As an internal medicine resident, we were often in the emergency room (ER), admitting new patients. During my three years of residency, we spent only two to four weeks working in the ER. It was a valuable time when I firsthand saw and experienced the life of an ER clinician.
I was blown away by the pace, variety, efficiency, and organized chaos that is emergency medicine (EM). Many of my classmates and later trainees would find a way to skip or slack on this rotation. My experience with EM, however, has given me a valuable perspective which I’d like to share.
I am a critical care clinician and spend a good amount of time in the ER seeing consults. The ER triages, manages, admits, and discharges a significant number of patients. Therefore, clinicians working in this setting must be highly versatile, quick on their feet, and trained to respond to emergencies while being able to fight common colds with ease. They can simultaneously help a patient with a dislocated shoulder and a heart attack. They hold down the fort as the gatekeepers to hospitals, which are perpetually busy and usually struggling to keep beds open.
Yet, many clinicians treat those in the ER with a good dose of disregard, often questioning their decision-making, treatment choices, and blaming them for the extra workload they apparently thrust upon us. What often is looked past is the workload they have, going through about 30 patients during a shift, on an average. We forget that they discharge a lot of patients — ones we never come across ourselves. They shoulder the immense responsibility of sifting through the pile of patients charts in order to triage effectively. ER clinicians face the unique job of being the first set of clinicians encountering a patient within a hospital system. They have to trust their ability to prioritize emergencies when the problem list is likely long.
When they discharge a patient, they risk sending home a potentially untreated fatal disease masquerading as a simple headache or cough. When they admit patients, they can be met with disdain and skepticism. When attempting to sign out a patient, they usually have to deal with multiple unanswered phone calls. When they try to justify the treatment they provide, they are interrupted by consultants and admitting clinicians that sometimes hint how inadequate their job has been. When they try to be as thorough as possible, their attention is being constantly challenged by beeping alarms, belligerent patients or family members, nurses who need orders entered, or a nervous resident trying to get a signature on a consent form.
The intensive care units (ICUs) and the operating rooms (ORs) can seem similar. However, they receive a filtered kind of patient population. The ER, on the other hand, has to deal with patients that visit the ambulatory care or require the ICU, OR, or general medical ward. It is a unique place where all kinds of patients can show up without prior notification in the majority of the cases. The rest of us receive our patient seen by at least one other clinician.
It goes without saying that ER docs are fearless trailblazers in clinical settings. Outside of hospitals, too, they have been trusted as pioneers of cutting-edge developments in medical technology. They were amongst the first to embrace bedside ultrasound, for example, demonstrating the utility, ease, and efficacy of using point-of-care ultrasound. While it was previously confined only to Radiology, bedside ultrasound has grown widespread to become an integral part of today’s ICUs, ORs, in-patient wards, and even out-patient clinics.
Medical simulations, first introduced and adopted by clinicians in EM and anesthesiology, is now making its way across the board at various career stages, starting with medical school. In Situ Simulation has become a popular way to teach clinicians about the ER. Once again, EM was the first specialty to offer a medical simulation fellowship after an ER residency compared to most other specialties.
FemInEm, an online community for women in EM is the first-of-its-kind organization building a collaborative voice to work for gender equity outside of any formal medical organization. FIX17, billed a storytelling event and held in NYC, was their first conference idea exchange and brought the online community to life. Very well-received in 2017, it has now become a yearly conference. Thanks to them, women in other specialties are beginning to do the same.
Meanwhile, Social Media and Critical Care (SMACC) was the most fun conference I have been to yet. SMACC has mostly ER clinicians on the organization's committee. They are hosting their next conference in Sydney in March 2019. They make it a point to have an equal number of male and female speakers every time. And strive to create a vibe that is informal, attempting to break the silos rampant within traditional Medicine.
Since EM clinicians are facing concerning burnout rates, many have started to take on side hustles. By doing so, they have successfully found ways to merge their creativity and passion with medicine to create lives that are gratifying. Many of the blogs and podcasts I follow are created by ER docs. Personally, I have learned a lot from these clinicians. I have been inspired, motivated, and embraced this side of medicine.
Yes, as clinicians, we all work hard. And most of us are overworked, stressed, and sleep deprived. This is simply an attempt at providing a tiny bit of perspective as a visiting consultant-clinician who regularly frequents them. They teach me so much about medicine. Many have become my close friends and part of my trusted, inner circle.
So, ER docs, we do appreciate what you do, and we thank you sincerely, even if that gratitude isn’t apparent at times.
Have your colleagues in the ER ever taught you something that impacts the way that you practice medicine?
Sonali Mantoo, MD is a critical care clinician, simulation educator, dancer, and yoga teacher. Originally from India, she is based in New York and has over five years of experience as a consultant. Currently on a sabbatical, she is devoting her time to family abroad, travel, and creative pursuits such as writing.