Decisions!

Decisions

As a medical student, I remember once watching a team of physicians and nurses resuscitating a patient who had a cardiac arrest. And while the team worked cohesively like cells that make up a multicellular organism, there was a clear team leader. The ER physician at the foot end of the bed was giving clear instructions to the team and leading the resuscitation. As time passed, I could see the expression of the ER physician change as he finally asked his team to stop resuscitating the patient. In that moment, I remember being aghast and even appalled at the decision of the doctor to stop resuscitating the patient. A few years and many exams later, having found myself in countless similar situations as an ER Resident, I have just begun to understand the complexity of making such decisions.

ER physicians make difficult decisions

Can You?

As physicians, we constantly make decisions in the best interest of our patients and while finding confidence in our decision making is a slow and steady process, it is a process which begins even before we graduate. As a medical student, the choice of medical specialty can be one of the hardest decisions to make. There is a definite finality to the decision of which specialty one decides to pursue. Those who go into medical school with an intended career path may find it easier while others may make their decision as they are exposed to different specialties through their clerkships.

Is Emergency Medicine the right specialty for me?

If you are contemplating if a particular specialty is right for you, then you are already on the right track. All specialties have advantages and disadvantages. Dermatology is often viewed as an attractive specialty by those who like a bit of calm in their lives. But, I know many dermatologists who would not mind a little change from their usual routine of patients every once in a while. (Okay, not many but a few of them).

So, what are the pros and cons of Emergency Medicine?

Pros

  • Variety Is The Spice Of Life

    The great thing about working in the ER is exposure to a variety of cases. At the end of a shift, you could have resuscitated a patient with myocardial infarction, sutured a bleeding scalp wound and even delivered a baby in the ER. If you are someone who enjoys working in a dynamic and fast-paced environment, then working in the ED will definitely be in your comfort zone.

  • No On Calls… Ever!

    Limited working hours, predictability of hours and offs during the week are some factors that attract physicians towards a life in the ER. An ER attending once joked to me that he could not predict a single minute of the shift but knew the exact time he would be sleeping in his bed comfortably. The flip side however, is managing shift schedules and disrupted sleep patterns, which will be discussed under cons.

  • Hands Off While Delivering Shock but Hands-On Otherwise

    I have to admit that not every shift will be like an episode of ‘Code Black,’ but you will still have many shifts where you would get to do hands-on procedures like chest tubes, intubations, and central lines as well as point of care ultrasound which is gaining rapid use in the ED and is an exciting area for further development in the ED.

  • Looking Into The Future

    This can be listed as an advantage or disadvantage, depending on the way you look at it. Emergency medicine, as an independent medical specialty, is relatively young. If you are planning to pursue EM in a place where it is in its nascent stages, you are likely to hit a few speed bumps on the way. This, however, provides you with plenty of opportunities to develop a new model of health-care in your community and make a difference. If you are pursuing EM in a place where there are already well-developed training programs in place (for example the US, UK, Canada or Australia), there is still a lot of potential for research and exploring new tools that will make EM more efficient.

Cons

  • Burn-out

    If you have already done a clerkship in the ER, then you would have probably heard the word ‘burnout’ at least a couple of times and if you have not then I simply do not believe you. Burnout continues to be a pervasive issue among physicians - but not just in the ER, it affects physicians from all specialties. The fact that burnout is discussed and debated so much in the ER is actually comforting as that means there are just as many people looking to fix and help with the problem.

  • Working in shifts

    If you choose to be an ER physician, then working the night shift, on public holidays and weekends is now an unspoken truth of your life. This lifestyle may particularly get more difficult as one gets older and shoulders more responsibilities, especially towards the family. Another challenge that ER physicians face is the circadian rhythm changes, constantly shifting from day to night shifts and back to day, can certainly put one’s health at risk.

  • So what happened to my patient?

    If you are someone who likes to develop long term relationships with your patients, the ER setting can be a challenge for you. However, for most ER physicians, the lack of follow up is a non-issue. Personally, I believe there are many opportunities to develop a rapport with the patient in the ER while knowing that you may never see the same patient again.

What if I am a woman wanting to work in the ER?

One of the success stories involving employment for women since the late 20th century has been the increasing proportion of women in the medical profession. Data from the US suggests that while there was a dramatic upward trend in the representation of women in EM programs (28% in 2001 to 38% in 2011), but sadly this trend has now plateaued in the last few years. Some of the reasons cited for women not choosing EM as a specialty include lifestyle in the ER (working shifts, weekends, etc.) and under-representation in EM leadership.

The reasons could be countless and influenced by the social and cultural norms of each place. The right people to guide you in your decision making are the female residents and attendings working in your local ER. So seek them out and definitely factor in their experience in your decision.

There are also many organizations and blogs which support the empowerment of women in Emergency Medicine. American Association of Women Emergency Physicians, Women in Emergency Medicine (WEM), FemInEM are few that you should definitely check out.

How do I finalize my decision?

Keeping an open mind throughout your clerkships helps. Try to experience each speciality to the maximum you can. So that by the end of medical school, you would have a fair idea of what choosing that specialty would entail.

Try to schedule electives in the speciality you would like to pursue. In the ER, use this opportunity to try working in shifts and get a taste of what it’s like to work in a fast-paced environment. Also, speak to the residents and attendings about their experiences to gain invaluable insight into the specialty.

What if I want to know more about EM?

A good way to learn more about emergency medicine is to join local and international professional emergency medicine organizations as a student. You can also sign up for newsletters, listen to podcasts and follow blogs dedicated to Emergency Medicine to keep up with the latest happenings in EM.

ISAEM is a global student organization which is a active collaborator of iEM Education Project
IFEM is a global organization aiming to improve emergency medical care and education. IFEM is the main endorsing organization of iEM Education Project

Final thoughts

I understand that the above article might portray an ER physician as a superhero/woman navigating through all that chaos, trying to make a difference in the world. But in reality, one does feel like that if lucky enough to pursue something that one is passionate about. So find your passion and do not stop until you do. If you find it in Emergency Medicine, perhaps we may cross paths in the future, if not, I still wish the best for you.

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Cite this article as: Neha Hudlikar, "Decisions!," in International Emergency Medicine Education Project, August 2, 2019, https://iem-student.org/2019/08/02/decisions/, date accessed: November 18, 2019