Done With Residency? 3 Pieces of Advice for New Emergency Medicine Physicians

January may be the universal month for new starts, new years resolutions, and self-reflection, but for those of us in medicine, it has always been July.

Do you remember your first shift as an ED attending? I sure don’t. I’m sure I was nervous, overwhelmed, and scared I was going to hurt somebody or, perhaps that I’d look really stupid in the eyes of one of my new colleagues. I really can’t remember too many specifics from my first month, but I do remember I gave tPA for the first time without a neurologist at the bedside. Twice actually. It scared the hell out of me both patients got better. So did I.

What I do remember vividly, though, is the drive in to work during those first couple of months. Especially on night shifts, where I’d be fighting the good fight alone, while the rest of the “normal” world was fast asleep. I remember feeling terribly alone. I wasn’t of course; I had a full cadre of nurses and techs with many more years of experience in the ED than I did. With that in mind, I offer three Pieces of Advice for the new grads:

1. Rely on your senior nurses, particularly the ones who are calm and have been there a while. This may be your first rodeo, but it isn’t theirs. Listen to them, keep them in the loop, but trust your medical decision-making. You are the one with the most medical knowledge and training. At the end of the day, it is your call, and you should trust yourself. But trust their opinion if they tell you something isn’t right. Sometimes it isn’t.
2. If you find yourself getting frustrated or angry with a patient, the problem is either with the patient…. or with you.  Take a step back. Think a little harder about why you are angry. Is your approach to the patient the best one? Do you need help? There probably is a resource available to help you if you look for one. Making medical decisions when you are angry or frustrated is a really bad idea.
3. Know what you want to accomplish before you pick up a telephone in the ED,  whether it be with a consultant, a family member, or the CT tech. Do you know what you need from the person on the other end of the line? The only real difference (its obvious, isn’t it?) when you become an attending physician is that you are now the person responsible for this patient when they are in your emergency department. Perhaps what you need is somebody else to assume some portion of this responsibility. Maybe it’s a specific skill set that you don’t have in your medical armamentarium. Whatever it may be, figure it out before you pick up that phone.

And, most importantly, know what the patient needs. This is invariably what you need.

There is a reason that ABEM calls it the “life-long learning self assessment”. The first six months is most certainly the steepest part of the curve, but it never really stops. Rely on your colleagues, nurses, and your consultants for this learning. It really is the fun part of becoming a professional. Never used Droperidol before in residency? It’s wonderful. Little nervous about tPA?  Come on in- the water’s fine.

Best of luck in your first year. Welcome to the practice of emergency medicine!