Stepping into the fast-paced world of Emergency Medicine is akin to embarking on a rollercoaster ride of adrenaline and unpredictability. As you contemplate your future path in medicine, the allure of the ER may beckon with promises of action-packed days and the thrill of saving lives in the nick of time.
But before you dive headfirst into the whirlwind of Emergency Medicine residency, allow me to share with you a glimpse behind the curtain. In this insightful guest post penned by a seasoned Emergency Medicine Physician in the metro, you'll discover eight invaluable truths that transcend textbook knowledge and delve into the heart of what it truly means to navigate the chaos of the ER.
From the surprising diversity of cases that grace the halls of the ER to the poignant moments of tragedy and resilience, each revelation offers a nuanced perspective on the realities of life as an Emergency Medicine practitioner.
Join us as we unravel the complexities of this exhilarating yet demanding specialty, where drama unfolds with every patient encounter, and the line between life and death is often razor-thin. Through the eyes of our guest writer, you'll gain newfound insights into the challenges and triumphs that await those who dare to embrace the unpredictable nature of Emergency Medicine.
So, whether you're a medical student on the brink of choosing your specialization or a seasoned physician seeking to broaden your horizons, let this enlightening discourse serve as your compass in navigating the tumultuous waters of Emergency Medicine residency.
For in the midst of chaos lies an opportunity to make a difference, one patient at a time.
Without further ado, let's dive into 'Eight things I wish I knew before taking Emergency Medicine residency training' and embark on a journey of discovery that promises to reshape your understanding of medicine and humanity.
Eight things I wish I had known before taking Emergency Medicine residency training
If you’re reading this, then there is a big chance that you are about to finish medical school or your internship, or maybe you have just passed the PLE and are wondering what specialization to take.
Most of us don’t really end up with our planned specializations when we started medical school and the exposure during junior and senior internship, helps change our perspectives.
All specializations will have their pros and cons. Having initially tried rehabilitation medicine for pre-residency, I decided that the benign life wasn’t for me and that I needed some action and variety, so I went into emergency medicine.
For those contemplating taking up emergency medicine, here are some things I wish I knew before getting into it.
Not all patients you see in the ER will be emergencies
Most ERs today don’t handle just emergency cases, but also OPD cases. In fact, the cases you will see in a 24-hour shift are mostly non-emergencies.
Modern emergency rooms have also become a “convenience” for patients who have busy lifestyles and cannot or have a hard time seeing a doctor during clinic hours. Be prepared for this reality once you get into emergency medicine.
You get to see all kinds of stuff in the ER
Think everything you see in the ER will be either pediatrics, GS, IM, or OB? Heck, you’d also see the occasional patient with behavioral or mental status changes coming in, and having the acuity to determine an organic or psychiatric cause for this will be an important skill.
Drama!
Lots of drama happens in the ER! From irate patients and relatives who think the doctor-to-patient ratio is 1:1, to patients and relatives who think you’re their personal concierge. You also have the drama from patients and relatives who panic.
There is also some drama when dealing with attending physicians from other specializations when you don’t manage a patient in the same way they do in their practice, despite following the proper guidelines and evidence-based medicine. “Eminence-based medicine” is a thing in the Philippines!
You will see a lot of tragic stuff
Being an emergency medicine physician, you will be first in line to see patients in their most dire moments. From serious vehicular accidents to victims of crime, and patients who come in as emergency cases due to unforeseen circumstances.
It can get pretty emotional since many cases come in, where patients and relatives are not prepared to say goodbye. I’ve had patients in their 20s who never woke up from sleep.
Sometimes you will be paranoid
You make a lot of critical decisions as an emergency medicine physician. Part of this involves admitting people or sending them home.
This is particularly true for government hospitals, unlike most private hospitals where you can admit all patients regardless if they’re admissible or not.
Sometimes you will have this nagging feeling if you just sent a patient home with a potentially catastrophic underlying condition. There are plenty of medical conditions that can catch you by surprise.
Oftentimes, your colleagues from different specializations won’t be so “cooperative”
Sometimes, or maybe often, your co-residents from other specializations will use you as a buffer zone, and use delaying tactics to not admit a patient immediately once all the things that need to be done at the ER are done.
Ideally, a patient stays in the ER for a maximum of 6 hours only, but when residents from the concerned specialization start those delaying tactics, the patient may stay in the ER for days, or even become an ER admission.
That means you will now have long staying patients to add to your patient load along with the ER and OPD cases that you have to manage.
You will not have your own patients
Whether in residency or as an attending, you will never have your exclusive patients as the patients you see tend to be transient, and patients of doctors from other specializations.
Your job is to resuscitate and stabilize emergency cases, treat OPD cases, and have the acuity to detect patients with potentially catastrophic conditions and admit them to the concerned specialization.
You will normally not have a longstanding and formal patient-doctor relationship, unless that patient only goes to the ER.
Beware of the next pandemic
In many cases during the pandemic, it was the ER doctors who were willing to see patients face to face. Other specializations opted to do online or halted their practice altogether. In some hospitals, it was the ER resident or attending who was rounding patients that were supposed to be handled by other specializations already.
Do you think EM residency training is for you?
These are just a few of the things I wish I knew before taking emergency medicine residency. I have good coping skills, so I was able to handle these problems gracefully (that, and a little manipulativeness as well).
Will I change a thing? Of course not, if I had to do it all over again, I’d still choose the same specialization. I get the variety of cases I want, help a diverse range of people, get “made for TV” cases, and my 'off days' are real 'off days'. I wouldn’t change a thing.
-A guest post written by TriMD
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