My second week of ED was anticlimactic. The adrenaline and excitement I felt as a medical student on my ER rotation is completely different from the blase lack of interest I am experiencing now. I'm not sure if it because it is a different environment or because I have already chosen my path. I realized that I am more concerned in the long term outcome for patients. I cannot turn off my concern for a patient, just because I have 'dispo'd' them. I still enjoy it, but because I get to actually make decisions with patients not just watch.
The main goal of an emergency room physician is to disposition patients. They essentially are supposed to sort out and classify patients: do they go home, do they stay in the ED and get treatment then go home, get admitted, need surgery or are they dying. It seems the only patients the doctors really work on in the ED are those that are dying or get treated before they can send them home. The first I understand because it is life or death. However, all the others I have had to work to understand. When patients are deemed admittable, then basically their care is turned over to the admitting doctor and even if they sit in the ED for hours, the ED doc is done with them. The entire work up is left to the internist/hospitalist. There are those (as in my rant from last week) who just take up time and resources. Then there is that fine line between patients who are sick enough to need IV fluids, meds, etc, but go home and those that need all of that and get admitted. I am trying to learn where that line is, but it is different for each of my preceptors.
The other thing that I have to remind myself of is that Emergency Medicine docs are trained for emergencies. Emergencies. This last week was plagued with doctors sending patients from the office that had complaints that were chronic and they just couldn't figure them out or make the patient happy, so they told them to go to the ER for a workup...This is one of the saddest things I see. ER docs do not have the time/finesse/training to do the mental masturbation that internal medicine doctors do. The idea is that if the patient goes to the ED, all the work up will happen quickly. Work up in the ED does happen quickly for those that need it quickly, but if it is a chronic issue your primary doctor can't figure out, the ED doc is most likely not going to figure it out either.
These are lessons learned in how to appropriately utilize resources, I guess.
YOU ARE READING
Confessions of an Intern
Non-FictionThese are musings of mine, told as I grow through residency. I hope to share a little insight into the making of a doctor, one who still cannot believe she's been blessed with this responsibility.
