My school gives us a very quick rotation through our hospitals' Emergency Departments. It's been pretty fun! Here's what I've taken away from my brief time in the rotation:
1) Scope of practice: everything
Everything comes through the ED. Every body system, every age, every stage of life. Sure, there's the bread-and-butter conditions (I've seen a lot of chest pain this week), but the variety is really unique compared to other specialties. I've had more "firsts" in my medical training this past week alone than in the previous 3 months of clerkship and 2 years of pre-clerkship. I'd say this is the first rotation where I've come home excited on a regular basis and it's because I've gotten to do something different every day. I'm really enjoying the diversity of conditions in the ED.
2) Oh, shift work...
The best and the worst part of EM is the same - you're working shift work at all times of the day. It's a bit disorienting. This week I got off a shift at 11 pm, then started my next one at 9 am the following day. I've got a shift that ends at 4 am in a few days. That throws off your internal clock a bit...
On the plus side, shift work is limited to, well, shifts. If you're scheduled for 8 hours, you get off after about 8 hours, with maybe half an hour or so to wrap up patients. You get days off, even during the week, to do things that normal people do like run errands, get exercise, and watch copious amounts of TV. For attending, shift work also means things like taking vacation are fairly easy to do. EM docs don't have their own patients, so any shift can be covered by any qualified EM physician. That makes taking some time off easy, you just ask to not have any shifts during a given period of time!
3) Process Improvement
I've been very frustrated with how the medical system (and the medical education system) is organized, especially within individual departments. The processes in place don't seem set up to optimize outcomes for patients, providers, or students. Worse, efforts to improve these systems are non-existent or face substantial resistance from those in positions of power (often physicians).
In that respect, the ED has been a breath of fresh air, at least at my institution. The system isn't perfect, but it's clear efforts have been made to improve experiences for patients and physicians alike. More importantly, there seems to be a lot of energy being devoted to making the system better. Emergency departments have, rightfully, been the focus of a fair bit of criticism in the past, so maybe this is just a natural outflow of the field's past weaknesses, but I can't say how happy I am to see the status quo in medicine under scrutiny.
4) Rush, rush, rush
Everything moves pretty quickly in the ED. As a student, I'm usually at least partially shielded from the true craziness, but students aren't fully immune to the department's brisk pace. Most times I've been on so far, it'd been me working with a staff physician and a resident. Today, the resident called in sick and I was running off my feet trying to get patients moved through (or at least not slow down those who were actually moving patients through). It was both exhilarating and exhausting.
5) Not my job
If there's one thing I really didn't like about being in the ED, it's that they have a very specific role in health care. Once a patient is stable and there are no acute interventions to do for whatever brought them in, that's it, they're either going to be admitted or sent home. In most cases, this works just fine. In a select few, however, I found it a bit frustrating to go through a whole work-up that basically gave us the diagnosis, which has an obvious longer-term treatment that's easy enough for us to start in the ED, but we held off in favour of having them follow-up with a clinic or their Family Physician. I get it, long-term stuff should be covered by a physician following them long-term, but it sucks to get 90% of the way to solving the patient's problem and stop short of finishing the job.
6) The Happiness Test
The ED is a high-stress environment, where in any given shift, several of your patients could be at risk of death if not managed properly. When we're on the job and running around, I've certainly seen the serious, no-nonsense side of Emerg physicians come out. Yet, the second we have a chance to sit down, the seriousness disappears instantly and the smiles come out. Every physician I've worked with so far seems pretty happy, usually joking around between reviewing patients. They've all been incredibly nice to me so far. Maybe it's just my institution, maybe the only people drawn to the field are those who can handle stress with a smile, but I have to consider EM docs positive on the Happiness Test.
No comments:
Post a Comment