Be the EM Expert

How to (quickly) become an Expert in Emergency Medicine

The usual route to becoming an expert in any medical specialty is to spend about thirty years in clinical practice. When combined with a sound basic medical education and an inquiring mind, plus keeping up with new developments, a high level of expertise may be attained. At about this time many physicians in stressful fields like EM want to retire or they may start to develop infirmities that limit their ability to practice. Thus there are relatively few practicing experts.

To the extent your author has expertise; it was developed in the typical “hard way” described above. My desire in writing these essays is to try to impart lessons learned and in so doing allow others to more rapidly achieve “expert” status. The main outcome difference between the expert practice of EM and simple competence is best characterized as efficiency. The kind of efficiency referred to will be reflected in more rapid patient disposition, overall less diagnostic testing and consultation, and fewer hospital admissions with no increase in morbidity or mortality. Doing everything for everybody was somewhat justified generations ago. At that time interventions and tests were relatively few and inexpensive. In the 21st century this is no longer the case and is bad medicine, not good in any way.

As a junior level practitioner of EM, whether a medical student, resident or a categorical EM resident you may see another style of practice modeled. Especially on inpatient units, the model is often to order every test your team can think of and multiple consults. While usually well motivated and sometimes even appropriate, this is not a sustainable general paradigm for a medical care system awash in red ink and is unsustainably costly. In addition, it has never been shown to improve outcomes or even to reduce liability. It just costs a fortune and takes forever. This kind of “shot gunning” is also intellectually unsatisfying and reduces the physician to a patient manager and checker of boxes on an order sheet. It is especially unsuited to efficiently practicing EM. ED’s thrive on rapid turnover of patients. And individual EP’s thrive when they are using their intellect and skills to rapidly identify patients needing specific emergency treatment from those with non-acute problems.

It’s fun when you get it right. These essays are intended to help you do that. The opinions are mine and I stand by them. However, you need to decide for yourself how best to use them. Accept nothing uncritically, question everything.

To access the individual essays, clink on the links on the left.