losing perspective on EM

[wanderlustin]

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today has been a very long day and i need some perspective on emergency medicine. i've gone through third year thinking more and more that em would be a great fit for me--wide variety of problems, able to manage (initially) just about anything, first dibs at a workup/evaluation, some trauma with procedures, and a decent lifestyle.

lately, though, when i talk to students or read threads on sdn, i feel like i'm getting a lot of negative feedback. "oh, don't do em, all those doctors do is babysit drunks." "er doesn't even assess the patient." or these threads talk a lot about customer service, which is something i'm learning to hate more and more.

i want to practice real medicine, evidence-based medicine, and improve our healthcare system in the us. i haven't had my em rotation yet, but i'm starting to fear that it may not be all that i hope.

how do you guys deal with these frustrations? doesn't the customer service aspect drive you nuts? is it like this everywhere?

i don't want em to "just" be my job. and i get the idea that's what a lots of the docs see it as. i guess i'm more one of those people who wants more from medicine than that. can i still be that in emergency medicine?

 

[Rendar5]

All medicine is customer service to an extent. we just happen to have more new customers than established customers. as for everyone talking all the trash about EM, you usually learn to just ignore it and realize that what they complain about is not necessarily grounded in reality, just in their reality. If what other people think about you eats away at you though, then this may not be the field for you. But honestly, wait until your EM rotation and see if the ER is the right place for you. If you don't feel at home in the ED, then honestly even with all it's incentives, it may not be the right fit. And if you do, then hey, you'll stop caring about what others think and start caring about what you want out of medicine.

 

[docB]

You've got two separate kinds of points there. The jabs aimed at EM by outsiders "They just babysit drunks." are almost always crap as are many criticisms by people without a clue what they're talking about. The points about EM by EM folks "We hate being held accountable for customer satisfaction." are real issues. But they don't (yet) define the specialty. Every specialty has its pitfalls. By reading these threads you are aware of stuff many at your level aren't. Take some of these with a grain of salt, they are real issues but they don't make the specialty a bad choice.

 

[wanderlustin]

the babysit drunks thing comes from a student who's already taken em. i think a lot of my anxiety is just not having the experience in the ed to know what's true and what's not.

 

[Saladin MD]

At least at the program I'm currently working in, Internal Medicine is who babysits drunks (who are admitted for alcohol withdrawal).

By the way, give me an alcoholic to admit to the floor over any train wreck of a patient any day! Makes writing the orders infinitely easier.

 

[december07]

the babysit drunks thing comes from a student who's already taken em. i think a lot of my anxiety is just not having the experience in the ed to know what's true and what's not.

haha, yep, we hang a banana bag and send the drunk to the floor. If he becomes combative as he sober up.... page the IM attending. Drunks are the first that we move out of the ED.

Now, Psych can be an issue sometimes when they can't be medically cleared. But that's not common.

 

[gro2001]

OP, I don't think you can really know whether you will like EM until you do a rotation. It's a field, like any other, with a lot of compelling pros and cons. Until you do it, it's hard to know whether you like the pros enough to tolerate the cons.

As for the trash talk, there is NO speciality that is not trashed by somebody somewhere. Funny how it's usually the service that gives people more work that is usually being trashed. The ER gives work to everyone (by calling for admits) so everyone has an axe to grind. Also, it's sometimes difficult for other services to comprehend that the aim was never for us to be specialists in THEIR field.

For what it's worth, some people (myself included) feel like EM is damn near the last thing out there that feels like 'real medicine'. EM and maybe rural FM. IM was compelling until it began to feel like you are a clerk trying to reconcile the sub-specialists' opinions, surgery was always fun in the OR and evaluating in the ER but the floor rounds are even worse than medicine because all the patients become reduced to just one malfunctioning orifice (can't eat, can't poop, bleeding out of one of them, or the ostomy is clogged). Ob was fun with the minute by minute changes and occasional crash c-sections, but... gyn. Nuff said. I won't even mention Neuro or Psych.

EM is different though. You start every day not knowing what you are going to see come through those doors. You often get to intervene in a critical, life saving way (few people get to do that as often as us). You get to go home at the end of the day and not think about what you will say at rounds the next day (an, no rounds!). And, you get paid reasonably well to do it.

