Choosing
your area of expertise in medicine often becomes a challenge for medical
students. This is a crucial decision, as you will be spending 8-10 hours a day doing
this job almost everyday for the rest of your life.
This post is specifically targeted towards students who
are thinking if they should consider EM as a career?
Emergency Medicine
is a certainly distinctive specialty. It primarily involves the initial
evaluation, resuscitation, and stabilisation of patients.
EM was born in 1970, when the first EM residency program began in the US in
1970. EM in India is
still developing and there is a long way to go. Currently, there are countless
programs that are run by various organizations to fulfill the emergency
healthcare demands of 1.2 billion people! However, the Medical Council of India
recognizes only a few of these programs.
At the outset, I would like to point out that there are
pros and cons with every specialty. It just depends what do like doing the
most. Here is what Emergency Medicine is like:
Unique features of EM as a specialty:
1. You get to
see a wide spectrum of pathologies. Problems that you might come across as
an Emergency Physician include drug overdoses, crash injuries, heart attacks, trauma, rape, abuse, and pregnancy
complications. On the other hand there can be minor issues such a cold,
sinusitis etc. EM always keeps you on your toes because you never know what you are
going to see next. A child with fever or a homeless demented elderly man with
sepsis. Patients from diverse socioeconomic, racial, and ethnic backgrounds
will see YOU first with all medical and surgical conditions. So, planning how
your shift is going to be is not an option!
2. Triage: In the ED,
the order in which patients are seen depends on the severity of
their illness not on first come first serve basis. Life threats and sickest
are treated first (Less acute conditions often wait for hours before
seeing the doctor)
3. You see undifferentiated
patients: Patients don’t come with a label of medical or surgical
disease. It is you who is going to figure out what is wrong, whether it is DKA
causing abdominal pain or Dengue fever or Acute Cholecystitis or it is a case
of Acute Intermittent Porphyria!!
4. Procedures: This is
your place to be if you are someone who likes to do procedures such as intubations,
central lines, I & D, Chest tube insertion etc.
5. Do you like
surprises?
Recognising who is sick and who needs intubation is a skill that
comes with time but anticipation is the key. Thinking the worst possible
outcome is the dictum in EM. Headache (SAH), Chest pain (ACS, Dissection), Back
Pain (Epidural Abscess), Breathlessness (Pulmonary Embolism) and so on.. Get
into the habit of expecting the unexpected.
6. Violent and
difficult patients: Whatever happens in and around the hospital, it is the ED that
faces the brunt whether it is due to overcrowding, violent patients, drug
seekers, and criminals. Often they come to the ED and hurl abuses at you but
you still need to stay professional and give the best possible care to them.
For the same reason, policemen and other security personnel are always closely
associated with the ED. This can make EM look intimidating and frustrating.
6. You make a
difference everyday, every shift: It is privilege to be with patients
during some of the most important times in their lives. Here is what an internist told me recently, “I was fed up adjusting the doses of Diabetic
and Anti-HTN medications. EM sounds much more interesting”. He switched to EM
after practicing Internal Medicine for 30 years!!
7. Be the patient’s
advocate: Frequently, you need to persuade the specialists about changing
their decisions and deliver you ideas succinctly. This needs self- confidence
and exceptional communication skills. Trust me, a wrong referral can turn over things
over completely.
8. Shift work: Emergency Medicine
is practice in shifts of fluctuating lengths. They work a number of nights but the benefits of
shift work include the ability truly to have time off when not on shift. You
can easily plan shifts as per your choice. On the contrary, your circadian
rhythm gets disrupted due to this. This becomes a major issue later in the
career.
9. Are you open
to Criticism?
Colleagues from other departments often question the
clinical decisions and knowledge of Emergency Physicians without truly
appreciating the situations that exist in the ED. It is easy for anyone to slam
the Emergency Department. Be prepared to handle that.
10. Burnout: All patients
presenting to the ED may not need emergency
care. Some seek their primary care in the Emergency Department because they did
not get access to primary. ED's are frequently abused and used as in-patient
wards which again can be very annoying. This may contribute to burnout. Scheduled
vacations, fixed time for friends and family might alleviate burnout.
11. You can’t
follow up on your patients in EM: If you are willing to spend some extra time, this is
possible. It can be done easily thru electronic medical records.
12. Financial
pressures: In India, this is a significant concern. You cannot discharge
any patient who needs emergency treatment but what if cost becomes a factor?
Have clear existing protocols about this because as a physician you should not
be discussing this with the patient. This can become a major source of stress
for the physicians.
Author:
Lakshay Chanana
Speciality Doctor
Northwick Park Hospital
Department of Emergency Medicine
England
Speciality Doctor
Northwick Park Hospital
Department of Emergency Medicine
England
