In the mailbag: Is EM for me?

In the mailbag:

Hello, Doc. I have cherished the idea of becoming an emergency room physician for quite some time now. The gratification of saving people’s lives aside (the effects are immediate and obvious), just to be able to earn the privilege of being a doctor is an enormous challenge (and reward no doubt) in itself. However as I researched the subject of ER physician further, I discovered that alas, what a rosy colored picture my naivet? had painted for me. The "scumbag medicine" (as it’s sometimes called), has lost much of it’s glory to me as I contemplate the reality of an emergency room
career: the obnoxious patients (or…hopeless junkies) being treated, the ever present bureaucratic interventions and threats of malpractic suits inflicted even on the good doctors.
Just to provide me with little additional information to aid my choice and hopefully clear up the confusion in my head, would you mind give a few thouhts as to whether is it worth it to be an ER physician and what has motivated you to apply for an ER residency slot in the first place?

First, I sincerely wish you luck in your path to medical school, and through the travails of medical education.  You will not be bored.

As for Emergency Medicine, my motivation was steered by past experiences and reinforced by my early medical training.  I took an EMT course during the summer following High School graduation, and I think that early exposure to emergent / prehospital medicine has had a profound steering effect on my career.  After a year of college, I took off a year and worked full-time in an ED as an EMT, while attending night school to become a Paramedic, so by then I was completely hooked on the EM path.  A surgical internship sealed my desire to have a specialty that didn’t involve living in the hospital, so EM was the course for me.  I have never regretted that decision.

Emergency Medicine does have the benefit of (occasionally) being able to make a difference, right then, which is appreciated both by the patient (if awake) and doctor, and those times are terrific.  No, more than terrific, they’re exhilarating, but we’re all pros so we downplay their effect (no high-fives in the resus bay, alas).  The immediacy of those interactions is striking, keeps me interested and helps me go back to work. 

There are very real downsides to EM as a profession, and the patient population can be one of them (if you let it).  The more I practice the less the drunk/high/malingering/drug seeking get to me, and that’s a good thing.  I cannot imagine getting through the end of my career if I let obnoxious behavior or less than satisfactory patients get to me on a personal level (and it used to, believe me, but part of the ‘professional veneer’ is realizing the patient is the one with the problem).  The reality is there are plenty of patients who are trying to be nice (or at least not deliberately awful), but it’s human nature to dwell on the ones that make your life painful.

Other downsides: 24/7/365.  It’s the reality of our specialty, someone has to be there, all the time, and sometimes (really, a lot of the time) it’s you.  The third straight weekend spent in the ED can wear on the psyche, if you let it.  Add in more job-insecurity than most other physician professions, a diminishing call list of specialists willing to help the sick and injured, higher than average medmal actions, and EM has its drawbacks.  However, if you can see the problems you can deal with them, and knowing what you’re in for is the best preparation.

For me, there’s no better profession.  I hope that helps.


Comments

  1. I second these thoughts. Especially the ones about the patient population. I have found that the longer I do EM, the less the less desirable patients bother me. Maturity, Experience, especially learning techniques to deal with them.

  2. I admire your blog, but I must add a few more points. I am an ER doc in Texas, also; been doing it more than 15 years. The hardest thing for me to get used to is the general low esteem we are held to by BOTH the public and our colleagues. Because we see so many patients basically for free, and the patients understand this, they have little regard for our skills. I have heard the line “I don’t have no money to pay a REAL doctor” more than I care to admit.

    Then there are interactions with our colleagues. NO ONE is coming to help you with that acute belly or that sick kid at 3AM. That’s just the way it is. No attending wants to get our phone calls. Sometimes it seems like doctors just don’t really want to take care of patients anymore.

    And of course, Lord help you if something goes wrong. You’re taking care of a large number of people who by definition get no regular medical care. If something happens, believe me some attorney will find an expert who is also head of the Department of Emergency Medicine somewhere in California, who will say that (without a doubt) you clearly violated the standard of care, and he can’t understand how that hospital lets you work there, anyway.

    Sure there are the great things – the family that hugs you after you successfully intubated their 2-yr-old with bad asthma; the 59-yr-old guy with an acute MI who you treated with tPA, and is now pain free.

    But you need to disabuse yourself of the notion that you will be “saving lives” – those cases will be few and far between.

    Have you thought about business school??

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