Maybe it's my young, naive perspective but to me, the great days in the ER are so AWESOME they beat anything anywhere else in the hospital, and the bad days are not nearly as bad because they are OVER at the end of the shift and you get to start over next shift fresh (unlike the other service where the badness tends to stick around for a while).

Don't take my word for it though, try it.

 

[Daiphon]

OP, I don't think you can really know whether you will like EM until you do a rotation. It's a field, like any other, with a lot of compelling pros and cons. Until you do it, it's hard to know whether you like the pros enough to tolerate the cons.

As for the trash talk, there is NO speciality that is not trashed by somebody somewhere. Funny how it's usually the service that gives people more work that is usually being trashed. The ER gives work to everyone (by calling for admits) so everyone has an axe to grind. Also, it's sometimes difficult for other services to comprehend that the aim was never for us to be specialists in THEIR field.

For what it's worth, some people (myself included) feel like EM is damn near the last thing out there that feels like 'real medicine'. EM and maybe rural FM. IM was compelling until it began to feel like you are a clerk trying to reconcile the sub-specialists' opinions, surgery was always fun in the OR and evaluating in the ER but the floor rounds are even worse than medicine because all the patients become reduced to just one malfunctioning orifice (can't eat, can't poop, bleeding out of one of them, or the ostomy is clogged). Ob was fun with the minute by minute changes and occasional crash c-sections, but... gyn. Nuff said. I won't even mention Neuro or Psych.

EM is different though. You start every day not knowing what you are going to see come through those doors. You often get to intervene in a critical, life saving way (few people get to do that as often as us). You get to go home at the end of the day and not think about what you will say at rounds the next day (an, no rounds!). And, you get paid reasonably well to do it.

Maybe it's my young, naive perspective but to me, the great days in the ER are so AWESOME they beat anything anywhere else in the hospital, and the bad days are not nearly as bad because they are OVER at the end of the shift and you get to start over next shift fresh (unlike the other service where the badness tends to stick around for a while).

Don't take my word for it though, try it.

Well said, gro...

Might I also add, too, one simple observation: for all the EM bashing the other services do, where do they send their patients when the excrement is hitting the fan?

Also, who do they call or come curbside when they're on the floor and need help (and we're one of the only attendings in the hospital)?

I'm proud to be an emergency physician, and wouldn't trade my career for anything. Nothing else in medicine even comes close. I revel in the fact that I am the proverbial Jack of All Trades; and I look at EM bashing as simple jealousy that others don't get to do what I do.

Cheers!
-t

 

[dotcb]

I'm a 4th year resident. I love the simplicity of our field. You come to the ER when and if you feel there's a problem. If we can fix your prpblem, we will. If we can't, we'll point you in the right direction. When the shift is done, we go home, no pager. It's generally fun and the pay is good. 'Nuff said.

 

[Venko]

Thank you for posting and I hope you find your way in the specialty selection process.

If you are trying to find a specialty that is perfect and without critics or flaws it has yet to be found. Take a step back and you'll realize that certainly those who say EM physicians "babysit" drunks, has a skewed view. I noticed that you held the comment in esteem as the student has already done an EM Rotation. I'll just caution you from accepting that as truth since one EM rotation in one location is not the same as a career in the specialty. There will be months that pass in every specialty that are more exciting than others and there are locations that have more excitement than others.

Also, keep in mind that every specialty is given criticism by other specialties. Surgeons, Internists, Radiologists, Psychiatrists, Family Physicians are all stereotyped by others and only partially justified. Does EM manage people when they are intoxicated. Certainly. Is it babysitting? I guarantee that it is not. I also diagnose and treat many other conditions daily.

Regarding customer satisfaction. This is an evolution of medicine as a whole that you are talking about, it is certainly not specific to Emergency medicine. There will be further evolution in the way we gauge customer satisfaction against evidence based science and all fields will adjust. We should be trying to make medicine palatable to our patients, after all we all have jobs only because of the patients.

