“How an Emergency Medicine Physician Thinks.”

A peek inside EM Physicians’ brains.

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While I posted a picture of this podcast earlier on the Kinnetik Medicine Instagram account, I think it is well worth a revisit and actual blog post with the link and some notes. The podcast is a lecture recorded at a Social Media and Critical Care (SMACC) conference in Berlin. I have now listened to this podcast half a dozen times, and have loved it every time. Throughout residency I developed my own theories about our practice in EM, but it was not until I listened to this podcast that many of those ideas were validated. Dr. Mallon is slightly rough around the edges, but hilarious, so enjoy.

SMACC. Hardcore EM: How an Emergency Medicine Physician Thinks. -Billy Mallon

Below are some “quotables” and notes from the podcast.

  • For an EM Physician, the sicker the better. We prefer sick patients, the decisions are already made.
  • The ED receives a variety of patient demographics, we enjoy the undifferentiated sick and the undifferentiated well.
  • The ED is a decision rich environment. No matter what you are doing in EM, you have to “move the meat.”
  • The ED is the great equalizer, it does not care who you are, everyone gets sick and injured.
  • Remember, as an EM Physician, the patient does not get to choose you.
  • We must maintain a nonjudgmental stance, we cannot care why the patients are there.
  • We do not think like intensivists, internists, or surgeons. But if you must choose between them, then we think most like surgeons.
  • The sicker patients get, the more procedures are needed.
  • We are procedurally biased despite most of our patients being medical patients.
  • We must see NEW patients, we must not leave procedures undone, we must know the rate limiting step.
  • We love bedside testing, because decisions must be made.
  • We are early adopters and innovators.
  • Our differential is disconnected from everyone else in the hospital. We think worst first. But we can’t work up everything, there must be a balance. If you chase too many zebras, you can’t “move the meat.”
  • Weird stuff is concentrated in the ER. Patients present to the ER because no one else figured out their problem.
  • We must be comfortable with uncertainty.
  • Straight A students don’t do well in the ER, they perseverate.
  • We are more test averse than risk averse. We are gamblers, we will roll the dice. If you are going to see thirty in nine hours, then you can’t be a test lover.
  • We must not miss surgical disease. When people need a knife and don’t get a knife, they do badly.
  • We take care of patientS, with an S, not patient.
  • We must not be perturbable.
  • We make deals with patients and consultants.
  • All arrhythmias eventually straighten themselves out.

-Brad Kinney MD

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