Putting the Myths of EM Docs to Rest!!

[EMCrazy]

Ok,
I want to start out by saying that I am a 4th year med student and even though I plan on going into EM Im not biased toward it, I just want to speak of how I feel and what I believe.
First off, Im Da%n tired of people calling EM docs not real doctors. They went to med school, graduated, got licensed, and practice medicine the hardcore way. They're like the marines. The first in to see the patient and the last to make any real difference. Ive heard of some radiologists reading films from their houses. WTF is that?
Second of all I think that EM is one of the few fields other than IM and FP and Surgery(General and only General) where one isn't a sell out by going into them. I mean this is real medicine. I can assure that not one of you went to med school to deal with the eye or look at a transparent film. No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist giving you a lolly pop.
Most people I know want a great lifestyle, a greedy paycheck, and less work, and less patient contact. In a nutshell basically a job where you can be far away from medicine as possible. Very strange.
Next, I don't know about everyone else but throughout my training I look at EM docs as being the badasses of the hospital. If a hospital were a mini-society, EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day. If the hospital were a war, EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse. Radiologists, Derms, opth, and the like are the ones who are miles behind the line making phone calls or the ones in the coast guard or something.
If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards.
And for all you future female EM docs I see the EM females as Xena the warrior princess or something while the lady dermatologist is the wife off of Life with Jim or some girl with mini white keds and fanny pack. Have you seen some female EM docs. They're HOT.
I can almost bet you that if you set up a group of anesthesiologists or IM docs against some EM docs, the IM docs would pissing their pants while trying to kill themselves with their stupid bow ties to avoid the pain. Have you ever seen an ED doc wear a bow tie????
The ED houses the good ol boys and will always continue to house them.
Im sure I might piss sooo many people off, but I just had to get that off of my chest. EM docs are hardcore people and they work hard and smart. Just try to show them a little respect.
And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending. "OHHHH the Horror!!!"

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[Idiopathic]

Yeah, I mean who else is going to do the 2AM pelvic exam?


The best quote I heard about ER (true or not) was from a cardiology fellow: "The ER basically only serves to screen people to get an H+P"

 

[person2004]

Yeah, I mean who else is going to do the 2AM pelvic exam?


The best quote I heard about ER (true or not) was from a cardiology fellow: "The ER basically only serves to screen people to get an H+P"

I was on call for anesthesiology and went to the ER for a blood patch patient with post-LP headache. The ER docs asked if we wanted to write some orders or to discharge their patient. At the end of the day, the goal of ER docs is to transfer care to someone else, anyone else, as soon as possible. That doesn't mean they aren't real doctors, but it's pretty weak.

 

[Winged Scapula]

EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day.

EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse.

The ER doc would be the football captain, the prom king, and the like.

Anyway, wonder where this will go? Into those trenches mentioned above, no doubt!

 

[PeepshowJohnny]

I want to start out by saying that I am a 4th year med student and even though I plan on going into EM Im not biased toward it, I just want to speak of how I feel and what I believe.

Your name is "EM Crazy" and you expect me to believe you're not biased?

Second of all I think that EM is one of the few fields other than IM and FP and Surgery(General and only General) where one isn't a sell out by going into them. I mean this is real medicine. I can assure that not one of you went to med school to deal with the eye or look at a transparent film

I actually have classmates who went to med school ONLY for this reason. Usually they had a family member, mentor in the field who got them interested in it.

No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist giving you a lolly pop.
Most people I know want a great lifestyle, a greedy paycheck, and less work, and less patient contact. In a nutshell basically a job where you can be far away from medicine as possible. Very strange.

Outside of Rads, a lot of those fields actually have a lot of patient contact. And Derm, for example, gets to see plenty of patients. And they get to spend PLENTY of time with patients (Since they have to deal less with the insane paperwork requirements of billing medicare and hospital paperwork).
In my time on IM, I spent more time processing paperwork for patients than actually seeing them.

Next, I don't know about everyone else but throughout my training I look at EM docs as being the badasses of the hospital. If a hospital were a mini-society, EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day. If the hospital were a war, EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse. Radiologists, Derms, opth, and the like are the ones who are miles behind the line making phone calls or the ones in the coast guard or something.

Oh, yeah, you're not biased.

If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards.

Hey, I happen to *like* D&D and Zelda. Um...*cough*

And for all you future female EM docs I see the EM females as Xena the warrior princess or something while the lady dermatologist is the wife off of Life with Jim or some girl with mini white keds and fanny pack. Have you seen some female EM docs. They're HOT.

Dude, Derm is famous (infamous?) for having the hottest chicks...get your stereotypes straight.

I can almost bet you that if you set up a group of anesthesiologists or IM docs against some EM docs, the IM docs would pissing their pants while trying to kill themselves with their stupid bow ties to avoid the pain. Have you ever seen an ED doc wear a bow tie????
The ED houses the good ol boys and will always continue to house them.
Im sure I might piss sooo many people off, but I just had to get that off of my chest. EM docs are hardcore people and they work hard and smart. Just try to show them a little respect.

Ok, now that you've got your ass kissing "EM are manly men" fantasy land stuff out of the way, let me tell you that I like EM people. They do an important job, lots of them do it well. I have good friends interested in the field and have met many awesome EM docs (and some of them tend to be thoughtful, intellectual down to earth guys, not the Harley riding, brew drinking, He-men of your vaguely homo-erotic fantasy).

