Trauma vs ER

[CanadianJello]

Hello, I have some simple questions regarding the practise of Trauma Surgeons. One of my big questions is that the differences between a Trauma Surgeon and an ER physician, if there is any. It seems like Trauma Surgery is a pretty non-operative specialty comparing to the other surgical fields. Do they run all traumas are just ones needing surgical care? I've seen shows like Trauma and such, I've almost never seen the trauma surgeons do surgery. So aren't they just like an ER physician? Do ER physicians also run trauma cases? If they do, I just don't see the point of going through all the trouble of the long surgical residency and fellowship to become a Trauma Surgeon. My uncle is doing his neurosurg elective right now and he said that he gets called down a lot to the ER for trauma cases when a lot of the cases has nothing to do with neurosurgery or any kind of surgical problems in general. I've heard that neurosurgeons also get called a lot to run traumas. Why is that?

---

Members don't see this ad.

 

[njbmd]

Hello, I have some simple questions regarding the practise of Trauma Surgeons. One of my big questions is that the differences between a Trauma Surgeon and an ER physician, if there is any. It seems like Trauma Surgery is a pretty non-operative specialty comparing to the other surgical fields. Do they run all traumas are just ones needing surgical care? I've seen shows like Trauma and such, I've almost never seen the trauma surgeons do surgery. So aren't they just like an ER physician? Do ER physicians also run trauma cases? If they do, I just don't see the point of going through all the trouble of the long surgical residency and fellowship to become a Trauma Surgeon. My uncle is doing his neurosurg elective right now and he said that he gets called down a lot to the ER for trauma cases when a lot of the cases has nothing to do with neurosurgery or any kind of surgical problems in general. I've heard that neurosurgeons also get called a lot to run traumas. Why is that?

Hi there,
A Trauma surgeon takes complete and definitive care of a trauma patient. This may or may not include surgery. Running a trauma case means stabilizing the patient but the definitive care is always done by a trauma Surgeon. It is useless to crack a chest if you cannot fix the problem inside. An ER physician might open a chest but the fixing is done by a surgeon who usually moves the ER physician out of the way as they take the patient to the OR. A Family Medicine physician can technically "run" a Trauma especially in locales that do not have Trauma surgeons. This was the idea behind ATLS (Advanced Trauma Life Support). There is a huge difference between stabilizing the patient and taking care of the patient.

Neurosurgeons generally handle the neurosurgery aspects of a Trauma. Not all Trauma cases need neurosurgery and many traumas only need neurosurgery treatment.

I have been in the operating room the entire night repairing injuries with a trauma surgeon. Many operative trauma cases have a multitude of injuries that can take many hours to fix such as liver injuries that need partial resection or bowel injuries from bullets or a partial tear in a major artery. Sometimes the neurosurgeon, the trauma surgeon and the orthopedic surgeon are all at work on the same patient.

An ER doc doesn't actually leave the ER. Once the patient leaves the ER, the ER docs job is done unless there is court testimony. The trauma surgeon practices in the ER and in the operating room and takes care of the patient in the unit or ward post-operatively and in follow-up after they are discharged.

If you do not want a long-term relationship with your patient, then ER medicine is for you. Most of an ER doc's time is spent doing walk-in clinic medicine with a trauma, heart attack or two thrown in once in a while. They stabilize and then turf the patient elsewhere.

