What I Love About...Emergency Medicine

As for me, my mind is made up. It has been right from the start. I’ve been blessed to be able to follow my path, informed by some of the best mentors anyone could ask for. I’m going to be an Emergency Department (ED) Specialist, and I don’t think there was ever any doubt in my mind.

In my first year of medical school, while in a patient communication class, I was performing a mock history taking. I was stopped only a couple of minutes in by the instructor who said, “You’re going to do emergency, right?” When I affirmed that I was, he went on to say, “Okay, that’s fine, continue.” I can be rather… straightforward… in my history taking.

What do I love about ED? It’s such a long list, but it boils down to this:

1. Shift work

“What? Are you crazy? That’s the worst part!”, I can hear you saying. But hear me out here.

I can get to the bank. I can go shopping. I can attend my children’s school events. While I miss out on the occasional Friday night with friends, the payoff is massive. Shift work and the ability to have some flexibility in when I work means I can front-load my shifts to the start of one fortnight and the end of the next fortnight to get a huge break, long enough to go to Bali, without taking any leave. I can get to events and do things that those up on the wards have to fight for weeks on end to do. Shift work rocks.

When you combine shift work with shift swaps, needing to take recreation leave to get to an event becomes a thing of the past. For me, rec leave is for proper leave, weeks off at a time – not to get eaten up one day here and there.

Watch MDA National’s video on Surviving Nightshift for practical tips on surviving shift work.

2. The fun part of every specialty

Let’s face it, we get to do the fun parts of every specialty in ED. The chest tubes of the Surgeons, the intubations of the Anaesthetists, the central lines and pressors of the Intensivists, the CPR and defibrillation of the Cardiologist and the stabilisation of sepsis of the Physician. We do the fun bits. A couple of years ago I had the honour of delivering a baby in the back of an ambulance outside the ED doors because there wasn’t time to get them inside.

Like I said, the fun parts.

3. Handing over your patients

The vast majority of the time, it’s the joy and privilege of this job to take care of patients and be a part of their recovery. But every now and then there’s the heart sink patient – that patient who tests your resolve and desire to be a doctor. If you are a Surgeon, a GP or a Physician, you may have to endure them for weeks or longer. For ED, no matter how bad it is, they will not be your patient tomorrow. The longest you will be with a patient is the shift you are on right now, and rarely that long. What happens to these patients? What becomes of the multisystem disordered patient that just can’t go home for some reason? They get admitted and cease to be our problem. Nice.

4. We get to work it out

While everybody (myself included) has stories of missed ED diagnoses, the reality is that more than 90% of diagnoses are made in ED. We start with a complaint, and end with a diagnosis and a plan for initial treatment. With the exception of GPs, everybody else gets 90% of their patients with a diagnosis and a plan and then takes it from there. The joy of being a Physician, as I understand it, is working out that 10%. Me? I’ll take the 90%.

5. Support and comradeship

ED registrars don’t need to compete with each other for positions or completion. We could all, in theory, succeed – so we behave like it. ED registrars don’t fear their consultants; we seek out their opinions and knowledge without making ourselves less. Watching some of the other trainees of other colleges and the suffering they go through makes me ever more thankful for being in my chosen specialty.

The list goes on, but you get the point. If you’re a bit crazy, drink lots of coffee, love variety and excitement, and really want to make a difference right here, right now – come play with us. See you in your ED term!

Dr Eric Richman (MDA National Member)
Emergency Medicine Advanced Trainee Registrar
Toowoomba Hospital, Queensland