That said, let's be honest here. There are plenty of doctors out there who DO see their job as nothing more than glorified triage Witch Doctors (Which doctor is actually going to treat this patient?) How is that being a "man's man?" And I guarantee you if you polled 100 random ED docs, very few are going to agree their life is anything like your high fiving fantasy.

I'm curious if you're still going to be singing your EM praises when you do your IM rotation and have fun dealing with the questionable admissions the ED tries to sneak in when they're full instead of practicing good medicine. Discovering your "cellulitis" patient really just has venous stasis is okay every once in a while, it gets old when every "questionable MI" turns out to have gas pain.

And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending. "OHHHH the Horror!!!"

Do you honestly have how many times I've heard EM hopefuls congratulating themselves on how great their schedule/lifestyle is compared to other specialties?

Get yourself rooted in reality.

 

[Dr Serenity]

[Dr Serenity puts on bulletproof armor as he readys himself to stumble through this thread...]

Is it just me or is it starting to feel a little warm in here?

 

[Winged Scapula]

 

[Idiopathic]

Good call, Coxy

 

[f_w]

 

[Richie Truxillo]

If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards.
And for all you future female EM docs I see the EM females as Xena the warrior princess or something while the lady dermatologist is the wife off of Life with Jim or some girl with mini white keds and fanny pack. Have you seen some female EM docs. They're HOT.

*spits coffee out on screen* Bwhwwhhahahahahhahaaha
This is the post of the day for sure. I am so showing this to my best friend who is in his 1st year of EM Residency. He'll get a kick out of it.

Oh and for the record, everyone loves some Legend of Zelda.

And another thing, where do urologic surgeons fit into the high school analogy.

I think we fall into this category.

 

[EMedGrrl]

Have you seen some female EM docs. They're HOT.

Thank you!


Have you ever seen an ED doc wear a bow tie????

Actually, yes - they don't pick up MRSA ...

 

[Dr. Will]

I was on call for anesthesiology and went to the ER for a blood patch patient with post-LP headache. The ER docs asked if we wanted to write some orders or to discharge their patient. At the end of the day, the goal of ER docs is to transfer care to someone else, anyone else, as soon as possible. That doesn't mean they aren't real doctors, but it's pretty weak.

While I don't completely agree with the OP on EM being the end all be all of docs, because honestly, everyone has a role to play, I do want to respond to this above post of "transfering care." Granted, I love being the first to really try and figure out what's going on with a patient/diagnoses. But sometimes, especially when you have a FULL waiting room, disposition is what matters most. So if the patient's going to get admitted b/c they're sick, there are times when the work up isn't finished since it can be finished on the floor. I think many of the other services forgot that for every patient that is admitted or consulted upon, there are far more that are discharged home.
Where I'm doing my residency, the admission rate is about 20-25%, and our waiting room is more often than not, full. But on days where the volume is constant, we have to "move the meat" since there will be sick people that have been waiting for hours that need to be seen.

And I would disagree that the goal is to "transfer care," but to quickly determine "sick vs not sick" to initiate the proper treatment/stabalize. Sometimes that does involve getting them to where they need to go quickly, ie surgery or the unit.

 

[EMCrazy]

Again people come at me with the "All the EM docs do is transfer the patient to the proper floor." That's such BS. I also especially love it when for instance the diagnosis is already made about something and the IM residents or other people act like they did it all.(or MOST IM residents). It's sort of like an actor taking credit for the whole movie and punching the screenplay writer in the face.

 

[EMCrazy]

Kimberly, be honest with yourself. Name me one endocrinologist or radiologist or surgeon who you think is remotely down to earth and has at least half the required 2cm of a testicle. (seriously)

 

[EMCrazy]

Also to relply to your conceited card fellow idiopathic, Im sure his statement was stemming from his laziness to do an h n P himself. Oh yeah and Im sure somewhere in his spectacular A/P was stress test or cath lab tomorrow AM. It was probably already on a stamp pad.

 

[EMCrazy]

Peepshowjohnny:

"I actually have classmates who went to med school ONLY for this reason. Usually they had a family member, mentor in the field who got them interested in it."

Buddy, your classmates who went to school ONLY for this reason are lying to you my friend. No one is going to admit at least not readily that they are in something for the money and lack of work and because they regret going into medicine in the first place.

"Outside of Rads, a lot of those fields actually have a lot of patient contact. And Derm, for example, gets to see plenty of patients. And they get to spend PLENTY of time with patients (Since they have to deal less with the insane paperwork requirements of billing medicare and hospital paperwork).
In my time on IM, I spent more time processing paperwork for patients than actually seeing them."

You were probably processing tons of paperwork because you were a student. Granted IM docs do process paperwork, but it's not so much that it overdoes the patient contact. Do you seriously think that Heme/Onc rounds are less time consuming than filling out a consult form or discharge summary. And by the way you failed to mention about EM docs and paperwork. I think you see my point on that one about how there's hardly none.

 

[Smurfette]

That high school analogy is very interesting. In a hospital, the LEAST popular person anyone wants to hear from or hang around is the ER doc. ER=consult or admit. Nobody's voting ER guys prom kings except ER guys.

Know who gets my vote for prom king/queen? The social worker who finds placement for my high-maintenance POD#44 patient needing long term ABx therapy or who can find loopholes in insurance policies to ensure my patients can get appropriate wound care/home health care/abx etc. without having to pay out of pocket.