Since most of the trauma in today's world is blunt which may not require surgery, the trauma surgeon may not be operating as much as a general surgeon but may be doing surgical critical care. In areas where penetrating trauma is more prevalent,the trauma surgeon does more operative work. The bottom line, a surgeon is trained to operate and anything that ends in "medicine" is not. If you want to operate, you have to have surgical training.

njbmd

 

[OSUdoc08]

Hello, I have some simple questions regarding the practise of Trauma Surgeons. One of my big questions is that the differences between a Trauma Surgeon and an ER physician, if there is any. It seems like Trauma Surgery is a pretty non-operative specialty comparing to the other surgical fields. Do they run all traumas are just ones needing surgical care? I've seen shows like Trauma and such, I've almost never seen the trauma surgeons do surgery. So aren't they just like an ER physician? Do ER physicians also run trauma cases? If they do, I just don't see the point of going through all the trouble of the long surgical residency and fellowship to become a Trauma Surgeon. My uncle is doing his neurosurg elective right now and he said that he gets called down a lot to the ER for trauma cases when a lot of the cases has nothing to do with neurosurgery or any kind of surgical problems in general. I've heard that neurosurgeons also get called a lot to run traumas. Why is that?

Trauma surgeons spend most of their time in the OR and SICU.

ER docs spend ALL of their time in the ER.

Do you want to operate and be on call, or do you value you time off?

They are completely different roles.

By the way, in order to be a Level I trauma center, a neurosurgeon must be available at all times, since head trauma is an important factor in the ability of a hospital to provide care.

 

[toxic-megacolon]

Hello, I have some simple questions regarding the practise of Trauma Surgeons. One of my big questions is that the differences between a Trauma Surgeon and an ER physician, if there is any. It seems like Trauma Surgery is a pretty non-operative specialty comparing to the other surgical fields. Do they run all traumas are just ones needing surgical care? I've seen shows like Trauma and such, I've almost never seen the trauma surgeons do surgery. So aren't they just like an ER physician? Do ER physicians also run trauma cases? If they do, I just don't see the point of going through all the trouble of the long surgical residency and fellowship to become a Trauma Surgeon. My uncle is doing his neurosurg elective right now and he said that he gets called down a lot to the ER for trauma cases when a lot of the cases has nothing to do with neurosurgery or any kind of surgical problems in general. I've heard that neurosurgeons also get called a lot to run traumas. Why is that?

ER guys have much broader training than trauma Surgeons, but can't operate, and are traditionally not as good at invasive procedures. They are, however, superior in other aspects of medicine such as psychiatry, obstetrics, general pediatrics, cardiology. From my experience, ER-residency trained ER physicians (many ER docs are NOT true ER-trained) are better at differential diagnosis and triage than surgeons. Of course no matter what diagnosis treatment you make as an ER doc, there will always be someone in the hospital that knows more than you in that field, ie obsetrician, cardiologist, neonatologist, etc. That was the biggest thing that turned me away from ER. Oh, and of course only surgeons can operate--most trauma surgeons do operate on non-emergency cases when not on call.

 

[Roux-en-Y]

ER guys have much broader training than trauma Surgeons, but can't operate, and are traditionally not as good at invasive procedures. They are, however, superior in other aspects of medicine such as psychiatry, obstetrics, general pediatrics, cardiology. From my experience, ER-residency trained ER physicians (many ER docs are NOT true ER-trained) are better at differential diagnosis and triage than surgeons. Of course no matter what diagnosis treatment you make as an ER doc, there will always be someone in the hospital that knows more than you in that field, ie obsetrician, cardiologist, neonatologist, etc. That was the biggest thing that turned me away from ER. Oh, and of course only surgeons can operate--most trauma surgeons do operate on non-emergency cases when not on call.

I try to avoid using the term "ER physician" and "superior" in the same sentence, so as not to confuse the reader.

 

[OSUdoc08]

I try to avoid using the term "ER physician" and "superior" in the same sentence, so as not to confuse the reader.

It would be a bit repetitive to do that, since they are synonyms.

(Kinda like "good personality" and "surgeon" are antonyms.)

 

[Roux-en-Y]

It would be a bit repetitive to do that, since they are synonyms.

(Kinda like "good personality" and "surgeon" are antonyms.)

Hardly.
See what I mean about confusing the reader.
BTW OSU, don't call me w/ anymore Bull$hit consults.

 

[toofache32]

BTW OSU, don't call me w/ anymore Bull$hit consults.