EM is not perfect, but I'll tell you, for me its the greatest specialty in the world. Everyone around you will have an opinion...ask yourself what you think and go with that.

 

[wanderlustin]

For what it's worth, some people (myself included) feel like EM is damn near the last thing out there that feels like 'real medicine'. EM and maybe rural FM. IM was compelling until it began to feel like you are a clerk trying to reconcile the sub-specialists' opinions, surgery was always fun in the OR and evaluating in the ER but the floor rounds are even worse than medicine because all the patients become reduced to just one malfunctioning orifice (can't eat, can't poop, bleeding out of one of them, or the ostomy is clogged). Ob was fun with the minute by minute changes and occasional crash c-sections, but... gyn. Nuff said. I won't even mention Neuro or Psych.

EM is different though. You start every day not knowing what you are going to see come through those doors. You often get to intervene in a critical, life saving way (few people get to do that as often as us). You get to go home at the end of the day and not think about what you will say at rounds the next day (an, no rounds!). And, you get paid reasonably well to do it.

Don't take my word for it though, try it.

everything you said here is my attitude about EM (albeit naive). thanks, gro.

thank you to all responders. sometimes it's easy to get cause up in the negative things people say, plus SDN seems to lean that way because most of you are in practice. as a student, it's good to hear what you love about the profession and get some reassurance that you actually like doing it. now just gotta see if i actually like my time in the ED.

 

[Valvool]

One thing that really concerns me is the shift work and impact on health/home life. I read a book recently by an EM physician called Something for the Pain: Compassion and Burnout in the ER. It seemed to me like half the chapters in the book were about the issues surrounding this doctor's rotating shift schedule. He describes sleep deprivation, inability to fall asleep or revert back to a diurnal schedule, marital problems related to his wife not keeping the kids quiet while he's trying to sleep, the need for marital counseling due to his perception of his wife not making his sleep a priority in combination with his bad temper bc of the sleep deprivation, buying a house based on the floor plan and whether or not it would be suitable for his sleep needs....it went on and on. I am wondering if others find it this big an issue.

Any comments on this would be appreciated.

 

[Rendar5]

shrug, i got no problems with sleep deprivation and i've got a sleeping disorder I try to keep in check. The only time I have sleep issues is when I'm rotating on another service and have to pull long calls.

 

[Birdstrike]

.

 

[heroin5]

one of the best parts of the ED for me is getting to meet so many different people and hear unusual stories. everyone has a story and most of them are dying (no pun intended) to share it. every once in a while you get a peak at what really makes someone tick (not talking thoracotomy) and you can make profound connections with another person in a few minutes without a lot of the bull**** that goes on in normal interactions.

 

[Old_Mil]

i don't want em to "just" be my job. and i get the idea that's what a lots of the docs see it as. i guess i'm more one of those people who wants more from medicine than that. can i still be that in emergency medicine?

Regardless of which specialty you enter, it will be "just" a job. You will soon find that you cannot save your patients, you cannot save the system, and you will be fortunate to save yourself from both.

 

[Venko]

Regardless of which specialty you enter, it will be "just" a job. You will soon find that you cannot save your patients, you cannot save the system, and you will be fortunate to save yourself from both.

Wow, this sounds like burn out. I fell entirely differently than this

Emergency medicine is certainly a job like money is just paper...

it means more to me than what you make it out to be. I can save some of my patients. I can make the system better each day and in the process I do save myself.

 

[Radonkulous]

Regardless of which specialty you enter, it will be "just" a job. You will soon find that you cannot save your patients, you cannot save the system, and you will be fortunate to save yourself from both.

Old_Mil, if you don't mind that is my new signature.

 

[AmoryBlaine]

Every specialty in medicine sounds god-awful when described in terms of its most negative characteristics.

Actually this is true for everything in the world pretty much.

Everyone has an opinion about the ER, usually related to that one time that the stupid EM attending did some unpardonable thing like forgetting to send anti Factor Q6a.4 levels on the pt who clearly had Lichtenstein's polygammanemia or like consulting surgery with an equivocal CT scan and moderate RLQ tenderness. For some reason other docs love to share this with medical students.

