Resident President's Message
Resident President's Message
As I progress further into my training, I realize more and more that emergency medicine is a very unique field. Where other specialties have defined themselves in regards to body systems and ever increasing subsets of body systems, emergency medicine has defined itself as a specialty of a temporal period in the duration of an illness. We are trained to be acute care physicians. I knew this going into the field, but as I progress through it, I am recognizing more and more that it creates some unique challenges.
First among these is that emergency medicine physicians work in a fishbowl. More specifically, we are judged as a selected catch from a wide ocean caught and examined in a fishbowl. On off service rotations, I see the occasional well-placed disdain and distrust of emergency medicine physicians. We are judged based on the least competent of our peers. When someone comes to clinic with a completely inappropriate splint, it is never Doctor X from ABEM General who applied it; instead, it is the completely generic "emergency room" (ER), and it is insulting.
It seems unfair, but we are still judged in the whole. In surgery, if a physician consistently has good outcomes, they are labeled as a good surgeon and known as such. The same with internists and any other physician who has long-term care of patients. The emergency medicine care provided, however, usually does not leave with a name indelibly attached to it — the physician and care provided is not good or bad; it is the specialty that is judged. This reason, more than any other, is why it is so important to enforce rigorous standards for the qualification and identification as an emergency medicine specialist. The weakest among us bring us all down, not just themselves.
The second thing came to me in a random encounter 100 feet from my house. I recognized the name on the side of a contractor's truck and the person standing beside it as the brother of someone I had coded and pronounced a few weeks prior. I went over to say hello and again give my condolences for his loss. In the process, I found out all sorts of things about a person I never knew in life. I also accepted his heartfelt thanks for our efforts that day to revive his brother. While our temporal specialty has traded away long-term relationships with patients, we have not lost the ability to make a long-term impact.
When emergency medicine specialists are appreciated, it is often completely anonymously. Even when your patients remember your name, they often never tell you again how much of an impact your care made on their life years later. I am guilty of this myself. One of the most important factors driving me into a career in medicine, and emergency medicine in particular, was a personal history of asthma. It is only through my hospital records that I even know the name of the physician in the ER at Keller Hospital in West Point, NY, on a cold December night in 1988. In an asthma attack that cumulated in pushing intravenous isoproterenol, I endured the scariest night in my then 5 year-old life. Though he has never heard from me since Dr. (then Major) Noce is the most important reason I am alive today and in medicine as a career; for that I would like to say thank you. There are undoubtedly hundreds of people out there that would be able to say the same to each and every person reading this article.
This will be my last column as AAEM/RsA president. Teresa M. Ross, MD of Georgetown University will take over next year along with the rest of the newly elected board of directors. I look forward to a wonderful year working with her as immediate past president. I want to thank the Academy for giving me this chance to see the larger moving picture this early in my career and will always value this year as a blessed experience.
As I progress further into my training, I realize more and more that emergency medicine is a very unique field. Where other specialties have defined themselves in regards to body systems and ever increasing subsets of body systems, emergency medicine has defined itself as a specialty of a temporal period in the duration of an illness. We are trained to be acute care physicians. I knew this going into the field, but as I progress through it, I am recognizing more and more that it creates some unique challenges.
First among these is that emergency medicine physicians work in a fishbowl. More specifically, we are judged as a selected catch from a wide ocean caught and examined in a fishbowl. On off service rotations, I see the occasional well-placed disdain and distrust of emergency medicine physicians. We are judged based on the least competent of our peers. When someone comes to clinic with a completely inappropriate splint, it is never Doctor X from ABEM General who applied it; instead, it is the completely generic "emergency room" (ER), and it is insulting.
It seems unfair, but we are still judged in the whole. In surgery, if a physician consistently has good outcomes, they are labeled as a good surgeon and known as such. The same with internists and any other physician who has long-term care of patients. The emergency medicine care provided, however, usually does not leave with a name indelibly attached to it — the physician and care provided is not good or bad; it is the specialty that is judged. This reason, more than any other, is why it is so important to enforce rigorous standards for the qualification and identification as an emergency medicine specialist. The weakest among us bring us all down, not just themselves.
The second thing came to me in a random encounter 100 feet from my house. I recognized the name on the side of a contractor's truck and the person standing beside it as the brother of someone I had coded and pronounced a few weeks prior. I went over to say hello and again give my condolences for his loss. In the process, I found out all sorts of things about a person I never knew in life. I also accepted his heartfelt thanks for our efforts that day to revive his brother. While our temporal specialty has traded away long-term relationships with patients, we have not lost the ability to make a long-term impact.
When emergency medicine specialists are appreciated, it is often completely anonymously. Even when your patients remember your name, they often never tell you again how much of an impact your care made on their life years later. I am guilty of this myself. One of the most important factors driving me into a career in medicine, and emergency medicine in particular, was a personal history of asthma. It is only through my hospital records that I even know the name of the physician in the ER at Keller Hospital in West Point, NY, on a cold December night in 1988. In an asthma attack that cumulated in pushing intravenous isoproterenol, I endured the scariest night in my then 5 year-old life. Though he has never heard from me since Dr. (then Major) Noce is the most important reason I am alive today and in medicine as a career; for that I would like to say thank you. There are undoubtedly hundreds of people out there that would be able to say the same to each and every person reading this article.
This will be my last column as AAEM/RsA president. Teresa M. Ross, MD of Georgetown University will take over next year along with the rest of the newly elected board of directors. I look forward to a wonderful year working with her as immediate past president. I want to thank the Academy for giving me this chance to see the larger moving picture this early in my career and will always value this year as a blessed experience.
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