Questions to ask while shadowing ER doc

[dutchie000]

Hey guys!

I'm shadowing an ER doctor tomorrow in a Level 1 trauma center. I've already seen some good questions in other threads to ask, but I was wondering if anyone had any ideas. I am coming at 0600 so I'm sure there won't be much going on then and it'd probably be a great time to ask questions before it picks up in there.

Thanks 🙂

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[Goro]

Why Medicine as a career?

Why ER as your specialty?

Would you do the same thing all over again?

Why school ___ as your medical school?

How do you remember all the stuff you've learned?

Any advice for me?

Hey guys!

I'm shadowing an ER doctor tomorrow in a Level 1 trauma center. I've already seen some good questions in other threads to ask, but I was wondering if anyone had any ideas. I am coming at 0600 so I'm sure there won't be much going on then and it'd probably be a great time to ask questions before it picks up in there.

Thanks 🙂

 

[medickdb]

Hey guys!

I'm shadowing an ER doctor tomorrow in a Level 1 trauma center. I've already seen some good questions in other threads to ask, but I was wondering if anyone had any ideas. I am coming at 0600 so I'm sure there won't be much going on then and it'd probably be a great time to ask questions before it picks up in there.

Thanks 🙂

Yeah, Sunday mornings are usually pretty slow in my experience. Things don't pick up until around 10 AM, so you should have plenty of time to ask questions.

Beyond Goro's questions, I would ask about his thought process in medical decision making. You can see how it differs from how we think in EMS.

 

[dutchie000]

Yeah, Sunday mornings are usually pretty slow in my experience. Things don't pick up until around 10 AM, so you should have plenty of time to ask questions.

Beyond Goro's questions, I would ask about his thought process in medical decision making. You can see how it differs from how we think in EMS.

He is on the main side though so it has the potential to get interesting 🙂 The citizens of this city are just going to bed around 6am haha.

True, and he was a medic for 5 years before going to medical school so I'm sure he will have a lot to say about how he made decisions before he was a doctor and his thought process now.

 

[abolt18]

Money. Always ask about $$$

Joking by the way.

 

[Strudel19]

To be honest, it can be tough to plan out questions like that. Some of them really won't be into questions, some might not want you in the way, etc. I would just wing it.

 

[WhyDoWeFall]

Just in general, don't forget to ask things about his tests AFTER you walk out of the panel. The Attendings always gave me a quick run down but if I didn't understand the basic "why" he is doing something I would always ask. I felt like I got more out of the experience that way and the Attendings could see I was interested. Have fun!

 

[radian313]

If you have any healthcare experience or knowledge about disease processes, you can ask questions like, what is your process of diagnosing a STEMI? Is it based off of just Troponins, CK-MB, and or an ST elevation on a EKG? (Some people dont know all this), I only mention it because the ER docs I work with, love it when a student knows his stuff and they reciprocate very well then to answering more questions....

 

[keels99]

Level 1 Trauma Center quiet in the morning? Not in our city.

 

[radian313]

Level 1 Trauma Center quiet in the morning? Not in our city.

hahaha I work in a Level 1 trauma center too.....you must be from Newark, NJ ;-)

 

[keels99]

hahaha I work in a Level 1 trauma center too.....you must be from Newark, NJ ;-)

Springfield, MO

 

[radian313]

Springfield, MO

Just messing with ya....thats awesome.....ER is the place to be....

 

[Beth_W737]

As a soon to be ED Intern (next month), I do NOT expect you to know about STEMIs and Troponin levels. I don't expect premeds to know anything medical. Don't ask while in the room with the patient unless doc asks you to, wait until after. Be careful not to ask too many questions if its crazy busy. Have fun and get a glimpse what life is like. Good luck!

 

[OPPforlife]

If you have any healthcare experience or knowledge about disease processes, you can ask questions like, what is your process of diagnosing a STEMI? Is it based off of just Troponins, CK-MB, and or an ST elevation on a EKG? (Some people dont know all this), I only mention it because the ER docs I work with, love it when a student knows his stuff and they reciprocate very well then to answering more questions....

DO not ask this! Do not ask any thing remotely medically related if you don't have a good understanding of it. You may look like an idiot and that can be very off putting. Case in point, diagnosing Stemi has nothing to do with trop...something you will not know as a premed. But if you were to ask this question you would look like a complete idiot.


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[radian313]

DO not ask this! Do not ask any thing remotely medically related if you don't have a good understanding of it. You may look like an idiot and that can be very off putting. Case in point, diagnosing Stemi has nothing to do with trop...something you will not know as a premed. But if you were to ask this question you would look like a complete idiot.


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Ummm it was merely a suggestion, that if one does have sufficient knowledge, it is worthwhile to state your question like "what are some necessary tests to dx an MI etc or even rule out.....would you use an iSTAT analyzer for troponins or just having an EKG with a ST elevation enough to activate Cath lab?",

FYI....I am a medical student....2nd year, but transferring to a different one, and to answer your question.....cardiac markers such as CK-MB, Troponins T and I ARE used to measure muscle injury.....atlthough some doctors argue the specificity and sensitivity of these markers, it is still used in common practice as part of the diagnosing process (i.e. LDH is no longer used as a useful cardiac marker). Not to start an argument by any means, you are well entitled to your opinion, but like many of us, and ofcourse you, we've all had our share of clinical exposure....including being EMTs and medical students.

source: http://content.onlinejacc.org/article.aspx?articleid=1127469

Thanks for your concern though. Have a great day.