I just sort of laugh inwardly and think about the times when we've had a STEMI, a stroke, an intubated MICU player, then the radio calls a hypotensive GSW to the abdomen and none of the ER attendings or residents even flinch.

 

[Birdstrike]

I just sort of laugh inwardly and think about the times when we've had a STEMI, a stroke, an intubated MICU player, then the radio calls a hypotensive GSW to the abdomen and none of the ER attendings or residents even flinch.

I really think that this is one big factor that feeds the animosity that bubbles up toward the ED from time to time. We run towards any level of chaos, fear or mayhem we're dealt. They reserve the right to run away. Deep down it hurts. What ER doctors do is amazing, and incredibly difficult to do well.

 

[Venko]

I really think that this is one big factor that feeds the animosity that bubbles up toward the ED from time to time. We run towards any level of chaos, fear or mayhem we're dealt. They reserve the right to run away. Deep down it hurts. What ER doctors do is amazing, and incredibly difficult to do well.

Now this should be that other persons signature. Its filled with so much truth.

 

[Birdstrike]

today has been a very long day and i need some perspective on emergency medicine. i've gone through third year thinking more and more that em would be a great fit for me--wide variety of problems, able to manage (initially) just about anything, first dibs at a workup/evaluation, some trauma with procedures, and a decent lifestyle.

lately, though, when i talk to students or read threads on sdn, i feel like i'm getting a lot of negative feedback. "oh, don't do em, all those doctors do is babysit drunks." "er doesn't even assess the patient." or these threads talk a lot about customer service, which is something i'm learning to hate more and more.

i want to practice real medicine, evidence-based medicine, and improve our healthcare system in the us. i haven't had my em rotation yet, but i'm starting to fear that it may not be all that i hope.

how do you guys deal with these frustrations? doesn't the customer service aspect drive you nuts? is it like this everywhere?

i don't want em to "just" be my job. and i get the idea that's what a lots of the docs see it as. i guess i'm more one of those people who wants more from medicine than that. can i still be that in emergency medicine?

Keeping Perspective On Emergency Medicine
​

Now that I've had some time to digest this original post, I think a somewhat philosophical question, needs a somewhat philosophical response:

As someone who knows plenty about "losing perspective on EM", the core of what you need to keep in perspective, if you're considering dedicating your life to EM, actively working in EM, if you're a hospital administrator, and especially if you're ever in an ED as a patient or family member, is this:

Emergency Medicine is "God's work". Those who do it, do so because they're called to a higher purpose (to make a sick, chaotic world a little bit better). It is a "calling", much like being a soldier on the front lines of a war (to defend his country) or a religious devotee (to serve God's will). You will give much more than you will receive. The bullets you take will greatly outnumber the "medals" you'll receive. You will likely plow ahead despite fighting burnout and fatigue, from time to time. You'll encounter sickness, mayhem, chaos, disease, hysteria, and anxiety, shift after shift, patient after patient. You will make the world a little bit better, healthier, less chaotic, less anxious, less insane, less ignorant, less cold, less hungry and a little bit less broken every day. Much of the time, this gift to humanity will go on unappreciated and unnoticed by the masses, the administrators and "customers", but you'll know damn well, without a doubt that you made this world a better place.

Keep Up The Good Work, ER Doctors And Nurses. You Make This World A Much Better Place​

 

[MCAT guy]

Keeping Perspective On Emergency Medicine
​

Now that I've had some time to digest this original post, I think a somewhat philosophical question, needs a somewhat philosophical response:

As someone who knows plenty about "losing perspective on EM", the core of what you need to keep in perspective, if you're considering dedicating your life to EM, actively working in EM, if you're a hospital administrator, and especially if you're ever in an ED as a patient or family member, is this:

Emergency Medicine is "God's work". Those who do it, do so because they're called to a higher purpose (to make a sick, chaotic world a little bit better). It is a "calling", much like being a soldier on the front lines of a war (to defend his country) or a religious devotee (to serve God's will). You will give much more than you will receive. The bullets you take will greatly outnumber the "medals" you'll receive. You will likely plow ahead despite fighting burnout and fatigue, from time to time. You'll encounter sickness, mayhem, chaos, disease, hysteria, and anxiety, shift after shift, patient after patient. You will make the world a little bit better, healthier, less chaotic, less anxious, less insane, less ignorant, less cold, less hungry and a little bit less broken every day. Much of the time, this gift to humanity will go on unappreciated and unnoticed by the masses, the administrators and "customers", but you'll know damn well, without a doubt that you made this world a better place.

