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Why I Love Emergency Medicine

Posted by on Wednesday, January 20, 2016 in Specialties .

Hi! I’m Nate, a third-year medical student, and I plan to go into emergency medicine.

When you get to medical school, you’ll quickly find out that every specialty, from family medicine to neurosurgery, has stereotypes. Often these are unfair, but most have a grain (or two) of truth to them. The stereotype for EM doctors is that they are “jack-of-all trades” with a short attention span and a love of procedures.

The truth – at least, from what I’ve gleaned through my medical education so far – is that EM physicians are one of the last true “generalists.” In an era when the drive is toward increased specialization, EM doctors are some of the only providers to utilize the entirety of their medical training.

It’s a field that emphasizes quick thinking, a deep comfort with Big Scary Things like codes and traumas, and a general affinity for procedures. EM people like “doing things” more so than they like involved conversations about disease processes (more of an internal medicine thing) or spending hours fixing one specific thing (more of a surgeon’s domain). 

Personally, I love emergency medicine for all of the above. I love thinking on my feet and the full spectrum of disease that walks through the door. I love, in general, Doing Things, and especially love bright lights and shiny objects. There’s a certain adrenaline jolt that you get when an emergent patient comes in that you simply don’t get anywhere else, and on top of all that it’s shift work – at the end of the day, you go home, and home life and work life need not overlap. You can have a life outside of your career.

Most importantly, the EM physician occupies a unique niche in the hospital: they are the first MD to see a patient, which means they may be the only provider to see what we call the “undifferentiated” patient. The way you’re trained in med school is to start from nothing except a chief complaint, but the reality of most other specialties is that most patients will come to your service or your office with a preexisting diagnosis.

For instance, if you’re a cardiologist, you’ll know what’s wrong with your patient most of the time before they arrive to your office: new heart failure, stable angina, cardiomyopathy. This is helpful but also can bias you in how you think about the possibilities. When you are the first person to see a patient, you are the first one to assign a diagnosis, even if it’s just a working one. It’s up to you to decide “sick versus not sick” and up to you to start figuring out what organ system is in trouble in a person who just plain old doesn’t look right. The mantra of an EM physician is “what bad things could this be that I don’t want to miss?” 

Emergency medicine is a tremendously diverse, varied field that attracts people for many different reasons. But no matter what, one of the most important parts of choosing a specialty – any specialty – is the other people working next to you. Yes, I love EM for the excitement, for the opportunity to use the full breadth of my skill set, and for its work/life balance. I love it for the Doing of Things, for the bright lights and shiny objects of codes and traumas, and for treating people essentially from scratch. But on top of all that, I knew when I started spending time in the ER that I had found my people. Once you’ve discovered that, the rest is easy.