Panda’s Quick n’ Dirty Guide to Third Year Rotations: Part 5

(Some schools offer students the chance to rotate in the Emergency Department in third year while some only offer it as an elective in fourth year.-PB)

Emergency Medicine

Your Real Responsibilities:
Nothing. You’re a medical student. You don’t count. But that’s all right. We’re happy to have you. It’s true you’re not much help but you will pull a few charts from the inexhaustible supply and it’s not like you’re in our way or anything like that. And, unlike almost every other rotation, we won’t fill your day with mindless scut. Even if we did, you don’t have to go very far to do it. Not to mention that as a rule, Emergency Medicine Physicians are pretty easy-going and you will rarely find the type of malignant personality that is common on some other rotations.

Your Pretend Responsibilities:
Pretty much what we do, albeit at a slower pace. Grab a chart, evaluate the patient, formulate a plan and present it to your resident or attending. You don’t have to move the meat. If you see five patients in a ten hour shift and do a really thorough job that’s not bad.

Things You Should Learn:
1. How to be succinct. It is generally not necessary to do a medicine-type presentation for every patient but the surgery-type (“Patient looked OK from door”) is not enough either. As an example, you can spin a long story about how badly the patient’s chest hurt after he mowed his lawn and how it felt like he was being stabbed and how he got, like, all sweaty or nauseous and had to, like, sit down and rest.

Or you can just say, “Mr Smith had sharp, severe exertional chest pain with diaphoresis and nausea relieved by rest.” Learn medical language. Not only is it precise but it saves time.

Bad: “Mr. Smith was feeling nauseous last night and threw up all over himself several times since yesterday. He’s hasn’t been feeling well lately and has been coughing up green stuff. He can’t hold anything down now and hasn’t eaten anything in two days. He has a burning pain in the left, lower part of his abdomen which he won’t let me touch. In fact, his abdomen is rigid.

Better: “Mr. Smith has a one-day history of nausea, vomiting, malaise, and a cough productive of green sputum along with constant left lower quadrant burning pain and and guarding.”

Best: “Mr. Smith was hurling like my prom date and I think we need to call surgery.”

2. How to let go. Come on. You can do it. There comes a point in every Emergency Medicine relationship when it is time to let somebody else have your patient. Tentative diagnosis made, appropriate tests ordered, patient stabilized, and admitting service notified. It’s time to wave goodbye to your pride and joy and hope that you raised them right and they won’t forget what you taught them. Why, you knew them when they first came in and now they’re all stable and pain free.

It almost brings a tear to your eye.

3. How to joke around a little. It’s all right. Some of the patients are idiots. It’s Okay to laugh at their exploits. You don’t have to get all pissy at some of the nicknames the nurses bestow on particularly odious patients either. There’s “The Lord of the Flies” in bay ten. “Mrs. Jabba” and “Jabba Junior” in room twelve. Not to mention “Your girlfriend,” drunk and stupid with garlands of crusted vomit in her hair screaming profanities in room six.

“Hey, Panda, can you keep your girlfriend quiet?”

“She’s my sister and no, I can’t.”

4. Maybe try to get a few procedures. Certainly offer to suture lacerations. You probably won’t get a chest tube but if you are interested, we might coach you through a central line or two. You can check for blood in stool all you want.

5. Look at a lot of CT scans, ultrasounds images, and films. This is high yield because almost everybody gets some imaging study or another and you can sit with an attending who, while not a radiologist, can point out most of the findings you are likely to encounter in any but the most obscure specialties.

Things That Will Suck
Everything if you don’t like it. Not everybody likes the pace. Some people like to deliberate a tad more and have just a little more information before they make a decision. They call this specialty “Internal Medicine.” No shame in that, of course. With the exception of those lazy bastards in PM&R, we are all a team and every member of the team is important. But if it bothers you to not have a clear diagnosis on every patient you will be desperately unhappy. I can only hope that you, at least, do not become one of those specialists who look disdainfully at Emergency Physicians when we do not immediately identify an obscure but obvious disease involving an organ system which they have spent seven years of residency and fellowship studying in excruciating detail.

Or, you just might be lazy and miss the opportunity to just sit around doing nothing like you do on a lot of other services.

You will also see a lot of smelly, nasty, obnoxious, and sometimes dangerous patients. You will either revel in it or not but there they are, scooped up and delivered fresh from the street in their natural condition which often involves a protective crust of vomit, feces, and other unspeakable substances. They don’t get sanitized for your protection until much later.

Cool Things About the Rotation:
If you can get over your brainwashing that every patient encounter must be a long, slow, mutually gratifying and environmentally pure simultaneous orgasm with metaphysical post-coital spooning, what’s there not to like? A huge variety of patients. Fast pace. Sassy nurses who won’t kiss your ass. Major trauma. Procedures. Even a lot of primary care if that’s your thing. And if you have a heart and like medicine at it’s most visceral, this is your specialty as it deals with a chief complaint which is addressed immediately and completely leading generally (believe it or not) to immense satisfaction on the part of the patient (if they are really sick, I mean, and not just looking for drugs or attention).

None. Zip. Zilch. You will work shifts and at most places, the medical students will only work the “rotator” schedule which is something like fourteen days in a month. Sure, the hours are screwy but I’ll take vampire hours with twelve or fourteen days off a month over Q4 call and 13-hour days with one day off every week.

Slacking Potential:
Good, because you are not tightly supervised unless you want to be an we are usually too busy to care where you are. It’s not like we have a lot of scut for you to do. But why would you want to be a slacker given that the hours are so good? Nothing motivates me to work hard more than the sure knowledge of when quitting time is. This is not to say that you will always get out exactly when you shift ends but at least you know when to start wrapping things up.

One thought on “Panda’s Quick n’ Dirty Guide to Third Year Rotations: Part 5

  1. I’m an M3 on my 2nd rotation (Peds). I’m systematically r/o specialties as I go. I have to say, your description here has only made me more sure that EM is probably the only thing I’d be happy doing. Keep up the great writing! It’s an invaluable humor escape for M3’s everywhere. “….fecal jambalaya….” priceless…

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