This month I’m rotating in Emergency Medicine.  It is one of my last “required” rotations, and it’s a rotation that I was not at all excited for.  One thing I’ve learned on previous Internal Medicine rotations is that a lot of Hospitalists have negative things to say about ER doctors.  (Don’t worry, as I learned this month, the feeling is mutual.)  So before starting this rotation I had a bit of a skewed view towards working in the ER.

As an example, on my first wards rotation in Internal Medicine I had three patients in one week who were admitted through the ER with pneumonia.  When I took a good history and physical exam and order some tests, I came to the conclusion that not a single one of those three patients had pneumonia.  So naturally I thought, What kind of idiot doctor down in the ER keeps admitting my patients with pneumonia when they don’t have it?!  This was the moment that I decided I didn’t like emergency physicians.

The problem further escalated through different rotations.  I would go down to the ER to talk to a patient I was admitting before they got to the floor.  I would try to find the ER physician to talk to them, and they were never around.  Hello!?  I need to talk to them about this patient, and they’re probably off getting coffee.  If I was lucky enough to find them, they always seemed scatterbrained.  What patient are we talking about?  Bed 24?  And the icing on the cake is when I would get admitted a patient who didn’t really need to be in the hospital.  This guy is clearly a drug seeker.  Why on earth did the ER physician admit him!?

But the more time I spent in the ER this past month, the more respect I have for ER physicians.  Before this rotation I thought that a lot of ER docs practiced “bad” medicine.  They didn’t put enough thought into the patient and think about what was going on before ordering tests and admitting them to the hospital.  But after working with them I can see that they are incredibly smart physicians.  They just know different things than Hospitalists.

The way I see it now, the ER physician knows how to diagnose and stablize patients, and the Hospitalist knows how to treat and manage patients.  And it really is a team effort.  I’ve learned that oftentimes ER docs don’t order tests because they think they need them, but they know that the Hospitalist appreciates having that data.  They’re trying to help as best they can.  They might not know exactly what is wrong with the patient, but they know that the patient needs to be in the hospital, and they want to help the Hospitalist make the correct diagnosis.

And if they’re not around or they seem scatterbrained, it’s because they’re trying to manage a lot of patients at one time, and some of those patients might be really ill.  They might be stopping a nosebleed in a different room or running a Code on a cardiac arrest patient.  Their shifts are unpredictable and can get busy at the drop of a hat.  In fact they rarely get time to eat and are often stuck on the phone calling consults and trying to get a hold of the Hospitalist.

They’re not bad doctors.  They’re really good doctors, but their job is very different than Hospitalists.  ER physicians will be the first to admit when they don’t know what is wrong with a patient or how to manage a certain diagnosis.  But that’s not really their job.  Their job is really to figure out who needs to be in the hospital and who doesn’t.  And I have been amazed at how often it isn’t black and white.

ER physicians don’t like admitting drug seekers or patients who probably don’t need to be in the hopsital.  In fact, they hate it just as much as Hospitalists do.  But that is the world of medicine that we live in.  If an ER physician sends a patient home and something was really wrong, they could get in big trouble.  One ER doc told me, “You have no idea how many drug seeking patients we screen out for you guys upstairs.”  And it’s true.  For every 1 drug seeker that gets admitted, there are probably 50 who get sent home.

So I guess you could say that I’ve changed my mind.  I’m thankful that Emergency Medicine was a “required” rotation because I definitely wouldn’t have elected to do it.  And it’s opened my eyes to a different aspect of medicine that I didn’t truly understand before.  I can see why people want to practice Emergency Medicine, even though it’s not for me.  And in the future, I’ll think twice before grumbling about the ER doc who sent a patient to me.