Here's what he's referring to. I see this all the time from general surgery:

The ER guy does a complete workup that takes hours of imaging and lab studies and then consults surgery. The general surgeon says "why didn't you call me sooner?! You're delaying this patien't care by postponing the consult!" So next time the ER guy consults them before the workup is done. Then the general surgeon says "You don't even have a diagnosis! Stop wasting my time and call me when your workup is complete and you have a diagnosis you dummy!"

The benefit of being a consultant is that you always have the last word, and the general surgeons at my institution abuse the ER docs this way every day. That's the personality issue that was referred to, at least in my experience.

 

[OSUdoc08]

Here's what he's referring to. I see this all the time from general surgery:

The ER guy does a complete workup that takes hours of imaging and lab studies and then consults surgery. The general surgeon says "why didn't you call me sooner?! You're delaying this patien't care by postponing the consult!" So next time the ER guy consults them before the workup is done. Then the general surgeon says "You don't even have a diagnosis! Stop wasting my time and call me when your workup is complete and you have a diagnosis you dummy!"

The benefit of being a consultant is that you always have the last word, and the general surgeons at my institution abuse the ER docs this way every day. That's the personality issue that was referred to, at least in my experience.

 

[tiene dolor?]

Hardly.
See what I mean about confusing the reader.
BTW OSU, don't call me w/ anymore Bull$hit consults.

You signed up for the pager. Suck it up.

 

[tiene dolor?]

Here's what he's referring to. I see this all the time from general surgery:

The ER guy does a complete workup that takes hours of imaging and lab studies and then consults surgery. The general surgeon says "why didn't you call me sooner?! You're delaying this patien't care by postponing the consult!" So next time the ER guy consults them before the workup is done. Then the general surgeon says "You don't even have a diagnosis! Stop wasting my time and call me when your workup is complete and you have a diagnosis you dummy!"

The benefit of being a consultant is that you always have the last word, and the general surgeons at my institution abuse the ER docs this way every day. That's the personality issue that was referred to, at least in my experience.

So very true. However, despite the occassional jackass, many surgeons are pretty cool people.

 

[toofache32]

So very true. However, despite the occassional jackass, many surgeons are pretty cool people.

But mainly just to other surgeons. Again, just my experience at one institution.

 

[toxic-megacolon]

I try to avoid using the term "ER physician" and "superior" in the same sentence, so as not to confuse the reader.

You really think that an ER doc isn't superior to a surgeon when it comes to drug induced psychosis or neonatal sepsis workup.


(Disclaimer: I'm going into surgery)

 

[TomC727]

Just from my experience with some general surgeons. They prefer gen surg over trauma because of the lack of opertating done on trauma, and this is at a level 1. The majority of trauma ends up to be a babysitting job in the icu. I personally still love it though.

 

[mmmmdonuts]

You really think that an ER doc isn't superior to a surgeon when it comes to drug induced psychosis

no, youre right. er docs are better at that. for example, look at this drug induced psychosis:

The ER guy does a complete workup that takes hours of imaging and lab studies and then consults surgery.

i can't beat that. nobody can.

 

[Von Hohenheim]

Here's what he's referring to. I see this all the time from general surgery:

The ER guy does a complete workup that takes hours of imaging and lab studies and then consults surgery. The general surgeon says "why didn't you call me sooner?! You're delaying this patien't care by postponing the consult!" So next time the ER guy consults them before the workup is done. Then the general surgeon says "You don't even have a diagnosis! Stop wasting my time and call me when your workup is complete and you have a diagnosis you dummy!"

The benefit of being a consultant is that you always have the last word, and the general surgeons at my institution abuse the ER docs this way every day. That's the personality issue that was referred to, at least in my experience.

Yeah, your're dead right. Those guys get a thumpin' no matter what they do. And yes, everyone loves to hack on them for their unnecessary consults and crappy workups but for the most part we're just shooting for a few easy laughs.