Why I Can’t Do Emergency Medicine

I can’t do Emergency Medicine. I do not like the environment of the ED. I don’t feel comfortable there. It has nothing to do with the people who work there. It has everything to do with the system. Allow me to explain.

There are many great things about Emergency Medicine. For one, I love the shift work. It must be awesome to leave the office and never have to carry a pager or be on call. When you’re on, you’re on. And when you’re off, you’re off. The salary is also an overall plus for those considering it. I mention just a few of the positives of EM to make the point that there are things I do like about it.

But the reason I can’t go into EM is the system and how it is (poorly) designed. I realize that my impression of the system is based on my experiences while rotating as a medical student through local hospitals that include a level 1 trauma center and a county medical center. So the picture I have is probably not representative of all hospital EDs. But I hope to stay in the area. I would like to stay in academic medicine. So I think my sample size fits.

While rotating through medicine and surgery I would often be sent to the ED to admit a patient. While going looking for my patient, I’d have to walk through hallways and aisles lined by chairs and gurneys filled with patients watching my every move. They watched because they hoped that my eyes would meet thesis and that I would stop. I hated that feeling. I wanted to stop an help them. But I couldn’t. I had no idea what they were there for. And they weren’t someone I was asked to see.

Perhaps this is just a small thing. But to me it was huge.

The second reason I can’t see myself going into EM is that there are just so many non-emergencies. The system of healthcare we have leads to so many people coming into the emergency departments due to complaints that should be dealt with in the primary care setting — or even the urgent care setting. I can only imagine that I’d be frustrated dealing with this on a daily basis.

It may not be much. Some may see this and minimize my reasons saying that they are silly. But in the end, they are the reasons that pushed me away from emergency medicine. And it’s a personal process everyone must go through for themselves.

  • MS3

    I am a 3rd year medical student currently on my Emergency rotation at an inner city level 1 trauma center. I am having the worst experience there. The doctors are overloaded with orders and computer work so I get no one on one interaction. From what I’ve seen most are jaded and label their patients as drug seeking or gang bangers instantly and delay care for them. The residents are constantly busy and don’t have time to teach me much of anything. The nurses are rude to me because I am only a week in and have never drawn blood or done the simple procedures they find routine. I ask how I can help and I am told “just stay out of the way”

    I spend my 8 hour shift seeing a patients gathering an HPI, ROS and physical. I have to wait 30-45 minutes between cases to present. There is a delay between resident – attending presentation and by the time the patient is seen by the attending it has been 2-5 hours. The traumas that come in are handled by surgery, I assist by getting supplies they need. I don’t get to do much more then talk to patients and do physicals.

    The only thing I have learned so far is how inefficient the system is.Something needs to change so that if someone comes in nauseated and vomiting they don’t have to wait 6 hours to get odansetron. I went into medical school with the intention of becoming an Emergency Physician. I can tell you I will avoid the position like the plague after experiencing it as a student.

    Maybe I had too good of a surgery rotation where the attendings would sit down and discuss patients with me. I was taught how to write orders and round on patients to help out during the day, they made me feel useful. In the ER I just feel like I’m in the way.

  • Joe

    You probably are in the way, but that’s not your fault. Remember, EM is not a field limited to inner city level 1 trauma centers. Your geography largely dictates patient population, which largely dictates level of sanity in the ED. In short, work in the burbs or the country if you want to enjoy the ED.