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how is em?
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tv vs reality -- is em boring in disguise?
- Thread starter tum
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The dismal truth of modern medicine (in America) is that anything you do must be recorded on paper to count. Anytime I do something kinetic or unpredictible sooner or later I have to sit down and dictitate it or write it out in longhand. But bear in mind, every other specialty has to do a ton of documentation too.
I would agree with docB that everyone has a great deal of paperwork to do. As the old saying goes "if you didn't chart it, it didn't happen".
>>>could you estimate #'s for time? like 40% doing paperwork 60% actual work?
1/3 paperwork, 2/3 patient care, and other activities (talking to consultants, lunch, etc)
>>>and of the work, how much of it is redundant?
not sure what you mean by redundant.
>>>do most people come in with trivial complaints?
1/3 real emergencies, 1/3 psychiatric complaints, 1/3 undiagnosed psychiatric.
The real numbers will vary depending on the location and type of hospital that you are working in.
>>>on an a kinetic scale of 1-10, with FP being a 1 and ER (the show) being a 10, where would you guys think real life actually was?
anywhere from 3-7
>>>could you estimate #'s for time? like 40% doing paperwork 60% actual work?
1/3 paperwork, 2/3 patient care, and other activities (talking to consultants, lunch, etc)
>>>and of the work, how much of it is redundant?
not sure what you mean by redundant.
>>>do most people come in with trivial complaints?
1/3 real emergencies, 1/3 psychiatric complaints, 1/3 undiagnosed psychiatric.
The real numbers will vary depending on the location and type of hospital that you are working in.
>>>on an a kinetic scale of 1-10, with FP being a 1 and ER (the show) being a 10, where would you guys think real life actually was?
anywhere from 3-7
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You could begin with reading previous threads. Your questions regarding hours and burnout have been discussed at length before.
Emergency Medicine is definitely different than many other specialties. No matter where you practice Internal Medicine, you're going to have your share of HTN, DM, Cardiac disease, Flu-like symptoms, etc. The same with Family Practice, and OB/Gyn (pregnancy,vaginal bleeding, STDs, and the like). However, with Emed, much of patient diversity and problem presentation has to do with where you practice--academic vs community, rural vs urban, lower east side vs upper west side, etc. Depending on what area in a city you work in, you may treat more heart attacks and blunt trauma vs more gun shot wounds and other penetrating trauma. As doctim pointed out, he didn't see any trauma while rotating for a month in the bayou of LA. Yet, if he worked at Charity in the heart of Orleans Parish, he probably would have had his share of trauma.
As for attendings regretting their decision to do emergency medicine---there are likely some. Hell, there are some in every field of medicine. Interestingly, a poll done on physician satisfaction showed that Geriactric docs were the highest satisfied physicians followed by the very close Emergency Medicine docs. Dermatologist were at the bottom. The key is to find the field that you fit best into, and not necessarily go where the money may be.
In emergency medicine you'll find many adrenaline pushies, ie they work hard, and play just as hard. I've known emed attendings in rock bands, rapp groups, ski-divers club, bartenders--they're just fun all around people. I was just at Mardi Gras this past week, and bumped into an emed resident I worked with while in NYC. So trust me, they have fun too. Because of the free time at many locations, some attendings operate their own business outside of medicine, some moonlight to make even more money, and some take their kids to Disney World. Basically, they're still people.
And honestly, I don't know how much people burnout. I do know that I have seen a lot of older physicians manning the emergency department without a care in the world...
Good luck....
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Sure there is alot of primary care type stuff, but it depends on the specific setting. On a very busy day in our ED I have seen as many as four simultaneous codes occuring at one time, have seen fellow residents intubate eight patients in a single shift, as well as crazy multiple traumas and shootings, and all types of wierd situations and basic care.
