After 20 Years in Emergency Medicine, The Worries and Tools I Take to a New ER

When I completed my training nearly 20 years ago, I always wondered what type of emergency department I would work in. Two decades later I can say I’ve worked in a lot of different emergency departments, seven of them to be specific. They range from bustling suburban hospitals to small rural facilities to busy trauma centers. The advantage of working in multiple practice settings is that it allows you as a physician to continue to hone your skill and become better at what you do.

The first time you walk into a shift in a new facility there’s always a little bit of anxiety regarding the patients you’ll see. It’s not that you won’t know what to do. The medicine is basically the same from patient to patient and hospital to hospital. Where the otoscope’s, where the difficult airway equipment, who admits for whom and how easy are the consultants to contact? Those are the issues that you worry about when you first start working in a new facility.

The one constant is the patients. In many ways emergency medicine is a very simple specialty. With all the talk of change in healthcare and the mega trends that we hear about and see about and read about, the care will always be defined as what happens at a patient’s bedside.

So what does the patient want? They want a provider who will be compassionate, who will listen to them, and who will be able to explain things in simple terms that they understand. They want someone who will see them quickly and move them through the system as effectively and efficiently as possible. They want someone who knows medicine, of course. They also want someone who cares.

Our group has had the opportunity to take over practices for various groups of providers. The providers who gave care before we arrived were not bad people, but something happened in the relationship between the hospital and the group that caused the hospital to look for an alternative. Perhaps it was the group’s poor business model and inability to sustain itself. Perhaps it was a weak QA process and an inability to self-police. Perhaps it was an inability to recruit or continue to recruit great providers, or an inability to maintain its partnership with the hospital and align with their strategic goals.

Whatever the reason, there was some point in the relationship when the hospital said enough is enough – we need to look for a new alternative. There are many fine groups of physicians that can provide this service. And as healthcare continues to change, the trend will be toward more consolidation of practices, more physician employment and more opportunities for great groups to continue to provide their services. It is the nature of the market.

So as a preparation for my next few night shifts in a place where I never thought I would be practicing, I am bringing a few tools with me. These tools include the ability to listen to patients and to extend a hand in a time of need, 20 years of experience treating patients in emergency medicine and a willingness to continue to learn to do it better. Life is indeed a journey. It is also one in which I give thanks every day for the opportunity to serve.