What's your least favorite thing about EM?

[MasterintuBater]

Seriously...what are the negatives of emergency medicine. I don't mean all the crap about lack of continuity of care and annoying patients in the ED who aren't really sick. I am loving EM and I think I need to be brought down off cloud 9 and back to reality before I rush into it for the rest of my life.

If you LOVE EM, what are the things that you LOVE to HATE about it? And for that matter, what are the things you hate to love, if there are any?

---

Members don't see this ad.

 

[The White Coat Investor]

Originally posted by MasterintuBater

If you LOVE EM, what are the things that you LOVE to HATE about it? And for that matter, what are the things you hate to love, if there are any?

I'm not sure I'm smart enough to understand that sentence, but the negatives of EM are several:

1) Lack of continuity
2) Since we see all comers, we see more than our share of psychos, homeless, drunks etc.
3) Night shifts
4) Rotating shifts
5) All services critique your work
6) Jack of all trades. You learn less and less about more and more until you know nothing about everything.
7) Crabby consultants
8) Difficulty with reimbursement. You're lucky to collect 40-50 cents on the dollar billed.
9) While at work you work very hard and have to multitask more than any other specialty.

That's about it. The rest is cool.

 

[Sessamoid]

Originally posted by Desperado
I'm not sure I'm smart enough to understand that sentence, but the negatives of EM are several:

It's funny, a few of those I considered positive.

1) Lack of continuity

That's a plus to me.

7) Crabby consultants

Yeah, that one sucks.

9) While at work you work very hard and have to multitask more than any other specialty.

Definitely a plus for me.

 

[deleted6669]

having to deal with certain internists and surgeons.........especially surgeons.........

 

[GCS:3]

Originally posted by Desperado
9) While at work you work very hard and have to multitask more than any other specialty.

I actually really like this aspect of EM. If I'm at work I don't want to be sitting around waiting for my patient's turn in the CT scanner. I'd much rather be too busy to worry about the CT until the results are actually in.

The big negative for me you've already mentioned. I hate not knowing which patients only want the Vicodin or the warm bed. It comes more naturally as you learn the population, but we still get fooled sometimes. (ie: the homeless guy who's well dressed...)

 

[beyond all hope]

Don't get me wrong. I love being a generalist, and that's one of the things I like about EM. Still, it would be nice if the Sultan of Arabia flew halfway around the world to see you because you were the premiere underwater-basket-weaving specialist.

Other specialties sit in a cushy office, not a crowded ER, and wait for patients to beg for their services. Specialists can also decide not to see irritating patients, which ER docs have no power to do.

Because of EMTALA (which I think is an important law that ensures some level of care to all people), ER patients have an enormous sense of entitlement. "When am I gonna see a doctor! I got me some pain". They feel they have a right to bother you at 3 am because they've had a headache for three months. Never mind they they are usually the ones that caused their own problems. Never mind that they have an expensive car and nice jewelry, they don't have insurance and will never pay for care.

All the bad things about EM are just the flip side of the good things.

Good: generalist
Bad: not specialits

Good: treat all patients, regardless of ability to pay
Bad: treat all patients, regardless how annoying/insignificant

Good: no continuity
Bad: no continuity

Good: no call
Bad: night shifts

etc

 

[Kalel]

My least favorite thing during my EM rotation was definitely the lack of satisfaction in knowing what your patient actually has. I know that many EM residents would disagree with this, but EM residents at my school used to always say that it wasn't their job to figure out what was making the patient sick, it was only their job to stabilize the patient and figure out if the patient needs to be admitted or sent home by ruling out things that could kill the patient in the immediate future. Anyways, don't flame me for that, because that's what just what an EM resident told me and how EM is largely practiced at my school.

 

[roja]

I still love what I do .... I imagine this will continue. No job is perfect and some times the things I consider negatives I later don't mind.

