no offense) but I'd like to hear from some people that hate pain and specifically what they hate about it. I think it would be educational for all of us in EM to hear both sides of the argument as we get a lot of posts in here singing praises about pain medicine and rarely get to hear the other side of the coin.
Go read up in the pain medicine part of the forum. Its pretty active and has a nice variety of view points - employed, PP, no opioids period, opioids prescribed judiciously, retired, just out of fellowship.I feel like I just walked into the bathroom to take a leak and a bunch of guys are standing there with their johnsons out...but nobody is interested in actually using the bathroom except me, so I'm nervously shuffling around them to get to the urinal...and then get out as quickly as I can. Can we just do away with the "I'm better than X,Y,Z" discussions? I think EM is a great addition to pain and we bring our own strengths, but I've never been under any confusion about the fact that pain medicine evolved from the field of anesthesiology. It's difficult to make an argument that a fellowship is better served by a specialist -outside the specialty- that actually created the field in the first place. I mean, I'm all for zeal...but c'mon guys. We're probably 2nd best pick for the field outside of gas. Regardless, the sandbox is plenty big for multiple specialties and I'm just glad it's an official fellowship now.
However, that's not the point of my post....
I've heard a few anesthesia guys on here mention that they hated pain. Do you guys care to elaborate what you hate about the specialty? For someone in EM who occasionally gets burned out and entertains the thought of jumping into something else for a day or two and then snaps out of it... I'd be curious. Birdstrike is the perfect Tony Robbins for the specialty (love ya Bird
So, what's so bad about pain? Let's hear it.
We're the 1st and best qualified. Period.
I don't think anyone's keeping any secrets for you on this. The patients can be very, very challenging. Clinic days can be boring. It would be better if we didn't have a million DEA rules to follow on the medication side, to prescribe even occasional low dose opiates to 95 year olds, to keep the regulators happy. But that's about it.
Since when has anyone hesitated to trash their own specialty on their own specialty forum when there was good reason? If anything, the negatives are magnified. There's not a ton of Derm bashing on the Derm forum, for a reason. That there's less self specialty loathing in certain forums has to tell you something, doesn't it?
That's totally fine. We like what we like. If it's not your bag, that's cool. I just don't want people not to consider it because they either don't know it's a thing, or think they're not good enough. Because they are good enough. More than good enough.
Is the EM patient population the type of patient you enjoy working with every day?
Nothing personal taken. We all have to find our own best path, our own way, as you have yours.
I feel like I just walked into the bathroom to take a leak and a bunch of guys are standing there with their johnsons out...but nobody is interested in actually using the bathroom except me, so I'm nervously shuffling around them to get to the urinal...and then get out as quickly as I can. Can we just do away with the "I'm better than X,Y,Z" discussions? I think EM is a great addition to pain and we bring our own strengths, but I've never been under any confusion about the fact that pain medicine evolved from the field of anesthesiology. It's difficult to make an argument that an original fellowship of anesthesiology is much better served by a non anesthesiologist. I mean, I'm all for zeal...but c'mon guys. We're probably 2nd best pick for the field outside of gas. Regardless, the sandbox is plenty big for multiple specialties and I'm just glad it's an official fellowship now.
However, that's not the point of my post....
I've heard a few anesthesia guys on here mention that they hated pain. Do you guys care to elaborate what you hate about the specialty? For someone in EM who occasionally gets burned out and entertains the thought of jumping into something else for a day or two and then snaps out of it... I'd be curious. Birdstrike is the perfect Tony Robbins for the specialty (love ya Bird
So, what's so bad about pain? Let's hear it.
It is
There’s a lot I can do to help people in chronic Pain, because I did the training. And for those for whom there is nothing, I don’t spend much time at all, telling them that. I just say it and I’m done. Like a surgeon, quick, painless. And it’s over. I’m a consultant. I’m not their PCP, therapist and not a miracle worker. Some people can’t be helped.
2 basic reasons. One, history. EM is a newcomer to pain. Birdstrike has gone over this part at length. Second, pain isn't just procedures. There is a very heavy psych component to many chronic pain patients which both Neuro and psych do a lot of in residency. Also, doesn't Neuro do a decent bit of procedures - EMG/NCS, LPs that would translate to pain pretty well?
EM is the best background for a fellowship in pain medicine of any specialty.
Emergency physicians are exposed to a tremendous amount of psychopathology in the ED. In fact, Emergency Departments are the virtual Hoover Vacuum of psychopathology. We suck up all the worst of it. Go walk through an ED at 3 am on a Saturday look around. Hell, you don't even have to look around. Just close your eyes and listen. If you don't see, smell and hear psych exploding through the curtains and walls, you need to check your senses.
Emergency Physicians, even before modern EM residencies and the title, have been taking care of patients in pain for thousands of years, since the days Hippocrates in ancient Greece in 400 BC. And that's all types of pain, not just peri-surgical/peri-anesthesia related pain, which is only a tiny sliver of types of pain and didn't even exist pre-mid 1800's.
You're losing it again. Just because you see a lot of acute psych doesn't come close to making you the equal at psychiatric disease in general to a psychiatrist and doubly so for chronic psych.
I meant the subspecialty of pain management.
No one is arguing that EPs are bad at anything (or at least I'm not). Pretty sure I even said I think more EPs going into pain management is a great idea.
I don't think any of them are the best. Each field brings its own strengths to the field but I don't see how any particular one can be unequivocally "best"
I don't see why not. In fact, I know someone who combines both. He did for a while anyways. I'm not sure if he still does.
I think if you prescribe a few opiates as possible, follow all state and federal regulations and recommendations (including CDC) and do what's reasonable and right for the patient, you don't have much to worry about. I don't think prescribing opiates without examining patients and prescribing opiates to patients who've used them to attempt suicide before, without even having them see psych, fits into that box. I could go through a long post about risk reduction in opiate management, but it would bore you to death. A little bit of common sense and an insistence on sticking to your guns goes a long way.
Find a way to take (or make for yourself) and elective Interventional Pain rotation so you can get some experience in fluoroscopic-guided procedures, even if you have to extend your residency a month or even you have to squeeze a couple of weeks if somewhere. An alternative would be to do the same, but with an interventional radiologist who does spine injections. If you can't manage either one of these, shadow somebody in your free time. If all else fails, pay to do a spine-injection course held by either ASIPP or SIS, so you can get hands on experience doing fluoro-guided procedures on cadavers. Ask for the resident and fellow discount (often 50-75% off). Of course, shadowing is free. Call a local interventional Pain MD or two and spend some off time, following them around. It's amazing what you'll learn.