 

[NinerNiner999]

To all of the internists, family practitioners, surgeons, dermatologists, cardiologists, etc. who refer their patients to my ER because their office is too busy - and then complain about us "passing them off" or "inappropriately admitting them" I would like to say thank you. Thank you for placing your trust in me to examine your patient for life-threatening diagnoses. Thank you for contributing to my mental process, as I sort through the 25 drugs your patient is taking to figure out why they have an arrythmia. Thank you for referring your patient to me without any medical records or documentation of any history. And, above all, thank you for having your PA hospitalist discharge this patient to have 8 weeks of outpatient follow-up, and no doubt return to my ER under the same circumstances before the workup is complete.

Look - we may not have all of the answers all of the time, but at least we are giving these patients what they need - a doctor.

 

[fineline]

First off, Im Da%n tired of people calling EM docs not real doctors. They went to med school, graduated, got licensed, and practice medicine the hardcore way. They're like the marines. The first in to see the patient and the last to make any real difference.

I'm actually not sure if this guy is kidding or not because, even though it sounds like he's exaggerating, a lot of EM people actually think this is true. It's their defense mechanism or something; they've actually convinced themselves that they are the ones who are "in the trenches" and "facing the first wave." If that war analogy holds, then they sure are like the Marines -- first in and everyone is dead when they leave.

The thing is, I'm not denying they see a lot of people, but so what? Even the EM guys -- go to their forum -- complain ALL THE TIME about how they are the ones who get all these losers who come in with sniffles and coughs. Anyone with any major issues gets seen by another service, maybe even the wrong service who has to tell them which service to call. So, essentially, EM physicians in many places are just primary care physicians who don't have to follow patients for more than one visit.

By the way, EM ripping on anyone for being "too sissy to work" or "afraid of hitting the 40-hour wall" is ridiculous. I mean, they're telephone jockeys and they spend their time worrying about "how many shifts do I have to do per month if I do 10-hour shifts as an attending instead of 8-hour ones?" Also, I think I've seen one hot female EM resident (but she was so poor that she almost made the other EM residents look good by comparison). They really age poorly, too, like nurses -- I think they spend a lot of time eating on their shifts.

 

[DJ LACTULOSE]

ophtho wears bowties not IM! IM is moving towards no ties (almost 50% of the male IM interns at my home program don't wear ties).

 

[Dr. Will]

I'm actually not sure if this guy is kidding or not because, even though it sounds like he's exaggerating, a lot of EM people actually think this is true. It's their defense mechanism or something; they've actually convinced themselves that they are the ones who are "in the trenches" and "facing the first wave." If that war analogy holds, then they sure are like the Marines -- first in and everyone is dead when they leave.

The thing is, I'm not denying they see a lot of people, but so what? Even the EM guys -- go to their forum -- complain ALL THE TIME about how they are the ones who get all these losers who come in with sniffles and coughs. Anyone with any major issues gets seen by another service, maybe even the wrong service who has to tell them which service to call. So, essentially, EM physicians in many places are just primary care physicians who don't have to follow patients for more than one visit.

By the way, EM ripping on anyone for being "too sissy to work" or "afraid of hitting the 40-hour wall" is ridiculous. I mean, they're telephone jockeys and they spend their time worrying about "how many shifts do I have to do per month if I do 10-hour shifts as an attending instead of 8-hour ones?" Also, I think I've seen one hot female EM resident (but she was so poor that she almost made the other EM residents look good by comparison). They really age poorly, too, like nurses -- I think they spend a lot of time eating on their shifts.

Your n = ? If you read my post, I even state I don't agree with the OP. I especially don't agree with anyone using a war analogy to describe what we do. I would say it's the vast minority based on my experience...but I can't really back that up, and neither can you, b/c I just don't have the time to sit down with every EM physician in the country and ask them.

 

[yaah]

I love how people like the OP counter generalizations that they disagree with with generalizations of their own. And then people respond as though it has any real validity.

 

[8744]

Ok,
I want to start out by saying that I am a 4th year med student and even though I plan on going into EM Im not biased toward it, I just want to speak of how I feel and what I believe.
First off, Im Da%n tired of people calling EM docs not real doctors. They went to med school, graduated, got licensed, and practice medicine the hardcore way. They're like the marines. The first in to see the patient and the last to make any real difference. Ive heard of some radiologists reading films from their houses. WTF is that?
Second of all I think that EM is one of the few fields other than IM and FP and Surgery(General and only General) where one isn't a sell out by going into them. I mean this is real medicine. I can assure that not one of you went to med school to deal with the eye or look at a transparent film. No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist giving you a lolly pop.
Most people I know want a great lifestyle, a greedy paycheck, and less work, and less patient contact. In a nutshell basically a job where you can be far away from medicine as possible. Very strange.
Next, I don't know about everyone else but throughout my training I look at EM docs as being the badasses of the hospital. If a hospital were a mini-society, EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day. If the hospital were a war, EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse. Radiologists, Derms, opth, and the like are the ones who are miles behind the line making phone calls or the ones in the coast guard or something.
If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards.
And for all you future female EM docs I see the EM females as Xena the warrior princess or something while the lady dermatologist is the wife off of Life with Jim or some girl with mini white keds and fanny pack. Have you seen some female EM docs. They're HOT.
I can almost bet you that if you set up a group of anesthesiologists or IM docs against some EM docs, the IM docs would pissing their pants while trying to kill themselves with their stupid bow ties to avoid the pain. Have you ever seen an ED doc wear a bow tie????
The ED houses the good ol boys and will always continue to house them.
Im sure I might piss sooo many people off, but I just had to get that off of my chest. EM docs are hardcore people and they work hard and smart. Just try to show them a little respect.
And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending. "OHHHH the Horror!!!"

