell? 63!? When are you going to outgrow this stuff?" He said, "Today doc, I've learned my lesson." It really scared him. Doubt he'll quit, but I was surprised he wasn't dead yet and still had a whole mouth full of teeth after 30 years.

 

[lmnopeieio]

Yes, but consider the alternatives. You can reignite your love for the field by looking at how other countries do the same thing, research, residents often have infectious curiosity. If the ER were an EKG it would be Afib - irregularly, irregular. If you have become board, then it's time to take the next professional step. For you it could be flight med, rural med(creepy, alone,no backup, nurses inexperienced .... Can you be Dr. McGyver all alone for hours?) management,research, education, dive med, off label use of hyperbarics, etc,etc,etc......

 

[Arcan57]

Adrenaline comes from doing things that are exciting. Much of that excitement is generated from unfamiliarity and uncertainty. As you get better at EM, a lot (but by no means all) of the unfamiliarity and uncertainty go away. Boredom is the price we pay for competence. Now there are plenty of other things about EM to combat the boredom besides interesting pathology but the degree to which we engage in these other activities varies widely. If you aren't interested in the people or if you dislike your team or you're seeing 4 pts/hr and don't have time to do anything besides screen the patient then this job gets wearisome quickly.

 

[VienneseWaltz]

If the ER were an EKG it would be Afib - irregularly, irregular.

Heh heh heh...and some days you're in RVR...

A lot of things get monotonous, but at least once a week I or someone else tells a story about a patient that ends with, "You can't make this **** up..." And every so often you do actually save a life (and not just from the drear of a Dilaudopenic existence).