tzenmaster12

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Hi,
I work in a non american set up. i have worked in many departments. I had been thinking of pursuing this field as my boss has been very encouraging.

PROS:
1. no ward rounds
2. less hierarchy, less politics, less need to run errands for various bosses
3. flexible working hours
CONS (overwhelming me now):
1. rude ward doctors. when referring a case, having to endure lots of insults from them (they think all ED docs have shallow knowledge). There are cases with normal labs/vitals but clinically you know they need to be reviewed, but the ward docs sit crossed legged in their wards and expect to settle the case via 'telemedicine' rather than coming and seeing the patients. When working in a stressful environment, these insults really ratchet up the tension.
2. violent patients - encountered 3 over the past month. What do you do when a HIV drug addict on withdrawal is waving a scissor at you? the guards usually come late and are clueless..tranqulizer gun? If any damage occurs to the patient, their family will sue you, but if you are incapacitated, can you sue the addict's family?
3. The politicians promise 30 minutes waiting time to the public, but they do not provide adequate staff. So, the patient's kick the door and claim the doctors are sleeping (happened quite a few times) They make complaints if their demands are not met. A refused sick certificate caused one patient to accuse the doctor of playing video ganes in the hospital computer. The system is 'negative' based. You can treat 100's of patient with speed and quality, but if even one patient complains (delayed labs, delayed diagnosis) - the hospital director/ media will be all over you - but with most of these allegations being false, much time is wasted writing explanation letters/ attending committe hearings. We are not allowed to counter sue the media/ patient for wasting our time/ causing stress as the politicians are scared of antagonizing the media/ public perception..
4. It's weird the way people place value on things. You save the life of an assault victim who is HIV positive, and nobody bats an eyelid. You're lucky if someone says thanks, but do a nose job - you make millions and get accolades..superstar plastic surgeon (notice the lifestyle of docs in ER versus Nip/Tuck...mere movie stereotyping? You can be an astrologer making $$, but customers can't sue if your prediction is wrong. You can open a pub, and the guy who met an accident after drinking at your pub won't sue you, but the brightest in our society who sacrifice thier youth to care for the sick gets sued for 'negligence' - they forget doctors are humans, therefore high insurance premiums/ high patient charges - people don't know how to value the important things...

So although the ward rounds are a bore (even ED have started ward rounds now) and hierarchies stifling, Why not be a ward doctor who can bark orders through the phone, lay back and retrospectively laugh at the wrong diagnosis the ED doc made under stress/time pressure (monday morning quarterbacks) and take the credit when a thankful patient gets discharged - when the ED doctor got the right diagnosis/ stabilized this patient who walked into the ER with aggresion secondary to drugs 3 days ago.. Tell me guys, why should i pursue this field? (PS ..you guys are lucky to get 4 days off, we'll be lucky to get 4 days off in a month, with half workdays on post call days - staff shortage..)
 

GeneralVeers

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2. violent patients - encountered 3 over the past month. What do you do when a HIV drug addict on withdrawal is waving a scissor at you? the guards usually come late and are clueless..tranqulizer gun? If any damage occurs to the patient, their family will sue you, but if you are incapacitated, can you sue the addict's family?

Where can I get one of those tranquilizer guns?
 
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WilcoWorld

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You only saw 3 violent patients in a month?!?! I saw that many last night.

All the downsides you mention are true. Just as I don't try to convince young students to go into medicine, I wont try to convince you to practice EM. They are both callings, and if one needs convincing, one should probably reconsider...
 

notdeadyet

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tzenmaster12- if your personal cons outweight your personal pros, you should stick by your guns and go with your gut.

I don't think anyone will argue your feelings. I think convincing anyone to pursue a particular specialty is a very bad idea. If it's not right for you, it's not right for you. Investigate other specialties more to your liking.
Why not be a ward doctor who can bark orders through the phone, lay back and retrospectively laugh at the wrong diagnosis the ED doc made under stress/time pressure (monday morning quarterbacks) and take the credit when a thankful patient gets discharged
I'd do a little more homework into being a ward physician. If you're seeing nothing but roses working the wards, you might have unrealistic expectations. Even folks who eat that life up see a lot of negative in it. If you don't, you might want more exposure.

Best of luck to you...
 

howelljolly

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Sounds like more of a vent, than solcitiing opinions on what the OP should do. But the issue of liability is something to think about. Thanks for the pearl.
 

notdeadyet

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Sounds like more of a vent, than solcitiing opinions on what the OP should do.
He started out with "I had been thinking of pursuing this field" and ended it with "Tell me guys, why should i pursue this field?"

Sounds more like soliciting opinions and justifying not pursuing EM than it does venting.
 

biophysicianai

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He started out with "I had been thinking of pursuing this field" and ended it with "Tell me guys, why should i pursue this field?"

