Wednesday, March 5, 2014

Reflecting on My Clerkship Experience: Emergency Medicine

From the AAMC Careers in Medicine Clinical Evaluation 

My cool Emergency Medicine doc look ;-)
1. Name and Location of Clinical Rotation: 

  • Indiana University Health - West: I was so excited to get placed at this hospital because it was close to our house and I thought a community hospital ED would be a slower pace. 
2. What did I like most about this specialty?

  • The speed. Even though you get all the pertinent information as far as chief complaint, medical history, family history, social history, etc., you have to be EXTREMELY efficient and I love that. 
  • The variety. All in one week I was ruling out strokes, managing vaginal bleeding, suturing lacerations, diagnosing cancer, and cardioverting an abnormal heart rhythm.
  • The shift schedule is different in that you can spend your whole day at home and then come in overnight - however, it is also tiresome...
  • Working on a team. The entire ED works so hard to make sure all of the patients are taken care of. I had a great time working with the attending physicians, the nursing staff, and the consultants. 
3. What did I like least about this specialty?

  • As stated above, the shift work got exhausting in that it was very variable from day to day. I would work a 2-11PM one night, a 5PM-2AM the next, and then a 10PM-6AM. My sleep schedule was all off by the last week. 
4. Did this clinical rotation give me a good sense of what practice in this specialty would be like? 

I think so. I thought that I would have a very limited perspective on what it would be like in an ED since I wasn't in one of the hospitals downtown. However, West has been extremely busy recently and many times I was seeing 10-15 patients per day. There was one day when patients had been in the waiting room for a little over 2 hours, but for the most part, the team was great about keeping things moving so we could get our patients seen.

5. Did my interests, values, skills and/or personality "fit" with this specialty? If yes, in what way did they "fit"? If no, why might they not be compatible? 

Although not having continuity (ongoing relationships and follow-up) with my patients was something I knew I would have an issue with, it did not bother me as much as I thought it would - at least for the month. I did find myself wondering about how patient so-and-so did. Especially when we made a new cancer diagnosis and or confirmed new pregnancies. Also, the ED has its "regulars" too and by the end of the month there were a few patients that I had seen two or three times...

I think my personality would not do well in the ED just because I do like to see that my work helped to "cure" or fix the patient's problem. In the ED, the priority is to address anything life threatening and then have the patient follow up with their primary care provider for anything else.

6. What are the possible practice settings for specialists in this field? Which of these settings interest me and do I know enough about them? 

Like most specialties, you can find ED physicians in academic and/or community settings.

7. What information do I still need to find out about this specialty? 

N/A. Everyone was really sweet and said that I was great at Emergency Medicine. My attendings even told me it wasn't too late to switch specialties, but I think I will stick to OB-GYN ;-)

8. Has my perception of this specialty changed based on my clinical rotation experience? 

Yes, before the EM doctors called a consultant in another specialty, it is very likely that they had done everything they could to make sure deferring to another doctor was totally necessary. One of the things my staff kept trying to impress upon me is that when the emergency department calls an OB-GYN doctor for a patient - for example, someone with vaginal bleeding, it is not because they don't want to take care of them. All of the basic work-up is done beforehand, and they really would like a second opinion/some guidance on the issue. I was told not to get jaded during my intern year while I'm returning pages from the ED. I'm sure I won't :-D

9. Did my clinical rotation experience influence the likelihood of choosing a career in this specialty? If yes, how did it influence me? 

I think that EM is a lot of fun, and I was excited to get more practice with women's health issues in addition to all of the other interesting cases I say, but I still absolutely still love OBGYN more, so I know I made the right choice.  

10. Right now, on a scale of 1-10, how interested am I in this specialty as a career option? 

N/A

11. Other comments or reflections about this rotation or specialty: 

When I first started medical school, many people suggested that EM would be a good specialty for me as a wife and mom because it is shift work. Sure, you do not take call, and when you leave the hospital for the day you are done with patients until the next shift, however, the shifts are long (9+ hours usually). And even after your "shift" is over, none of the physicians are able to go home right away because you need to follow through and make sure all the loose ends are tied on the patients you have that are still in the ED - i.e. waiting on tests, getting medications or fluids, waiting to see specialist or be transferred. Most of the time you stay at least an hour past your shift end time - and I watched my attendings charting sometimes 2 and half hours past their shifts.

Long story short, being able to explore the specialties for yourself is invaluable and you should always take other peoples suggestions with a grain of salt. Only you know what is best for you and your life. Don't let other people's opinions of what would be a good career for a wife and mom influence your specialty choice. Or career choice for that matter. Because if I had listened to all those with opinions, I probably wouldn't be in medical school right now :-)

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