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PA Talks Struggles of Emergency Medicine and Promise of Telemedicine

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Name: D. Cristopher Benner, PA-C, MMSc., FAWM

Specialty: emergency medicine, wilderness medicine

Education: Emory University School of Medicine

Current position: staff physician assistant, emergency department, Boulder Community Health, Boulder, Colorado

How do you prepare for your workday?

I usually like to get a workout in before my shift. On my way to the hospital, I will take a mental pause before every shift to remind myself how lucky I am to have a profession that allows people to share with me their concerns and their pain, and to be able to offer some assistance, even if it’s only in the form of listening to them. Before I walk into the hospital and before I walk into a patient’s room I stop and take a few breaths to slow myself down and get ready to help people.

What is the most challenging part about emergency medicine?

There are several challenges to the practice of emergency medicine as I see it, some of these are: 1) An emergency medicine clinician needs to be able to work with a lack of information and feel comfortable with that lack of information, 2) Not having a pre-existing relationship with a patient and asking them to suddenly trust me when they’ve known me for only a few seconds, 3) Getting followup for patients with limited to no health insurance. Where I practice I am fortunate to have highly competent staff and case management as well as local resources that go above and beyond to help our patients.

What are some exciting new developments or technologies in emergency medicine?

The increased use of bedside ultrasound in emergency medicine has allowed clinicians more rapid diagnostic ability with progressive improvements in the size, portability, and ease of use for clinicians. Telemedicine is another area that is seeing an increased use in emergency medicine, especially in tele-neurology and tele-psychiatry. As other complementary technologies are improved, such as higher screen resolutions and faster broadband speeds, and with increased challenges in finding specialists, I think we will see in increase in usage of telemedicine in emergency medicine.

What is the last journal article or piece of research that significantly changed your practice?

“A Randomized Controlled Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral Prednisone in Acute Adult Asthma,” Annals of Emergency Medicine, November 2016.

This study almost immediately changed my clinical practice. Because of compliance issues, I like the idea of providing a single dose of dexamethasone versus multiple days of prednisone. It’s much easier for the patient.

Outside of your daily practice, do you have any personal or professional projects that you’re passionate about?

Wilderness medicine has been a long passion for me. I am fortunate to be a member of an volunteer mountain search and rescue team in Boulder, Colorado. This group of men and women consistently amaze me with their dedication and skill level. Most members are not involved in the medical field as their paying profession, so I will regularly assist with medical trainings.

What is a common misconception that other clinicians have about emergency medicine?

That emergency medicine clinicians are adrenaline junkies. The majority of medicine that is practiced in emergency departments is not gunshots and made-for-TV multi vehicle car and helicopter crashes. I enjoy talking to and listening to my patients. I enjoy being silly with pediatric patients. I enjoy connecting with patients, even if only for a short while in the ER.

Who are your mentors?

Personally, my wife, parents, and sister have been sources of stability and advice on a variety of topics, helping me wade through sometimes murky waters in life.

Professionally, I have been fortunate to learn alongside some great physicians. Dr. Sushma Shah in the San Francisco area would hold regular didactic sessions with the PAs in the ER group, doing everything from journal club activities to mock oral boards. She really made me think on my toes and pushed me to learn. I am very grateful to her.

What’s the best advice you’ve ever received?

“You need to be able to sleep at night,” was something uttered to me early on in my emergency medicine career by a ER physician. What she meant was that at the end of your shift, you should be able to go home and not worry whether you could/should have done more, whether you ordered the right test/medicine or not, whether you should have admitted the patient or not. Most of the time, if I simply do the right thing for my patients I can sleep soundly at night.

What would your colleagues be most surprised to learn about you?

That I grew up in a bilingual household (Spanish & English). That I lived in Ecuador with my family growing up. Also, that I have a karaoke machine at home. Actually, they probably guessed that already.

What are your favorite Doximity features and how have they helped your productivity (Dialer, DocNews, Career Navigator, e-Fax, etc.)?

I really like the DocNews feature for quick and highly palatable information. The Doximity dialer is a great feature because I will often call patients the following day to see how they are doing. If I’m at home and have the day off it’s nice to be able to mask my personal mobile number.

What area of emergency medicine is changing most rapidly?

1) Non-opioid treatments for acute pain has received a lot of press recently and with good reason. My hospital is using a variety of non-opioid pain options, including intravenous lidocaine, ketamine, haldol for the acute treatment of a variety of conditions. 2) Better, faster, higher resolution and lower radiation CT imaging. The speed and resolution of CT machines today continue to amaze me.

How do you unwind after a challenging day?

Depending on the shift I’ve worked it may be as simple as playing with my wife and son at home or sometimes watching mind-numbing TV to decompress. Simple things like cutting the grass or pulling weeds can be surprisingly relaxing.

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