Keep Up The Good Work, ER Doctors And Nurses. You Make This World A Much Better Place​

Pertinent question: Are you still leaving EM for another specialty?

 

[Birdstrike]

Pertinent question: Are you still leaving EM for another specialty?

You missed the entire point of the post:

http://forums.studentdoctor.net/showpost.php?p=11014279&postcount=22

It's the best thing I've ever posted on this forum, by far. You're focusing on the one flaw in the diamond, seeing the negative and ignoring the positive. Everyone wants to read about the "12 reasons not to go into Emergency Medicine", but no one wants to read about the one reason you should.

What I'm doing in the future is irrelevant. I can speak with authority only about my past experiences, not about the future, mine or anyone else's. I can't tell any of you what to do with your lives anymore than you can tell me what to do with mine. Just because you see someone walk out of a theater, does that mean you shouldn't walk in?

I've never told anyone Emergency Medicine is "terrible" and declared the specialty dead. I've also never said it's all perfect with no downside. I have no greater guarantee about my future than any of the rest of you. I know some people read this forum and certain posts like it is an Oracle, and base major life decisions on it. Because of this, I only post about which I know, so that my posts may be helpful to someone else, now, in 5 years or maybe 100 years. I cannot make the world black and white. I cannot tell any of you to choose EM or not choose EM.

If in the future, if I can say with certainty I've found something better for myself, my family and my patients, and I think it'll be helpful to those reading this forum, I'll post about it. Or maybe I won't. There may be no point. However, it makes no sense to blog on and on about the grass being greener when I haven't even walked on it yet. What's best for my family and I over the next 20 years, may have no bearing on what's best for any of you for your lives.

 

[MCAT guy]

You missed the entire point of the post:

http://forums.studentdoctor.net/showpost.php?p=11014279&postcount=22

It's the best thing I've ever posted on this forum, by far. You're focusing on the one flaw in the diamond, seeing the negative and ignoring the positive. Everyone wants to read about the "12 reasons not to go into Emergency Medicine", but no one wants to read about the one reason you should.

What I'm doing in the future is irrelevant. I can speak with authority only about my past experiences, not about the future, mine or anyone else's. I can't tell any of you what to do with your lives anymore than you can tell me what to do with mine. Just because you see someone walk out of a theater, does that mean you shouldn't walk in?

I've never told anyone Emergency Medicine is "terrible" and declared the specialty dead. I've also never said it's all perfect with no downside. I have no greater guarantee about my future than any of the rest of you. I know some people read this forum and certain posts like it is an Oracle, and base major life decisions on it. Because of this, I only post about which I know, so that my posts may be helpful to someone else, now, in 5 years or maybe 100 years. I cannot make the world black and white. I cannot tell any of you to choose EM or not choose EM.

If in the future, if I can say with certainty I've found something better for myself, my family and my patients, and I think it'll be helpful to those reading this forum, I'll post about it. Or maybe I won't. There may be no point. However, it makes no sense to blog on and on about the grass being greener when I haven't even walked on it yet. What's best for my family and I over the next 20 years, may have no bearing on what's best for any of you for your lives.

I don't think I missed the point, I think its relevant. I understand there are pluses and minuses. At the same time when one of the advocates for the field is leaving it because its bad for your family and other reasons, well I think I'd like to know that because I don't want to be in a position tochange specialties half way into my career because its rough on my family. Your experience teaches me a lot.

 

[Sir James Bond]

Shift Work Sleep Disorder has been associated with cancer and heart disease. Personally, the severe toll on the body and my future family outweighed the excitement and meaningful career of emergency medicine, so after much introspection I've switched to a different future. Certainly everyone working in the hospital contributes to saving lives and making the great wheel of medicine turn, some in more direct ways than others. Applause to my colleagues who will fill the EM role.