What's different from TV is that you learn what it's all about I guess. Trauma isn't really that exciting to me, it's pretty simple and can actually get pretty boring and annoying when the 15 minutes of "pseudo-action" is over and you're left to babysit in the CT scanner, stitch while your other eight patients stagnate, and track down the radiologist to look a a bizillion films with you.
Just choose your setting well. I wouldn't take back my choice to go into EM, but know what it's all about before you committ.
What's different from TV is that you learn what it's all about I guess. Trauma isn't really that exciting to me, it's pretty simple and can actually get pretty boring and annoying when the 15 minutes of "pseudo-action" is over and you're left to babysit in the CT scanner, stitch while your other eight patients stagnate, and track down the radiologist to look a a bizillion films with you.
Just choose your setting well. I wouldn't take back my choice to go into EM, but know what it's all about before you committ.
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Well said - all of it. You have the intangible of EM.
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Wrangler, you said it.
To think that surgeons claim that trauma is a surgical domain. The vast majority of trauma patients will have care rendered by a radiologist, but only a few will go the the OR with a trauma surgeon.
Of the cases that are surgical, neurosurg and ortho get the most.
Right now in the Annals of EM, there is a bit of a turf battle going on between surgeons that won't admit the trauma is a multidisciplinary domain rather than an exclusively surgical domain.
To think that surgeons claim that trauma is a surgical domain. The vast majority of trauma patients will have care rendered by a radiologist, but only a few will go the the OR with a trauma surgeon.
Of the cases that are surgical, neurosurg and ortho get the most.
Right now in the Annals of EM, there is a bit of a turf battle going on between surgeons that won't admit the trauma is a multidisciplinary domain rather than an exclusively surgical domain.
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About the "surgical disease..."
If the gifted hands of the surgeon are the best treatment for the victim of trauma, then why is so @#$% hard to get that surgeon out of bed at 0200 when I (a paramedic) call in a trauma alert?
NOTE: this is a rhetorical question!
If the gifted hands of the surgeon are the best treatment for the victim of trauma, then why is so @#$% hard to get that surgeon out of bed at 0200 when I (a paramedic) call in a trauma alert?
NOTE: this is a rhetorical question!
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Fabfrank,
I don't think anyone argues that the field of trauma is not multidisciplinary. There does however need to be one "captain" who directs the triage, treatment, post-injury care, and transport (if needed) of the severly injured trauma patient. The people most qualified to do this are most often the surgeons & I think one of the major themes of the debate is the call for renewed involvement by the practicing general surgeons outside of the major trauma institutions to step up to the plate as far as being active participants in the trauma systems of their respective regions.
Radiologists do not deliver care unless they are interventionalists for the few cases requiring endovascular treatments (very rare), & few radiologists in practice outside the larger hospitals have the skills or inclination to be involved with trauma related interventions.
Most admissions for trauma services (as you point out) do not end up requiring operation, however the care for these is often the unilateral responsibility of trauma surgery services at many institutions. In the care of these patients the emergency room physicians play an important, but ultimately limited role in the global care. It is this perspective, rather then a sleight towards Emergency Medicine that is the debate you refer to
I don't think anyone argues that the field of trauma is not multidisciplinary. There does however need to be one "captain" who directs the triage, treatment, post-injury care, and transport (if needed) of the severly injured trauma patient. The people most qualified to do this are most often the surgeons & I think one of the major themes of the debate is the call for renewed involvement by the practicing general surgeons outside of the major trauma institutions to step up to the plate as far as being active participants in the trauma systems of their respective regions.
Radiologists do not deliver care unless they are interventionalists for the few cases requiring endovascular treatments (very rare), & few radiologists in practice outside the larger hospitals have the skills or inclination to be involved with trauma related interventions.
Most admissions for trauma services (as you point out) do not end up requiring operation, however the care for these is often the unilateral responsibility of trauma surgery services at many institutions. In the care of these patients the emergency room physicians play an important, but ultimately limited role in the global care. It is this perspective, rather then a sleight towards Emergency Medicine that is the debate you refer to
