Disillusionment or Illumination

I walked into medical school with a vague sense I might want to be a small town family practice doc. Sometimes I talked about doing pediatrics, but I suspect mainly to seem sensitive when trying to get a date. After one rotation in emergency medicine, however, I was convinced I’d found my calling. Shift work, broad scope, fast pace, no pager… perfect. Plus others in emergency medicine seemed similarly wired. This has been my bread and butter since starting residency in ’97.

After finishing residency in 2000, I became a professional drifter for a few years, working in New Mexico, Wyoming, Hawaii, New Zealand and Tasmania. Unfortunately, however, the allure of emergency medicine progressively lost its strength. To fill some psychological gaps I worked on a nonprofit, Endorphin Power Company, in New Mexico for about a decade, while sporadic shifts in various hospitals kept me fed.

In 2012 I moved to San Luis Obispo, met my wife, bought a house, baby en route, and finally, today, it appears I’m headed toward practicing what I think I’d had in mind on day one of medical school. I’m not bidding emergency medicine adiuex. But this Pre-R experiment is making clear to me how much more enjoyable medicine can be with actual follow up. It’s also exposing me to flaws in healthcare, as I’m getting a closer look at the plight of patients seeking primary care physicians, their insurance headaches, and related expenses.

Being a relatively young field, emergency medicine is still rapidly evolving. But unfortunately, I think it’s evolving away from me. Today I treat charts more than patients. ICD-10 is yet another wedge.

Even at its core, I’m just not convinced any more that one wide funnel that captures everything the public considers an “emergency” should be directed to a single point. When doctors in France travel to trauma scenes, are they wrong? When patients in India are segregated at the door to medical and surgical wards right off the bat, are they wrong? Does it make any sense at all to care for infectious problems in a central point in a community? Shouldn’t these patients receive care at home? Does a little kid with a gash on his chin truly need to scream through a set of vital signs a curtain away from a grumbling alcoholic? Is suicidality best served under floursescent lights with ambient chaos and screaming? Why send pregnant women to an ER for simple IV rehydration? Who would ever bring their neonate to an ER waiting room?

Emergency medicine itself is a massive ship with many gears and levers, that employs many caring people, and yes, saves lives. I love what I’ve learned and the people I work with, as well as the opportunities emergency medicine has provided me. But the Cool-Aid no longer tastes as sweet. Pre-R is my new drink.

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