I disagree with the 'jack of all trades, master of none' comments. Emergency Physicians are specialists. Our specialty is emergency medicine... in figureing out if a patient is safe to go home, really sick, etc. Our specialty requires us to be familiar with many fields. We stabilize and we figure out if people are really sick. Often times, diagnosing them. (I have seen malaria diagnosed in the ED).

Our specialty requires us not to come up with the huge 'most common to least likely' differential that medical school teaches us. It is to figure out what is going to kill this person or damage them in this differential for the person in front ofyou. I don't care if ruptured AAA is not the most common diagnosis for abdominal pain. What I care about is ' does the person in front of me have one?'

Its a subtle difference and one that shouldn't be missed.

What do I think is bad about EM? Like everywhere, there aren't enough nurses. I want to be able to get tylenol out of the pyxis without asking a nurse because the hospital wants to bill for it.

I don't mind nights, I like working with other services. Grouchy consults give me something to have stories about. Same goes for drunks, etc.


And if you want to know about a patient tha tyou saw, especially if it was interestinng, then you just follow up.

 

[realruby2000]

I heard that it's a B**ch to get into...

 

[The White Coat Investor]

Hey people....I'm not saying the "negatives" I listed aren't positives for me...its just that they are things that some people do consider negatives. Some people like continuity, some dislike multi-tasking etc

I disagree with the 'jack of all trades, master of none' comments. Emergency Physicians are specialists. Our specialty is emergency medicine... in figureing out if a patient is safe to go home, really sick, etc. Our specialty requires us to be familiar with many fields. We stabilize and we figure out if people are really sick. Often times, diagnosing them. (I have seen malaria diagnosed in the ED).

I like to think of myself as a specialist too, but I would argue we are more generalists than specialists nonetheless. Just as FPs know all about the long term management of illnesses of many different specialties, so EPs know the short term management of illnesses of many different specialties. Its all semantics I suppose.

 

[docB]

I hate:
-Docs who treat us like their afterhours and overflow clinic.
-Docs who send a patient through the ER just to avoid writing direct admit orders.
-Patients with unrealistic expectations.
-And my most hated aspect.. Being everyone's clinic of last resort. I have about 3 conversations a shift that go...
Me: "So you've had this for months and you've seen your PMD and several specialists about it, what can I do for you at 3 am in the ER?"
Pt: "I don't know. I just can't take it any more."

 

[MasterintuBater]

THanks for all the good replies. Honestly it seems to me that EM folks really have less to complain about than most of the other specialities. I don't want to spend my life around a bunch of whiney complainers that hate their fields and find nothing but the negative in what they are doing. EM folks seem to swallow the bad with the good and remain positive about what they are doing more than most.
ONe other questin:
How much do EM physicians find themselves doing social work?...like their internist counterparts

 

[docB]

I'd say we do less social work that PCPs but it's 10x harder for us to do the social work we do. We're trying to do it a 3am (most of the people you need to talk to to arrange social stuff keep banker's hours) and we have to do what we can do in one visit. We can't tell the pt to come back next week after we make some phone calls.

 

[DrQuinn]

I dislike:

-the *slightly* smaller # of drug rep dinners that are offered to us compared to our primary care counterparts... that being said, I'm going to Fleming's Steakhouse twice this week.

-the 1 in 1000 patient who leaves AMA despite truly having a medical emergency (had a diagnosed-by-me large pericardial effusion who was symptomatic (like a class IV CHFer) who left AMA because he didn't want to be admitted to a hospital on his vacation).... that really sucked, I wish he would have let us take care of him!

s'bout it. Having started my EIGHTH rotation as an intern (can you guys believe it?), I am absolutely convinced I picked the right specialty.


Q, DO

 

[doc05]

What's your least favorite thing about EM?

it's EM

 

[DrQuinn]

Originally posted by doc05
What's your least favorite thing about EM?

it's EM

Q, DO

 

[MasterintuBater]

Originally posted by doc05
What's your least favorite thing about EM?

it's EM

I may be stupid, or just naive, or...heck you may just be padding your posts here. ...but would you care to explain your succinct yet slightly ambiguous view of EM?