What I learnt this week: Am I narcissistic in my enjoyment of emergency care? #WILTW

This is the 25th #WILTW

I spent an evening at my old school this week for a careers fair. I was hosting a stand on a ‘Career in Medicine’ and had a very enjoyable couple of hours speaking to students about admission criteria, specialty choices and whether the work is ‘really hard.’ A common question was, “Why did you choose Paediatric Emergency Medicine?”. It’s good to reflect on this as I have no idea what I said at my medical school interview about why I wanted to be a doctor and my interview to get into Paediatric Emergency Medicine Specialty Training was a car crash from the first question; so not quite sure what I said then either.

It was easy to speak about the nature of the job: I enjoy the frenetic pace, the practical element and the fact that sick kids get ill quickly but well again even faster. I was also honest about how out-patient clinics frustrated me and I tended to see them as something to ‘get through’. Given this attitude probably isn’t conducive to a great patient experience I realised it wasn’t for me.

Medical Staff Tending a Patient

But I had a nagging suspicion that there was something else as well. It’s rewarding working in Emergency Care. The feedback is very visceral and immediate. Whether it is ameliorating pain, correcting a deformity or relieving an anxiety “don’t worry, I can see why you are worried but this rash isn’t serious” a lot of what happens in urgent and emergency care is positive reinforcement of your skills. Even in the most desperate of tragedies you can avoid breaking bad news badly (I am uncomfortable about saying you can be good at breaking bad news). I ponder whether this is a benefit of Emergency Care or something that I need to happen to enjoy working there? This was a bit unsettling. Is there something about Emergency Care that satisfies an inner lack of confidence that positive feedback partially corrects? Am I rejecting in- (or out-)patient care not because I find the medicine unexciting but because I don’t find the potential feedback as fulfilling….

On a related vein do we see more emergency and critical care physicians on social media as this also provides a great deal of positive reinforcement of our self worth or place in the community? I am sure the situation is not as binary as this, but it is a thought I have not been able to shake. It is a good chance to be open about my intrinsic motivations although I am pretty sure I am not going to be leaving emergency care anytime soon 🙂

What did you learn this week? #WILTW

2 thoughts on “What I learnt this week: Am I narcissistic in my enjoyment of emergency care? #WILTW”

  1. You want gratification? Be a rural clinician? We get to see patients when well in clinic….then get to see ’em when critically unwell in ED…..then follow them up afterwards. Immediate AND delayed gratification. And for those of us doing procedural stuff like obs or anaes, there’s the added bonus of sorting out their need for a procedure, scheduling them for surgery, doing the procedure (GA, epidural etc) and following them up again afterwards. From cradle-to-grave care – I find the most rewarding parts of my work are both critical illness and palliative care – both time for utter honesty with patients and family who are ‘up against it’

    It’s like EM on steroids – all the BEST bits of medicine, lots of personal reward (and professional & financial)

    The danger of course is thinking that you are indispensible. We’re not – when a colleague died, he was mourned by many of his regular patients at the funeral – then, next consult “when’s the new doctor arriving”.

    We are but bit players in patients lives.

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