satisfaction in em

[2nd year]

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I'm just curious to hear from any attendings or residents. Do you get much personal satisfaction in emergency medicine without having significant relationships with patients? Also, do you provide much significant definitive care in the ed?

 

[docB]

Troll?

 

[roja]

I'm just curious to hear from any attendings or residents. Do you get much personal satisfaction in emergency medicine without having significant relationships with patients? Also, do you provide much significant definitive care in the ed?

Yup

 

[Febrifuge]

I dunno... I think maybe not a troll, just a student who is new-ish to online communication, definitely hasn't read a ton of this particular folder, and doesn't see how terse and potentially offensive he/she sounds.

2ndYear: If I understand you correctly, i think you're making some assumptions (i.e., 'significant relationships' can't happen in the ED, those significant relationships are key to job satisfaction, 'definitive care' is somehow antithetical to emergency care). I think you'll get better answers from residents and attendings if you sort out those assumptions from the core of your question. I doubt too many of them will accept these ideas as givens, the way you've presented them.

From the ED tech/ future practitioner angle, I'll say this:

- Personal satisfaction comes from doing one's job well. Patient interaction is a big part of that, but not the only part. And think of it this way: if you interact with 35 patients in a shift, maybe you get more of 'significant' interaction than in an ICU where you have 12 patients and 3 of 'em are awake, know what I'm sayin'?

- If I had an asthma attack so bad I needed to be tubed, and some doc helped me out, I'd consider the relationship a significant one, and I'd call the care pretty definitive. Conversely, the provider who diligently manages my meds for 36 months until a magic lab value comes back doesn't exactly prompt a "holy crap, doc, that was AWESOME! Thank you!"

- Plus, when I think about how 'significant' my relationship is with the FP doc I see once a year, ehhhh. I ask him how it's going, he asks me about school, he tells me to lose 10 pounds. Not exactly a Daniel and Mr. Miyagi situation there, either.

 

[Febrifuge]

"yup" was the more ED-appropriate way to answer that question. This is a teaching point, actually: observe the difference between a resident and a student on break...

 

[EctopicFetus]

IMO this is the part that annoys me...

Also, do you provide much significant definitive care in the ed?

Febrifuge has it right I dont have a "relationship" with my primary and neither does my wife. Sure their chart is a little fuller of my medical info but I dont send Xmas cards to him and he doesnt send them to me.

The definitive care thing is interesting! I wonder what the assumption is that we do down there? We save the world from seeing their primary doc as docB's sig says. I know this has been beaten like a dead horse twice over so I wont get into it all again..

But many people come in sick to the ED, we turn them around and ship them upstairs, think DKA.. they are 99% better by the time their ICU bed opens up (at least where I have been).

To answer your Q, yeah we develop "sginificant" relationships, heck we even sometimes develop long term relationships (not by choice 🙂) and we def provide definitive care.

 

[nadeem]

Yes, i do, luv EM. I think we're very blessed to take care patients who are literally dying or patients who are there for routine primary care stuff. Not to worry about insurance mumbo jumbo. I do sometimes am curious about what happens to some of my patients when they get discharged from the ED or go up to the ICU. If they are upstairs & i have the time, i look them up on the system and if home, i do make calls to find out how they are doing.

Ahmed

Ahmed Nadeem DO PGY-2
MWUCCOM EM Residency Program

 

[NinerNiner999]

I went into EM because I hate people, I despise medicine, and I really don't ever plan on making someone healthier - ever. I want to make other consulting services do all of the work for me, I get scared whenever someone really sick comes in becuase I don't know what to do. In fact, I usually don't even bother working up my "patients," I just find the first thing that is wrong with them and call the closest consultant I can think of (with my limited knowledge base) to run down to the ED and fix them for me. Sometimes I even make things up on the phone to get them down faster, like "This patient needs to be seen right away before I tube them and make their neuro exam impossible," or "This patient has toe pain, and needs to be admitted to your service because they are REALLY diabetic." My favorite thing to do is to pretend like I'm actually looking up labs on the computer and make them wait - sometimes in the room, sometimes in the waiting room, and, if I'm having a really good day, I may even get the ED put on divert so nobody else comes in. These fancy people come into the ED wearing their white coats and speaking jibber jabber to me like I know what they are really saying. Truthfully, I just fire away a few labs, write down what the computer says, and nod my head with them so they think I know what I'm doing. After all, I'm just an ER doc, right? That is me, McFattypants, Doctor Fatty McFattypants, M.D.

 

[roja]

"yup" was the more ED-appropriate way to answer that question. This is a teaching point, actually: observe the difference between a resident and a student on break...

A resident who is essentially starting her felloship 6 months early! My whole weekend is getting sucked up with abstracts, statements, transcripts, etc!

 

[basementbeastie]

double yup/.....