And to the OP, I wish you well in your endeavors....and hope have a great outing in the ED....

 

[dutchie000]

Ummm it was merely a suggestion, that if one does have sufficient knowledge, it is worthwhile to state your question like "what are some necessary tests to dx an MI etc or even rule out.....would you use an iSTAT analyzer for troponins or just having an EKG with a ST elevation enough to activate Cath lab?",

FYI....I am a medical student....2nd year, but transferring to a different one, and to answer your question.....cardiac markers such as CK-MB, Troponins T and I ARE used to measure muscle injury.....atlthough some doctors argue the specificity and sensitivity of these markers, it is still used in common practice as part of the diagnosing process (i.e. LDH is no longer used as a useful cardiac marker). Not to start an argument by any means, you are well entitled to your opinion, but like many of us, and ofcourse you, we've all had our share of clinical exposure....including being EMTs and medical students.

source: http://content.onlinejacc.org/article.aspx?articleid=1127469

Thanks for your concern though. Have a great day.

And to the OP, I wish you well in your endeavors....and hope have a great outing in the ED....

Thank you!! 🙂 It was a good time, that's for sure. I wish I'd seen all these suggestions before I went in, but for some reason I stopped getting notifications about them. I did ask questions related to diagnostic tests because I am a medic and I've had exposure to the ED environment. The doc was great about letting me look at 12-leads, give my interpretation, and then he would throw in some stuff that wasn't covered in medic school.

Anyway, I asked whatever popped into my head. Maybe some of them sounded dumb, but you have to start somewhere. I asked a lot about family life and how his previous medic experiences help him/hinder him in the ER. I hope that if/when I become a doctor I will be able to allow students come in so they can ask all the burning questions they might be too afraid to ask others.

Thank you all for the advice and the well wishes 🙂 I'm lucky that these docs allow me to come follow them around all day and hearing patients and their gratitude toward the physicians really reinforces my career choice.

 

[radian313]

Thank you!! 🙂 It was a good time, that's for sure. I wish I'd seen all these suggestions before I went in, but for some reason I stopped getting notifications about them. I did ask questions related to diagnostic tests because I am a medic and I've had exposure to the ED environment. The doc was great about letting me look at 12-leads, give my interpretation, and then he would throw in some stuff that wasn't covered in medic school.

Anyway, I asked whatever popped into my head. Maybe some of them sounded dumb, but you have to start somewhere. I asked a lot about family life and how his previous medic experiences help him/hinder him in the ER. I hope that if/when I become a doctor I will be able to allow students come in so they can ask all the burning questions they might be too afraid to ask others.

Thank you all for the advice and the well wishes 🙂 I'm lucky that these docs allow me to come follow them around all day and hearing patients and their gratitude toward the physicians really reinforces my career choice.

That's great to hear. Glad you had a good day. 🙂

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[Beth_W737]

Glad it went well

 

[medickdb]

If you have any healthcare experience or knowledge about disease processes, you can ask questions like, what is your process of diagnosing a STEMI? Is it based off of just Troponins, CK-MB, and or an ST elevation on a EKG? (Some people dont know all this), I only mention it because the ER docs I work with, love it when a student knows his stuff and they reciprocate very well then to answering more questions....

Well to be fair, a STEMI is based off of ST elevation in two or more contiguous leads with reciprocal changes after being compared to prior EKGs if available. So, that would need to be present for diagnosis. You couldn't just base it off of labs even though getting them is a good idea. The other poster was right in that you don't need a trop to diagnose it, but the two, ST elevation and elevated trop, are certainly not unrelated as he or she states. EMS can often bypass the ED and activate the cath lab if this and other criteria are met (SOB, altered mental status, hypotension, etc.). NSTEMI is diagnosed off of cardiac labs as well as patient history and presentation. The EKG can look completely normal. Then, there are concerning precursor syndromes such as Wellens', etc. But, I get what you're saying in that there are multiple factors to determine the location and extent of myocardial ischemia, injury and/or infarct.

 

[radian313]

Well to be fair, a STEMI is based off of ST elevation in two or more contiguous leads with reciprocal changes after being compared to prior EKGs if available. So, that would need to be present for diagnosis. You couldn't just base it off of labs even though getting them is a good idea. The other poster was right in that you don't need a trop to diagnose it, but the two, ST elevation and elevated trop, are certainly not unrelated as he or she states. EMS can often bypass the ED and activate the cath lab if this and other criteria are met (SOB, altered mental status, hypotension, etc.). NSTEMI is diagnosed off of cardiac labs as well as patient history and presentation. The EKG can look completely normal. Then, there are concerning precursor syndromes such as Wellens', etc. But, I get what you're saying in that there are multiple factors to determine the location and extent of myocardial ischemia, injury and/or infarct.

You are correct sir/ma'am 🙂