I would have made a damn good EM doc, and I suspect the specialty will lose a few good men and women until the major issues of EM are at least somewhat improved.

 

[deleted65604]

ER is no more "God's work" than any other specialty. A smart internal medicine doc who can, Houselike, figure out a complicated patient is invaluable. A surgeon, who can cut out dead-gut without making more dead-gut, and without leaving behind infection is a godsend. Having had to admit patients to terrible surgeons who have subsequently killed them, I would label a general surgeon as a soldier in God's army more than any other specialty. Maybe not a soldier I guess...How about the heavy artillery blasting disease to smithereens?

How about a nephrologist that can keep people's electrolytes in balance for a decade after they should have long been dead? How about a GI doc that can stop pouring GI bleeders? A neurologist that can get a parkinson's patient to walk again?

Come on, a cardiologist, who can turn back the hands of time and the ticking time bomb of bad genes, cancelling out the effects of decades of hard living with a few well placed stents? Incredible. A cardiothoracic surgeon who literally holds your loved one's heart in there hand and puts in new valves? A true miracle. How about the anesthesiologist working with that surgeon who kills the patient and then brings them back to life? Christ-like.

What more valuable than an FP who educates a patient on how to take care of their diabetes, adding literally decades to their life-span? A pediatrician that gets woken up incessantly at night by paranoid, demanding parents for inane, and sometimes life-threatening concerns, and learns how to separate out the two by phone, talking to sometimes far less than intelligent people?

We are just a cog in the machine of healthcare. Hopefully we do our part.

 

[Venko]

ER is no more "God's work" than any other specialty. A smart internal medicine doc who can, Houselike, figure out a complicated patient is invaluable. A surgeon, who can cut out dead-gut without making more dead-gut, and without leaving behind infection is a godsend. Having had to admit patients to terrible surgeons who have subsequently killed them, I would label a general surgeon as a soldier in God's army more than any other specialty. Maybe not a soldier I guess...How about the heavy artillery blasting disease to smithereens?

How about a nephrologist that can keep people's electrolytes in balance for a decade after they should have long been dead? How about a GI doc that can stop pouring GI bleeders? A neurologist that can get a parkinson's patient to walk again?

Come on, a cardiologist, who can turn back the hands of time and the ticking time bomb of bad genes, cancelling out the effects of decades of hard living with a few well placed stents? Incredible. A cardiothoracic surgeon who literally holds your loved one's heart in there hand and puts in new valves? A true miracle. How about the anesthesiologist working with that surgeon who kills the patient and then brings them back to life? Christ-like.

What more valuable than an FP who educates a patient on how to take care of their diabetes, adding literally decades to their life-span? A pediatrician that gets woken up incessantly at night by paranoid, demanding parents for inane, and sometimes life-threatening concerns, and learns how to separate out the two by phone, talking to sometimes far less than intelligent people?

We are just a cog in the machine of healthcare. Hopefully we do our part.

But we are certainly no less a part of "Gods army" and no less impressive.

 

[Birdstrike]

ER is no more "God's work" than any other specialty. A smart internal medicine doc who can, Houselike, figure out a complicated patient is invaluable. A surgeon, who can cut out dead-gut without making more dead-gut, and without leaving behind infection is a godsend. Having had to admit patients to terrible surgeons who have subsequently killed them, I would label a general surgeon as a soldier in God's army more than any other specialty. Maybe not a soldier I guess...How about the heavy artillery blasting disease to smithereens?

How about a nephrologist that can keep people's electrolytes in balance for a decade after they should have long been dead? How about a GI doc that can stop pouring GI bleeders? A neurologist that can get a parkinson's patient to walk again?

Come on, a cardiologist, who can turn back the hands of time and the ticking time bomb of bad genes, cancelling out the effects of decades of hard living with a few well placed stents? Incredible. A cardiothoracic surgeon who literally holds your loved one's heart in there hand and puts in new valves? A true miracle. How about the anesthesiologist working with that surgeon who kills the patient and then brings them back to life? Christ-like.