 

[EctopicFetus]

I went into EM because I hate people, I despise medicine, and I really don't ever plan on making someone healthier - ever. I want to make other consulting services do all of the work for me, I get scared whenever someone really sick comes in becuase I don't know what to do. In fact, I usually don't even bother working up my "patients," I just find the first thing that is wrong with them and call the closest consultant I can think of (with my limited knowledge base) to run down to the ED and fix them for me. Sometimes I even make things up on the phone to get them down faster, like "This patient needs to be seen right away before I tube them and make their neuro exam impossible," or "This patient has toe pain, and needs to be admitted to your service because they are REALLY diabetic." My favorite thing to do is to pretend like I'm actually looking up labs on the computer and make them wait - sometimes in the room, sometimes in the waiting room, and, if I'm having a really good day, I may even get the ED put on divert so nobody else comes in. These fancy people come into the ED wearing their white coats and speaking jibber jabber to me like I know what they are really saying. Truthfully, I just fire away a few labs, write down what the computer says, and nod my head with them so they think I know what I'm doing. After all, I'm just an ER doc, right? That is me, McFattypants, Doctor Fatty McFattypants, M.D.

niner you are my secondary hero, you would be primary but turtle has secured that spot. I assume you have seen our shrine to turtle. I do have to admit your posts are prob the most interesting.

Of course to be honest docB's are the most informative.

 

[2nd year]

Honestly, I'm just trying to figure out what I want to do for the rest of my life. I'm in my third year (yeah, I know its not a good sign on name for a 3rd year) and I really enjoy surgery, particularly ortho. I'm worried though that the novelty will wear off and the lifestyle won't be worth it. My wife is a family doc. which isn't exactly the same thing as a stay at home mom. I'm trying to consider all of these things. The thing is I haven't had a chance to rotate in EM yet and I'm trying to decide if I should. I don't have alot of elective time and I'll need lor's from the surgical fields if I decide that is what I want to do. I definitely enjoy interacting with patients and getting to know them some. I find the idea of Surgery to be very satisfying and I'm not sure if I'd get this from EM. That's just it, I'm not sure, maybe I will, maybe I won't. You all seem to have much more experience in the ED so that is why I'm asking. I'm honestly not trying to get under anyone's thin skin. Thanks again.

 

[EctopicFetus]

2nd yr i just think the tone left a little something to be desired. No biggie though.. In EM there is no "surgical" aspect but you do get some procedures. I think EM is a lot like some of the surgical subspecialties. If you think of the amount of time you spend with a pt outside the OR over their rehab (like in ortho) thats prob how much time you will see a sicker person in the ED.

Truth is if you dont know ask someone if you can shadow with them for a day to get a better idea of what it is they really do. I doubt anything anyone on this forum can say will be able to replace a little hands on time. If you are really interested take a Saturday and go shadow.

I hope we can help..

 

[roja]

ditto what EF said. Even before you start your elective time, most people will shadow a few shifts in the ED. Just contact the department, say your considering EM and could you shadow someone a few times to get a feel for what EM is like, even before you spend time doing a rotation.

This is what I did towards the end of my third year. Go down into the ED, say hey, what do you like about your job.

Forums here also help (when we aren't crazy busy).

Shadow a little and then start to decide. If you shadow a few times and you hate the ED, then you have your awnser.

 

[nuke laloosh]

I'm just curious to hear from any attendings or residents. Do you get much personal satisfaction in emergency medicine without having significant relationships with patients? Also, do you provide much significant definitive care in the ed?

From a EM PGY-3...

-Yes. I think everyone finds something about the job from which they derive satisfaction. For me there are several things, including stabilizing a really sick patient, feeling effecient on a busy day, and treating someone who is greatful for it. I am not interested in long term relationships with my patients, I save that for family and friends.

-No, although this is a matter of interpretation. To me, there is very little "definitive care" in Medicine. CHFer: sure got him to pee the fluid out of his lungs but what he needs is a new heart. Asthma: alb and steroids in but the child's mom needs to stop smoking. And so on. If someone has a surgical issue, then clearly the "definative care" will be handled by the surgeon. There are numerous minor procedures for which I am providing "definitive care" such as lac repairs, i&d's, FB removal, etc. By and large, however, what I do is decide sick v. not sick; and then dx, treat, and dispo accordingly. The job is what it is.

Good luck with your decision. Try to look past residency into your 40's and 50's and really ask yourself how you'll feel about your job then.

 

[crewmaster1]

Honestly, I'm just trying to figure out what I want to do for the rest of my life. I'm in my third year (yeah, I know its not a good sign on name for a 3rd year) and I really enjoy surgery, particularly ortho.

Do you want to actually think and make diagnoses? It all happens in the ER. I am doing my surgery rotation now and get to spend tons of time in the ER, but realize how little the surgeons actually get to diagnose...the ER doc has already done all of the work-up with labs, XR, CT ect. and calls the surgeon because the patient has X and it needs to come out. The surgeon just comes down, does a brief eval, and then usually does exactally what the ER doc told them to! Everytime I go into the ER for an incoming trauma all the cool stuff happens in the ER, then we go down to the OR where I am totally bored after a 2 hour lap chole with my ADD attention span. For ortho....how many of those guys actually get to diagnose the fracture? They just go off and do our scutt work of putting it back together...blue collar work!