EM Series: So You Want To Be An Emergency Medicine Doctor

Emergency medicine is the sexy side of TV medicine. With defibrillations, intubations, chest compressions and traumas, it is clear why the drama shows love to give screen time to the ED. But is that really what emergency medicine is? What do EM docs do?

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The truth is yes, that is EM… but only 5%.

WHAT?!?! Yep, very little of what we do is TV style trauma-thoracotomy-intuation-open cardiac massage. In-fact, most of what we do is actually dealing with much less “sick” patients.

I like to think of the emergency department (ED) as the safety net. We are the last line when someone has slipped through the cracks. They don’t follow up with their primary care provider (PCP) and then their disease worsens, and now they’re in your ED, and they need your help.

Sometimes that help is really an intubation or an albuterol breathing treatment. Other times it’s just reassurance that nothing life threatening is going on today.

ED Patient Breakdown

Remember, just because a patient is not sick or in an acute emergency does NOT mean they are not just as important

In EM, we actually focus very little on the “diagnosis” which is what drives patients crazy. Being the safety net, it’s our job to RULE OUT the “bad stuff”.

Now that’s hard… because to the patient, their cough and congestion is very important to get “treated”, but to an EM doc, we are much more concerned that there is not a pneumonia or a pulmonary embolism, or maybe even lung cancer or sepsis from another source.

 It really takes a shift of thought process, and it’s part of why I love the challenge in EM. What will KILL this patient in the next 24 hours is a WHOLE LOT different than “is this pneumonia or bronchitis?”.

So that’s what we do but who do we see? The answer is everyone. With laws like EMTALA, everyone is entitled to an emergency exam regardless of insurance, status of citizenship etc. We really see all types of people from the CEO with a blood clot from flying on his private jet to the homeless war vet who has frostbite from sleeping outside. Being able to manage your emotions and connect with ALL types of patients is a unique challenge in EM. This is especially true with how many patients we see in a shift, which leads me to my next point.  

We are the masters of task switching. You see a patient, put in orders, see another patient, the nurse grabs you for a trauma, you finish with your other patient, the Chest X-Ray (CXR) is back on your first patient, you get pulled away to help with an ultrasound guided IV, when you get back you start your note on your first patient, the tech asks you to sign your patients ECG, then you check the labs that are now back but radiology calls you about the CT Head on your trauma patient etc.

 You can see, we get interrupted… a lot. Oh, and the pace? It can be blistering at times.


All of that said, there are some times (although rare) where you might go 2 hours without seeing a patient on an overnight shift. Such is the beauty of EM, you never know what you are going to get, who you will see, or when they will come. It’s why we are the safety net, always on alert for what someone else might have missed, and the truth is we wouldn’t have it any other way.

 

-Adam Goodcoff

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