Sounds more like soliciting opinions and justifying not pursuing EM than it does venting.

pwned
 

howelljolly

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Eh, the way I read it, the OP is already an ER physician somewhere on the planet........ overseas and considering coming to the US for EM residency, or IM/FP in an ER in the US who has other options.... and is/was pretty committed to it.
I thought the "Tell me guys, why should i pursue this field?" at the end was a rhetorical question out of frustration. I hear attending EM physicians say "I should have gone into real estate, I-banking, plastics, derm, pro-sports...", out of frustration, when they really are committed to EM.
The OP already knows the advantages of EM, and isnt asking us what they are.

Whatever.
 

Frogmed

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It seems like your pros/con are more during training and not while practicing (with the exception of violent patients). It doesn't matter which specialty you choose, residency sucks.

Rounds: When practicing, unless you are in acdemics or a hospitalist, rounds are minimal and don't seem as painful as in training. Choosing EM because of this, isn't going to get you through the bad times.

Hierarchy: I've never seen an attending run errands for anyone in any specialty. There is hierarchy & politics in every specialty, including EM. The politics of running a private practice have many docs wishing they chose and changing to EM. EM docs have to convince other specialties to admitt their patients. Everyone hates it when the EM doc calls b/c it means work.

Rude ward doctors: Every insecure person, in any specialty, will dog another specialty. I've heard EM docs cut down other specialties. They're dic*s and you just have to put up with ******s. To be an excellent EM physcian (which we all strive to become) you must know it all. You have to be able to listen, do an excellent PE, DX, & Tx. Everyone knows that tests should only confirm what you have dedused by the Hx & PE. As far as tx, many illnesses are treated in the ED or the treatment is started if the pt will be admitted. Other docs running down EM is just a testamony to their ignorance of our specialty and just makes them look very stupid. If a pt needs surgery, we dx and get things started. We don't do the surgery, so what!

violent patients: This is everywhere. If you don't want violent pts then choose a hospital that doesn't have many of them. It is the same as if you are an IM doc, you choose your patient population. There is less control in the ED b/c you don't discriminate and you do treat everyone, but you can choose a place that keeps it at a minimum. I have done rotations at ECU (NC), UTSW (Dallas), & Presby (OKC). I haven't seen a single violent patient.

Why should you choose this field: If you want to sit back, bark out orders over the phone and laugh at everyone who offer a wrong dx, then don't choose this specialty b/c I really don't want to work with you (and I also hope you decide to get out of medicine). But, if you want to serve the public, do your best to help people in an acute situation or in a down-n-out situation, and offer the very best care you can, then this is the job for you. It even has its perks of predictable hours (when you are off, you are off), endless job possibilities (hospitals, sporting events, entertainment events, cruise lines), and benefits (salary, bonus, retirement, mal practice, little paper work, job security without overhead). I really don't see the problem.

The bottom line is do what you love, do your best, do the right thing and be nice. That should carry you through to the end of your life.
 

howelljolly

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Nah, I just thought howelljolly read it wrong. No biggie.

Ive gotta stop doing that.
Its a byproduct of being on the SDN too much.

Im +ve on C,G and E for the CAGE questionaire regarding the SDN
 

Blahblahologist

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Aw jeez-- he's going to jump off the ER? Has "Scrubs" not taught us anything?

Dr Cox: You keep going down this road, you're gonna go up to the roof of this hospital and jump the hell off. Mind you, it's only five stories high, so that means you'll just wind up back down here, where I, of course, will be the one who has to treat you, and then I'll be forced to jump off the roof of this hospital, which, as I was suggesting to you, is only five stories high, and are you starting to see a pattern forming here?
 

Drawing Dead

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To address the OP's cons to EM:
1- Kill them with kindness. When that doesnt work, ask them if they are declining the admission. If so, you offer it to the doctor on call or place a call to the administrator on call. Not that hard to get around
2- Violent patients entertain me. My first student rotation was a 110,000 visit county ED where at least one in 10 patients came in on crack/PCP/amphetimines or a combination +/- a pysch disorder, and about a third of which with HIV. I enjoyed their arrival because it broke up the monotony of yet another female abdominal pain or chronic back pain looking for narcs. And they didn't use tranq guns, but haldol/ativan/benadryl worked just fine. I miss those days, now that am where I am.
3- The people that complain about wait time are the ones that shouldn't be there, clogging up the ED in the first place, and I let them know that. As much as your chronic sinus headache hurts, you will live. Now go to the drug store and buy some OTC tylenol sinus.
4- I never went into EM, or medicine in general for the vanity or money, or any of the other accolades. I feel sorry for anyone who did. And you mention TV, are you kidding me? I hate tv doctor shows (with the exception of Scrubs, which is the most realistic of them all) because I feel that overall they give the public a bad perception of physicians. And yes, bar owners do get sued when someone was drinking at their establishment and crash.

I agree with WilcoWorld. I would never try to convince anyone to go into medicine or EM either. I'm just glad it's a field that I fit into perfectly, because I don't think I would have been able to do any other specialty. And when that ward physician is busy rounding on my patient that he thought was a bs admit now that the patient is stable and looks a lot better now than when they presented to the ED thanks to the EM doc, filling out his stack of paperwork to DC the patient, I'm hitting snooze on my alarm baby....
 
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