What more valuable than an FP who educates a patient on how to take care of their diabetes, adding literally decades to their life-span? A pediatrician that gets woken up incessantly at night by paranoid, demanding parents for inane, and sometimes life-threatening concerns, and learns how to separate out the two by phone, talking to sometimes far less than intelligent people?

We are just a cog in the machine of healthcare. Hopefully we do our part.

Nothing about my post was intended to compare specialties, to downgrade any other specialty, or any other legal occupation for that matter, all of which contribute to society in their own way.

My post (http://forums.studentdoctor.net/showpost.php?p=11014279&postcount=22) is a Tribute to Emergency Medicine and the people who dedicate their lives to practicing it, and also a counterbalance to the poster who said he was "losing perspective on EM". The field is special, it is incredibly difficult to do well, has unique demands and challenges and you should not sell yourself short, or apologize, for practicing it well. Ever.

You may not want to here it, but I know somebody out there needs to hear it.

For all the negativity on this forum, by myself and others about the downsides of the specialty I think the specialty and the people performing it, and who have performed it, deserve a tribute. It doesn't surprise me that you and others will downplay this. I am one of you. I understand the modest, un-assuming way people in the ED conduct themselves. Again, it is another tribute to the specialty, that those who are the subject of the compliment shrug it off. I've heard it before, in the trenches, on the from lines: "It's easy....it's no big deal.....that's why "they" get paid the big bucks...I'm just an ER doc".

What doctors in the ED do, is incredibly difficult, and is amazing. I see it from my partners every day. It doesn't need to be compared to other specialties, weighed against what others do, distilled and broken down into meaningless parts. The field is incredibly difficult to perform well. It is special. It is amazing and deserves its own tribute.

We don't get a second chance to make a life saving diagnosis. We don't have the luxury of being able to focus on one tiny little sliver of Medicine. We don't have the luxury of being able to perform our craft when we're feeling our most rested, and at the hour most convenient for the others in our lives. They don't let us use the retrospectoscope which some others rely on to look and feel superior. We don't have the luxury to pick and choose which patients are best for us, our practice and our schedule. Time is not on our side. Yet we soldier on, and expect no "thanks". That is pretty amazing in today's world, as far as I'm concerned.

I think keeping these things in mind, will help someone who's "losing perspective on EM", keep perspective on EM.

Pertinent question: Are you still leaving EM for another specialty?

You might ask, "How can you write these things if your thinking about leaving the specialty?"

Because that whole process has allowed and required me to evaluate what I'm leaving, or might be leaving. That process has made me realize how amazing that which we do, is. It is true that I am leaving the daily practice of EM, for a least a year, maybe permanently, or partially. Does that diminish any of the above? No. Does that diminish all that which I have accomplished, or my pride in all that I've done in the ED? No. Will that diminish what I think of those who'll still be in the trenches doing "God's work"? No. In fact it makes me even more appreciative and amazed.

If I wreck my car at 3 a.m. on New Year's eve - I know one of you has got my back.

If I sink into delirium with meningitis, no matter what day, what hour, what holiday it is - I know one of you has got my back (literally).

Now, some of you have asked what I'm going into, as if I've discovered something new (I haven't) or as if I've found something better (no, just different). I have not posted much about it because for one, I'm still practicing EM full time and haven't started anything new yet. Secondly, I have no "sour grapes" about what will always be my core specialty and I don't want anything to be incorrectly perceived as gloating about "the grass being greener" (it's not always). Third, I don't even know if the move I'm making is the right one. I know some of you are looking for career advice, so I don't want to mislead. It could be the worst decision of my life, or the best, who knows? When I'm in it (which will be soon), and I can speak about it with authority and from experience, I will.

If, and when, I have left the daily practice of EM for good, I will be it's biggest supporter and cheerleader as long as I'm around.

 

[jd221b]

Thanks for sharing. Personally, I'm paying attention to your posts and where your headed for some perspective on the permanence of the specialty I will eventually choose. Being a non-traditional student I'm very conscious of career boredom and want to avoid it if possible. Knowing there are options and what they are makes it a little easier. FWIW I've worked in the ED before as a tech and have nothing but the utmost respect for you guys. Good luck wherever the path may lead you.