Hey, I'm an EM resident and a former Marine and your post is ridiculous. Now, it's true that EM physicians tend to be more aggressive than other doctors when it comes to interventions but that's just the nature of the job. However, we'd be dead in the water if it weren't for our more deliberative colleagues in the other specialties to whom we refer or with whom we consult. Get a gory eye injury at 3AM and you will be happy, oh so happy, to see the Opthalmologist strolling in because, as our primary goal is to take care of our patients, he's the guy who will save the patient's eyesight.

I wouldn't say EM physicians are the bad asses. That rubrik belongs to the surgeons. We are, however, the most pleasant and personable physicians in the hospital and get along the best with our nurses and other ancillary staff. We also have the best sense of humor as we thend to attract people who are not as anal compulsive as in some of the other specialties.

The most important person in the hospital? The Family Medicine attending on call who will admit your extremely difficuly patient with a constellation of nebulous complaints but nothing to hang you hat on.

 

[bruinteg]

No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist giving you a lolly pop.

What are u gonna do when you have a retinal detachment? Go to an ER doc??
Dude - every aspect of medicine - from ER to radiology to whatever - is vital to the care of all patients - so don't talk crap about something u have no idea about

 

[velo]

Anyone else think its weird he posted his personal statement here?


Oh and OP you violated rule #1 of personal statement writing: "Don't sound crazy."

 

[--anon--]

Ok,
I want to start out by saying that I am a 4th year med student and even though I plan on going into EM Im not biased toward it, I just want to speak of how I feel and what I believe.
First off, Im Da%n tired of people calling EM docs not real doctors. They went to med school, graduated, got licensed, and practice medicine the hardcore way. They're like the marines. The first in to see the patient and the last to make any real difference. Ive heard of some radiologists reading films from their houses. WTF is that?
Second of all I think that EM is one of the few fields other than IM and FP and Surgery(General and only General) where one isn't a sell out by going into them. I mean this is real medicine. I can assure that not one of you went to med school to deal with the eye or look at a transparent film. No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist giving you a lolly pop.
Most people I know want a great lifestyle, a greedy paycheck, and less work, and less patient contact. In a nutshell basically a job where you can be far away from medicine as possible. Very strange.
Next, I don't know about everyone else but throughout my training I look at EM docs as being the badasses of the hospital. If a hospital were a mini-society, EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day. If the hospital were a war, EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse. Radiologists, Derms, opth, and the like are the ones who are miles behind the line making phone calls or the ones in the coast guard or something.
If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards.
And for all you future female EM docs I see the EM females as Xena the warrior princess or something while the lady dermatologist is the wife off of Life with Jim or some girl with mini white keds and fanny pack. Have you seen some female EM docs. They're HOT.
I can almost bet you that if you set up a group of anesthesiologists or IM docs against some EM docs, the IM docs would pissing their pants while trying to kill themselves with their stupid bow ties to avoid the pain. Have you ever seen an ED doc wear a bow tie????
The ED houses the good ol boys and will always continue to house them.
Im sure I might piss sooo many people off, but I just had to get that off of my chest. EM docs are hardcore people and they work hard and smart. Just try to show them a little respect.
And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending. "OHHHH the Horror!!!"

Go tell them E-Crazy, go tell the world!!!

The "myths" are real, other doctors will always judge you. If you can't handle the criticism either pick another specialty or continue to try to make yourself feel important and start wearing army fatigues.

 

[Winged Scapula]

Kimberly, be honest with yourself. Name me one endocrinologist or radiologist or surgeon who you think is remotely down to earth and has at least half the required 2cm of a testicle. (seriously)

Hmmm.....ME? Although, then again, I don't have any testicles. I didn't realize that was a requirement to be a surgeon. Besides, I thought you noted in your first post that surgeons weren't included in the group of physicians who "sold out".

I think your statements about other specialties are grossly overgeneralized. Do I know arrogant surgeons? Sure. I also know lots of friendly, wickedly funny and compassionate surgeons as well. But the biggest PITAs, IMHO during medical school and residency, were the Pediatricians. That doesn't mean that all Pediatricians are that way, it was just my experience. I knew two guys who wore bow ties...a med school classmate who went into Path and an ENT resident I worked with. Neither were nerds btu rather "southern gentlemen" who found it interesting.

Anyway, I've known good EM physicians and I've known others who did exactly as described here...faked H&Ps, billed for services they did not render, didn't examine patients before calling consults, etc. Bad doctors happen in all specialties.

This argument is ridiculous, especially coming from a self-described medical student. In the "real world" these stereotypes are not useful and get in the way of taking care of patients. I don't care who has testicles or wears bowties...unless I am considering dating them. As long as they take good care of our patients, that's all that matters.

 

[8744]

...If a hospital were a mini-society, EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day. If the hospital were a war, EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse. Radiologists, Derms, opth, and the like are the ones who are miles behind the line making phone calls or the ones in the coast guard or something.
If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards....

...And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending...

Uh...Dude...Emergency Medicine attendings typically work around forty hours a week or less. That's one of the appeals of the specialty, that is, making more than a surgeon for half the training and half the hours. And while I work hard as a resident, I rarely go over fifty hours a week now that I am working full-time in the department.

