Intro to ED

Worked a shift with Dr. L tonight at Tuba City ED. Not too many really sick people but that didn’t mean it was any less educational. My first patient, a 66yo diabetic with a 101.5 degree fever, sore throat, cough and body aches was pretty cut and dried . . . or so I thought. Body aches, cough, no red throat and her age made it VERY unlikely that she had anything other than a viral upper respiratory infection. And our Dartmouth teaching tells us that 90% of the diagnosis is in the history NOT in expensive, unnecessary and ultimately resource wasting lab tests and imaging. Yet we did a rapid strep swab, ordered a chest xray, drew blood from both her arms, made her pee in a cup all to rule out a possible life-threatening sepsis which my history told me she DID not have in the first 30 seconds.

So apparently the thinking goes in Emergency Medicine that to be right about the diagnosis is NOT as important as to be paranoid about the worst case scenario. In fact, forming a “differential” diagnosis in EM is upside down. Its more about looking at the worst possible 3 diagnoses for a patient’s chief complaint, ruling them out with tests and history rather than to gather data and based on that data, come up with the mostly likely diagnoses.

Toward the end of my shift, I also saw an aggravated patient with seizure disorder who was screaming profanities at the medics and staff trying to undress her and draw labs from her. Meanwhile I listened as Dr. L tinkered with the police dispatch radio testing it to make sure it was working in case they needed to contact us.

I guess the question after all this is: do I really want to be up at 4am in the morning dealing with all this stuff? Even if I do get to work 3 days a week and be off at predictable times, have a life outside medicine, etc.

Lately I’ve been thinking about the question “if you take away all the money, prestige, what is it that you would be excited about doing every day?” Would it be staying up all night in an ED?
It should be an interesting summer.