Nothing about my post was intended to compare specialties, to downgrade any other specialty, or any other legal occupation for that matter, all of which contribute to society in their own way.

My post (http://forums.studentdoctor.net/showpost.php?p=11014279&postcount=22) is a Tribute to Emergency Medicine and the people who dedicate their lives to practicing it, and also a counterbalance to the poster who said he was "losing perspective on EM". The field is special, it is incredibly difficult to do well, has unique demands and challenges and you should not sell yourself short, or apologize, for practicing it well. Ever.

You may not want to here it, but I know somebody out there needs to hear it.

For all the negativity on this forum, by myself and others about the downsides of the specialty I think the specialty and the people performing it, and who have performed it, deserve a tribute. It doesn't surprise me that you and others will downplay this. I am one of you. I understand the modest, un-assuming way people in the ED conduct themselves. Again, it is another tribute to the specialty, that those who are the subject of the compliment shrug it off. I've heard it before, in the trenches, on the from lines: "It's easy....it's no big deal.....that's why "they" get paid the big bucks...I'm just an ER doc".

What doctors in the ED do, is incredibly difficult, and is amazing. I see it from my partners every day. It doesn't need to be compared to other specialties, weighed against what others do, distilled and broken down into meaningless parts. The field is incredibly difficult to perform well. It is special. It is amazing and deserves its own tribute.

We don't get a second chance to make a life saving diagnosis. We don't have the luxury of being able to focus on one tiny little sliver of Medicine. We don't have the luxury of being able to perform our craft when we're feeling our most rested, and at the hour most convenient for the others in our lives. They don't let us use the retrospectoscope which some others rely on to look and feel superior. We don't have the luxury to pick and choose which patients are best for us, our practice and our schedule. Time is not on our side. Yet we soldier on, and expect no "thanks". That is pretty amazing in today's world, as far as I'm concerned.

I think keeping these things in mind, will help someone who's "losing perspective on EM", keep perspective on EM.



You might ask, "How can you write these things if your thinking about leaving the specialty?"

Because that whole process has allowed and required me to evaluate what I'm leaving, or might be leaving. That process has made me realize how amazing that which we do, is. It is true that I am leaving the daily practice of EM, for a least a year, maybe permanently, or partially. Does that diminish any of the above? No. Does that diminish all that which I have accomplished, or my pride in all that I've done in the ED? No. Will that diminish what I think of those who'll still be in the trenches doing "God's work"? No. In fact it makes me even more appreciative and amazed.

If I wreck my car at 3 a.m. on New Year's eve - I know one of you has got my back.

If I sink into delirium with meningitis, no matter what day, what hour, what holiday it is - I know one of you has got my back (literally).

Now, some of you have asked what I'm going into, as if I've discovered something new (I haven't) or as if I've found something better (no, just different). I have not posted much about it because for one, I'm still practicing EM full time and haven't started anything new yet. Secondly, I have no "sour grapes" about what will always be my core specialty and I don't want anything to be incorrectly perceived as gloating about "the grass being greener" (it's not always). Third, I don't even know if the move I'm making is the right one. I know some of you are looking for career advice, so I don't want to mislead. It could be the worst decision of my life, or the best, who knows? When I'm in it (which will be soon), and I can speak about it with authority and from experience, I will.

If, and when, I have left the daily practice of EM for good, I will be it's biggest supporter and cheerleader as long as I'm around.

 

[Raggaman]

A non-EM resident here. I am one of those that love to rip on the EM docs, but having worked in the ED myself as a student and intern I know how hard it can get. Seeing 20-30 dizzy/abdominal pain/chest pain patients a shift is hard work. A few are bound to slip by and a specialist consult be placed for what the specialist might consider "BS". Of-course there are good and bad EM docs just like every specialty. There are those who basically just act as triage and others who know how to weed out the "BS" pathology and consult when the problem is beyond their scope. So to answer the OP, EM is a great field in which competence in essentially every field of medicine is required, which is not easy. The ones who master this skill are appreciated by every specialist in the hospital, the others not so much. Great lifestyle and pay are also the positives, just don't expect to become a world renowned expert as you will be a jack-of-all-trades.