You are going to be so disappointed with EM. While its true that we do see a lot of real medical emergencies, these things will consitute maybe five percent of your cases. The rest are either acute but non-life-threatening things, dangerous presentations that turn out to be nothing but hysterics or drug-seeking, and a huge, heapin' helpin' of unquestionably ridiculous complaints from patients who need a kick in the ass more than anything else.

So there you're going to be, 3AM and staring at the mother who brought in her four kids because one of them was a little fussy wondering what the hell you got yourself into.

But don't you see? This is why we get paid so much. If we only saw bona fide emergencies we'd hardly make any money at all because at most departments in the United States the critical care or trauma patients are not numerous enought to even keep the lights on. But back pain? Headache? Upper respiratory symptoms? Ka-ching. You can move those patients by the bucketload. Four or five an hour. I always grab an extra chart or two if it's "back pain" or "ETOH" because you can really run up your numbers with no effort.

Thank God for EMTALA. I want to make a lot of money and I do not want any patient turned away. I don't even mind seeing the trival cases at all except that as a resident I don't actually get paid extra for productivity; in private practice however you do get paid for moving a lot of patients.

Typical shift? A couple of really, really sick patients who suck up a lot of my time, some sincerely sick patients who would probably live if even if they didn't come in, and bucketloads of crap. I like it that way because if every patient were a trauma or critical, I would only see four or five patients a shift.

Additionally, even many of the serious complaints can be "phoned in." The orders for a chest pain patient with a normal EKG and negative enzymes practically write themselves. We have check boxes on our order sheets and a standard T-sheet for this kind of thing so we don't waste time. History? Physical exam? Ten minutes. Tops. "Exertional chest pain relieved by nitro." Big whoop.

If you attempt to define your life by your career, you risk being emasculated when it turns out to be less macho than you thought. I was perfectly comfortable when I was a Marine Infantryman defining myself as a Marine because the Corps delivered. It's an organization that lives up to the hype and there was no self-deception involved.

I am very happy in Emergency Medicine and I like it a lot but I also don't go around thumping my chest like I'm some Billy Bad-ass super doctor who can do everything.

And you so do not understand chicks. Who do you think a good-looking, put-together, intelligent woman would rather marry? A guy working wierd and frequently stressdful shifts who works a lot of weekends and holidays or a guy, like a radiologist, pulling in the bucks but with the ability to work from home?

 

[AlternateSome1]

I don't care who has testicles or wears bowties...unless I am considering dating them.

Anyone need a new signature?

As for the thread...
Despite the bashing and hatred that is being spouted about various specialties, I for one am glad they exist. Maybe it is frustrating that psych won't take that patient with 134 sodium off your hands, but aren't you thankful that you don't have to deal with the "suicide" precaution patient who took 10 tylenol at 3 am after having a fight with her boyfriend? And it is irritating to get unworked-up consults from the ER, but at least the alcoholic soaked in his own urine has a place to go other than onto the floor. So...lets hug it out and go back to discussing what type of shoes to wear on the wards.

 

[8744]

I'm actually not sure if this guy is kidding or not because, even though it sounds like he's exaggerating, a lot of EM people actually think this is true. It's their defense mechanism or something; they've actually convinced themselves that they are the ones who are "in the trenches" and "facing the first wave." If that war analogy holds, then they sure are like the Marines -- first in and everyone is dead when they leave.

The thing is, I'm not denying they see a lot of people, but so what? Even the EM guys -- go to their forum -- complain ALL THE TIME about how they are the ones who get all these losers who come in with sniffles and coughs. Anyone with any major issues gets seen by another service, maybe even the wrong service who has to tell them which service to call. So, essentially, EM physicians in many places are just primary care physicians who don't have to follow patients for more than one visit.

By the way, EM ripping on anyone for being "too sissy to work" or "afraid of hitting the 40-hour wall" is ridiculous. I mean, they're telephone jockeys and they spend their time worrying about "how many shifts do I have to do per month if I do 10-hour shifts as an attending instead of 8-hour ones?" Also, I think I've seen one hot female EM resident (but she was so poor that she almost made the other EM residents look good by comparison). They really age poorly, too, like nurses -- I think they spend a lot of time eating on their shifts.

On the other hand, your post is ridiculous too. Every doctor is America except for a few highly specialized surgeons working on the cutting edge of their field see mostly "bread and butter" type patients. Emergency Medicine is no different except that we do actually see most of the sickest people in the city first and perform, in most cases not requiring surgery, most of the important work-up and initiate the definitive treatment. Not too many septic patients leave the department without being well into their Early Goal Directed Therapy to include lines and intubation.

As for being telephone jockeys, well, coordinating care is an extremely important part of our job. It's not just picking up the phone and saying,
"Hey, come admit the patient...bye." You have to almost prepare a case with evididence and exhibits because it is increasingly difficult to get consultants to come in. We often to the entire work-up and treatment and just call the specialist to arrange follow-up.

I don't know a single fat Emergency Medicine female resident. Not to mention that on most shifts we hardly have time to urinate much less eat.

The OP needs to read the latest four articles on my blog.

 

[8744]

Anyone need a new signature?

As for the thread...
Despite the bashing and hatred that is being spouted about various specialties, I for one am glad they exist. Maybe it is frustrating that psych won't take that patient with 134 sodium off your hands, but aren't you thankful that you don't have to deal with the "suicide" precaution patient who took 10 tylenol at 3 am after having a fight with her boyfriend? And it is irritating to get unworked-up consults from the ER, but at least the alcoholic soaked in his own urine has a place to go other than onto the floor. So...lets hug it out and go back to discussing what type of shoes to wear on the wards.

We never call for consults unless the patient is "worked up" or it is an obvious emergency. (Acute abdomen etc.)

 

[jessica84]

Anyone need a new signature?

As for the thread...
Despite the bashing and hatred that is being spouted about various specialties, I for one am glad they exist. Maybe it is frustrating that psych won't take that patient with 134 sodium off your hands, but aren't you thankful that you don't have to deal with the "suicide" precaution patient who took 10 tylenol at 3 am after having a fight with her boyfriend? And it is irritating to get unworked-up consults from the ER, but at least the alcoholic soaked in his own urine has a place to go other than onto the floor. So...lets hug it out and go back to discussing what type of shoes to wear on the wards.

Thank you, AlternateSome1. Hmm...I'm thinking crocs are kind of gay-looking...All of the specialities are needed, and we should all know that. You guys all have over 12 years of schooling, and you are comparing your various specialities to high school cliques and acting like immature high school snobs??? Have we not grown up? Seriously, no one needs to "one-up" the next guy nor any other profession in the hospital. If you are doing that, no matter WHAT your profession, you are in the the profession for the wrong reason, my friend...and I wouldn't want you for a doctor. Wouldn't you want someone who knows their field, but also knows their limits and uses other sources as needed ...not someone who thinks they're prom king of the hospital...what the??? I never thought that I'd be reliving the scene of high school amongst medical professionals of all people.

 

[Shinken]

I am very happy in Emergency Medicine and I like it a lot but I also don't go around thumping my chest like I'm some Billy Bad-ass super doctor who can do everything.

And you so do not understand chicks. Who do you think a good-looking, put-together, intelligent woman would rather marry? A guy working wierd and frequently stressdful shifts who works a lot of weekends and holidays or a guy, like a radiologist, pulling in the bucks but with the ability to work from home?

I think part of the OP's problem is that (1) he's unaware of the real life reality of medical practice in all specialties and (2) he's watched too many episodes of ER where the ER docs perform heart surgery in the middle of the cafeteria, kiss the hot nurse that has the hots for him to begin with, then do ten or so successful CPR resuscitations in a row.

 

[AmoryBlaine]

What a strange, strange post by someone who I sincerely hope is either an M1 or an M2. A few thoughts from an M4 going into EM.

1. EM docs are not the most stereotyped, but they are probably the ones who get the most pissed off about it. IM people are stereotyped as being cerebral and loving to talk for hours. Guess what buddy, if my dad suddenly comes down with some super weird auto-immune dz or vasculopathy I'm going to be super glad there's a "nerdy" internist who will sit down and figure out how to manage him.

2. As Panda said, the true "badass" of the hospital is the general surgeon who has fellowship training in trauma/critical care. This is the physician who knows medicine and surgery. When that big exciting trauma comes in that gets all the pre-med's hearts all aflutter, often they fail to understand that 99% of this person's hospital stay is going to be in the hands of the surgeon. 99% of their care is going to happen either in the OR or on *gasp* rounds.

3. If the OP is so sick of hearing the criticism, he should certainly make sure that he is never guilty of similar attacks. While the OP seems to hypersensitive to criticism of EM docs he is not above claiming that radiologists and internists are the equivalent of the high-school nerd.

4. Does ANYONE really notice that much similarity among people in any field? I know EM docs who spent years working for DWB, skydive, snowboard, run marathons, and who are ex-special forces and others who's favorite activity is baking. Some of my friends who went into IM last year were bodybuilders and former star athletes. I have a friend going into surgery who is the most "stereotypical" surgeon ever and another who seems like a pediatrician -- they both want to do trauma. I knew a guy who went into ortho who was a former college lineman and a girl who went into ortho who is barely 5' tall. I think you get it.


Let's all just get along! I have huge respect for my colleagues going into EVERY other field in medicine. Whatever you do, be good at it!

 

[person2004]

While I don't completely agree with the OP on EM being the end all be all of docs, because honestly, everyone has a role to play, I do want to respond to this above post of "transfering care." Granted, I love being the first to really try and figure out what's going on with a patient/diagnoses. But sometimes, especially when you have a FULL waiting room, disposition is what matters most. So if the patient's going to get admitted b/c they're sick, there are times when the work up isn't finished since it can be finished on the floor. I think many of the other services forgot that for every patient that is admitted or consulted upon, there are far more that are discharged home.
Where I'm doing my residency, the admission rate is about 20-25%, and our waiting room is more often than not, full. But on days where the volume is constant, we have to "move the meat" since there will be sick people that have been waiting for hours that need to be seen.

And I would disagree that the goal is to "transfer care," but to quickly determine "sick vs not sick" to initiate the proper treatment/stabalize. Sometimes that does involve getting them to where they need to go quickly, ie surgery or the unit.

Thank God I'm not a medicine intern anymore and really don't have much contact with the ED. When I was an intern though, they'd pull a lot of weak stuff; Ridiculous things like call us with a consult, then when we'd get down to the ED, the patient would ask the nurse for tylenol or something. The nurse would ask the ER doc if she could give the patient some tylenol and he'd always say, ask medicine it's their patient. We hadn't even laid eyes on the patient and the ER doc had already checked out. He'd rather have the patient sit in pain than have even a minor role in patient care. All dispo all the time. Refusing to give tylenol sounds like such a little thing but it demonstrates an ER doc's attitude and his desire to unload patients asap. I blame the lawyers though. ER docs live in fear of lawsuits day in and day out. Much to most of what they do is cya medicine. #1 goal of an ER docs = get other peoples names on the chart.

On the other hand, one of my favorite months as an intern was doing ER. It is nice to see brand new patients and do lots of minor procedures. I don't disrespect the specialty, just some of its practitioners.

 

[joe6102]

That is the single greatest post I have ever seen on SDN.

 

[Tired]

Your n = ?

Great, one more person using this dumba$$ argument.

Listen, when you argue that another person's experience is too limited to draw conclusions (ie - "you n is too low"), you don't get to draw the opposite conclusion unless your "n" is much higher.

Duh.

 

[docB]

Again people come at me with the "All the EM docs do is transfer the patient to the proper floor." That's such BS. I also especially love it when for instance the diagnosis is already made about something and the IM residents or other people act like they did it all.(or MOST IM residents). It's sort of like an actor taking credit for the whole movie and punching the screenplay writer in the face.

Enough. It is trolling to venture out of your own forum spoiling for a fight, like posting this on the general board. I'm amazed you didn't get flamed harder in the first 12 posts and to come back with the 13th and just restate your provocation is poor form. You're making us look bad. If you want validation or resssurance or just need to vent take it back to the EM forum.

 

[8744]

I've been known to rib my colleagues in other specialties but seriously now, if your self-esteem in your career depends on running other people down, people who have other interests than you and different career goals, you have a serious lack of maturity.

It would be like me, as a Marine Infantryman busting down on Motor Transport Marines or those guy in "bulk fuel" who really make the war go. We all have our jobs, nobody can do it all, and as an EM physician you are going to be thankful to have consultants of every specialty who are willing to come in to provide definitive care.

 

[colbgw02]

Ok,
I want to start out by saying that I am a 4th year med student and even though I plan on going into EM Im not biased toward it, I just want to speak of how I feel and what I believe.
First off, Im Da%n tired of people calling EM docs not real doctors. They went to med school, graduated, got licensed, and practice medicine the hardcore way. They're like the marines. The first in to see the patient and the last to make any real difference. Ive heard of some radiologists reading films from their houses. WTF is that?
Second of all I think that EM is one of the few fields other than IM and FP and Surgery(General and only General) where one isn't a sell out by going into them. I mean this is real medicine. I can assure that not one of you went to med school to deal with the eye or look at a transparent film. No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist giving you a lolly pop.
Most people I know want a great lifestyle, a greedy paycheck, and less work, and less patient contact. In a nutshell basically a job where you can be far away from medicine as possible. Very strange.
Next, I don't know about everyone else but throughout my training I look at EM docs as being the badasses of the hospital. If a hospital were a mini-society, EM docs are the ones who drive the harleys and the radiologist's wife dreams about day by day. If the hospital were a war, EM docs would be the ones in the trenches or the ones up on the beach on D-Day taking hell from everyone and kicking some arse. Radiologists, Derms, opth, and the like are the ones who are miles behind the line making phone calls or the ones in the coast guard or something.
If a hospital were a high school, The ER doc would be the football captain, the prom king, and the like. The radiologist and IM docs and the such would be the ones in the basement playing zelda and dungeons and dragons while trading magic cards.
And for all you future female EM docs I see the EM females as Xena the warrior princess or something while the lady dermatologist is the wife off of Life with Jim or some girl with mini white keds and fanny pack. Have you seen some female EM docs. They're HOT.
I can almost bet you that if you set up a group of anesthesiologists or IM docs against some EM docs, the IM docs would pissing their pants while trying to kill themselves with their stupid bow ties to avoid the pain. Have you ever seen an ED doc wear a bow tie????
The ED houses the good ol boys and will always continue to house them.
Im sure I might piss sooo many people off, but I just had to get that off of my chest. EM docs are hardcore people and they work hard and smart. Just try to show them a little respect.
And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending. "OHHHH the Horror!!!"

In a world gone mad, only a lunatic is truely insane.

 

[Hernandez]

Have you ever seen an ED doc wear a bow tie????

Actually, yes - they don't pick up MRSA ...

Completely and utterly false. I'll refer you to this article

Multicentre randomised double bind crossover trial on contamination of
conventional ties and bow ties in routine obstetric and gynaecological practice

 

[DogFaceMedic]

I've been known to rib my colleagues in other specialties but seriously now, if your self-esteem in your career depends on running other people down, people who have other interests than you and different career goals, you have a serious lack of maturity.

It would be like me, as a Marine Infantryman busting down on Motor Transport Marines or those guy in "bulk fuel" who really make the war go. We all have our jobs, nobody can do it all, and as an EM physician you are going to be thankful to have consultants of every specialty who are willing to come in to provide definitive care.

Panda! How ya been?
It sounds like the OP was watching too many movies and having strange dreams of John Wayne the ER doc charging up "The Sands of Trauma I."

Attitudes like this one get run out of EM because they want to be the hero. I like ER because I like the staff I work with; it's like a good unit.

In the infantry, if someone wants to be the hero, let them take point. If he wants to find trouble, he'll be the first to know.

 

[Misterioso]

We all have our jobs, nobody can do it all, and as an EM physician you are going to be thankful to have consultants of every specialty who are willing to come in to provide definitive care.

Exactly. You guys gotta understand that the EM doc is there to make sure the patient is stable and then get help from other docs for the definitive care of the patient...unless it's for things that most docs should be able to manage without help anyway. That's why docs trained in some other specialties (FM, IM, General Surgery) can cover the ER and do almost anything as well as a pure EM doc. And that's where, dare I say, the insecurity of a good number of people in EM comes from...that they know the old stereotype of them being a glorified triage nurse has a fair amount of truth to it.

 

[DogFaceMedic]

Exactly. You guys gotta understand that the EM doc is there to make sure the patient is stable and then get help from other docs for the definitive care of the patient...unless it's for things that most docs should be able to manage without help anyway. That's why docs trained in some other specialties (FM, IM, General Surgery) can cover the ER and do almost anything as well as a pure EM doc. And that's where, dare I say, the insecurity of a good number of people in EM comes from...that they know the old stereotype of them being a glorified triage nurse has a fair amount of truth to it.

I disagree, respectively. If some ER guy is not very good, then certainly the traige RN is better at determining where to turf the pt, but that is true of any specialty or profession. But, generalists are not trained the same way as EM. The guy in Seattle is the last hold out of IM who thinks EM is not a real speciality, to the detriment of EM education in the Seattle area.

One of the best parts of EM is being the first to do the real DDx. I considered Cards, but I want first crack at diagnosis. THen when it comes to straightforward pt mgmt, then I'm happy to pass the buck/pt. The downside is there is little follow up and there are times when I would like to follow the interesting cases and help out those pts whom I like. But each specialty has both good and bad and we choose what matches our personality.

 

[Faebinder]

Oh yes.... nurse... Can you get this guy an acute abdominal series please, rule out ER Patient Akinesia.

 

[Tired]

One of the best parts of EM is being the first to do the real DDx. I considered Cards, but I want first crack at diagnosis. THen when it comes to straightforward pt mgmt, then I'm happy to pass the buck/pt.

Boy, are you in for a suprise.

 

[DogFaceMedic]

Boy, are you in for a suprise.

??
Gotta go, have a date with a nurse.

 

[deleted109597]

Exactly. You guys gotta understand that the EM doc is there to make sure the patient is stable and then get help from other docs for the definitive care of the patient...unless it's for things that most docs should be able to manage without help anyway. That's why docs trained in some other specialties (FM, IM, General Surgery) can cover the ER and do almost anything as well as a pure EM doc.

Sure. And the vascular surgeon can cover general surgery almost as well as any general surgeon. They just have to read before every case, and take longer than a trained person does. Just like an ortho guy can take care of any medical problem....wait, who am I kidding.

And that's where, dare I say, the insecurity of a good number of people in EM comes from...that they know the old stereotype of them being a glorified triage nurse has a fair amount of truth to it.

Well, EM is about triage. However, a triage nurse doesn't provide much care, and often only takes the complaint and imagines the level of care the patient needs (at most places I've been anyway. [Spontaneous pneumo, that's a level 5 (low), nose bleed, thats a 2 (high)]) When the ED is the gateway to the hospital, as it is at most hospitals now, they have to decide who comes in and who goes. Less than 10% of the people I call consults for end up going home, because we rarely ask for help on people who don't need a bed at the inn. This may differ at other facilities.

Here is the biggest crux of the argument. If other docs could do it, why does every clinic end up sending somebody to the ED to treat something they aren't handled to treat? How many times have we gotten the falls, chest pains, abdominal pains, rectal bleeds, and the rest from IM, FM, and surgery clinics?

 

[PeepshowJohnny]

Peepshowjohnny:
Buddy, your classmates who went to school ONLY for this reason are lying to you my friend. No one is going to admit at least not readily that they are in something for the money and lack of work and because they regret going into medicine in the first place.

Well, that's odd. I must have imagined that time I actually met my friends father who inspired his son to follow him in his field of ophthalmology.

Or maybe he was just an actor, part of his elaborate conspiracy to make people think he wasn't in it for the money...

You were probably processing tons of paperwork because you were a student. Granted IM docs do process paperwork, but it's not so much that it overdoes the patient contact. Do you seriously think that Heme/Onc rounds are less time consuming than filling out a consult form or discharge summary. And by the way you failed to mention about EM docs and paperwork. I think you see my point on that one about how there's hardly none.

My point wasn't that EM had a lot of paperwork (Especially if you're one of the bad ones who just write down "Rule out GI bleed" and send to the floor). It was that the specialties you were highlighting that had a great deal of patient contact aren't really that high on patient contact.

And yes I was doing a ton of paperwork, but you know why? Because the intern/senior had a ton of paperwork to fill out and pushed what he/she could on to my plate to help them out. And while I've never rounded with Heme/Onc on a floor, I've been in a clinical practice with them, and the amount of paperwork was comparable, if not more, than the standard Internal medicine office. Not saying it dwarfs patient contact time by any means, but it definitely cuts into it significantly.

 

[Tired]

??
Gotta go, have a date with a nurse.

Good job!

I meant that the ED is pretty notorious for categorizing patients, rather than diagnosing them. Thus "abdominal pain" = call the surgeon, rather than determining the actual etiology. "Hyponatremia" = call the Medicine team, rather than tease out a cause. Dispo comes first, diagnosis is just an unnecessary extra,