Your posts are always excellent, and inspire me to dive (or at least wade) back into writing.
This one is particularly good -- I think one of your best, which is saying something -- and right on target.
When I started family practice residency – guess the date – CTs had just been introduced; there were no beta-blockers, ACE inhibitors, ARBs, or calcium channel blockers; MRIs were several years away, as were laparoscopic surgeries. Remove a gall bladder using scopes? Inconceivable! Computers filled rooms and utilized punch cards, and futurists predicted how they would enhance our lives in the near future. You are indeed correct in saying that the science has improved, but the culture, politics, and I might add economics surrounding medicine have become increasingly toxic.
Don’t get me started on EMRs, which continue their unruly adolescence, with a number of technical skills but lacking development of their frontal lobes. I have been retired for 1½ years, have not missed dealing with them for a nanosecond, and wonder how in the world new physicians grapple with all they must learn while feeding the data collection maw.
Thank you for this thoughtful greeting to new physicians, many of whom I hope will read it, and for fighting and documenting the good fight.
I retired at 72 after 44 years of primary care (not emergency) medicine, though I saw my fair share of emergencies. I didn't retire out of frustration, though I have watched for some time the worrisome trends that Ed writes about with such eloquence. I wanted to spend some time on other projects and travel with my wife while we are still able to do so. The opportunity to hand the baton to a younger physician presented itself at the right time, and I don't regret that decision.
You were created to be an emergency room physician, and it was my honor to work along side you in that season of our lives. Your skills and knowledge were excellent but your kindness, compassion, and discernment were what makes you one of the finest physicians I’ve ever known!
I have sat here trying to imagine what I'd say, encountering a new intern in this latter day. I think I'd simply greet them, ask them their story and say a silent prayer for their future. We're not leaving the house of medicine in better shape than we found it. In fact, it's on our watch that we allowed the terms of our service escape our control. We're leaving them a life as employees, rather than independent agents, able and empowered to truly advocate on behalf of our patients.
Best article I have read recently! I haven’t been very active in this platform, but I felt compelled to share your piece. The emergency room is probably one of the most challenging areas, and yes, you are spot on about the politics and climate poisoning the improvements science has made. It is refreshing to encounter folks who still see this crazy field of healthcare as a calling; over the years I worked as an RN, I got the feeling that many folks no longer view it as such, and some state that “calling” is a misnomer, even wrong. They feel it is why healthcare workers in whatever role have been repressed and not given their due. I recently had my own experience with emergency room physicians as a patient myself; there was a significant difference in approach between the ones who view themselves as “employees “ and the gentleman who definitely sees his work as more of a calling. I would imagine those who are welcomed by you can tell the difference as well.
Paul that’s great and than u for doing gods work for that long .fyi u would never had lasted that long in emergency medicine without an mi or divorce….or both…looking from the outside you are seeing just the tip of the iceberg
Ed wonderful , elegiac note …. But at soMe point one crosses into martyrdom and cognitive dissonance , even denial . You are perilously close to that line.Taking on a peripatetic career as a locus physician to leave the oppressive madness behind is a wonderful but ultimately temporary solution and not available to docs with a mortgage student debt, young children a working spouse or high cost of living metro areas where they grew up and or have extended family . The trajectory of emergency medicine is established and it’s ineluctably down unless we employees unionize . I love your spirituality but it’s of little solace to those who believe we don’t have an after life. Do bd circumspect when encouraging med students to enter the specialty unless plan b was social work or the clergy .yes family medicine all forms of primary are dispiriting at times but they don’t take the pressures and sleep deprivation our specialty does . For all but the adrenaline junkie we are suffering from ptsd. I can’t in good conscience recommend s career in emergency medicine.
Well said Edwin Ann’s welcome new brothers and sisters!
Your posts are always excellent, and inspire me to dive (or at least wade) back into writing.
This one is particularly good -- I think one of your best, which is saying something -- and right on target.
When I started family practice residency – guess the date – CTs had just been introduced; there were no beta-blockers, ACE inhibitors, ARBs, or calcium channel blockers; MRIs were several years away, as were laparoscopic surgeries. Remove a gall bladder using scopes? Inconceivable! Computers filled rooms and utilized punch cards, and futurists predicted how they would enhance our lives in the near future. You are indeed correct in saying that the science has improved, but the culture, politics, and I might add economics surrounding medicine have become increasingly toxic.
Don’t get me started on EMRs, which continue their unruly adolescence, with a number of technical skills but lacking development of their frontal lobes. I have been retired for 1½ years, have not missed dealing with them for a nanosecond, and wonder how in the world new physicians grapple with all they must learn while feeding the data collection maw.
Thank you for this thoughtful greeting to new physicians, many of whom I hope will read it, and for fighting and documenting the good fight.
Paul you are retired . Congratulations . May I ask why you retired if an em career en balance, remains “great”?
I retired at 72 after 44 years of primary care (not emergency) medicine, though I saw my fair share of emergencies. I didn't retire out of frustration, though I have watched for some time the worrisome trends that Ed writes about with such eloquence. I wanted to spend some time on other projects and travel with my wife while we are still able to do so. The opportunity to hand the baton to a younger physician presented itself at the right time, and I don't regret that decision.
You were created to be an emergency room physician, and it was my honor to work along side you in that season of our lives. Your skills and knowledge were excellent but your kindness, compassion, and discernment were what makes you one of the finest physicians I’ve ever known!
I have sat here trying to imagine what I'd say, encountering a new intern in this latter day. I think I'd simply greet them, ask them their story and say a silent prayer for their future. We're not leaving the house of medicine in better shape than we found it. In fact, it's on our watch that we allowed the terms of our service escape our control. We're leaving them a life as employees, rather than independent agents, able and empowered to truly advocate on behalf of our patients.
Nice honest and thoughtful
Best article I have read recently! I haven’t been very active in this platform, but I felt compelled to share your piece. The emergency room is probably one of the most challenging areas, and yes, you are spot on about the politics and climate poisoning the improvements science has made. It is refreshing to encounter folks who still see this crazy field of healthcare as a calling; over the years I worked as an RN, I got the feeling that many folks no longer view it as such, and some state that “calling” is a misnomer, even wrong. They feel it is why healthcare workers in whatever role have been repressed and not given their due. I recently had my own experience with emergency room physicians as a patient myself; there was a significant difference in approach between the ones who view themselves as “employees “ and the gentleman who definitely sees his work as more of a calling. I would imagine those who are welcomed by you can tell the difference as well.
Paul that’s great and than u for doing gods work for that long .fyi u would never had lasted that long in emergency medicine without an mi or divorce….or both…looking from the outside you are seeing just the tip of the iceberg
Ed wonderful , elegiac note …. But at soMe point one crosses into martyrdom and cognitive dissonance , even denial . You are perilously close to that line.Taking on a peripatetic career as a locus physician to leave the oppressive madness behind is a wonderful but ultimately temporary solution and not available to docs with a mortgage student debt, young children a working spouse or high cost of living metro areas where they grew up and or have extended family . The trajectory of emergency medicine is established and it’s ineluctably down unless we employees unionize . I love your spirituality but it’s of little solace to those who believe we don’t have an after life. Do bd circumspect when encouraging med students to enter the specialty unless plan b was social work or the clergy .yes family medicine all forms of primary are dispiriting at times but they don’t take the pressures and sleep deprivation our specialty does . For all but the adrenaline junkie we are suffering from ptsd. I can’t in good conscience recommend s career in emergency medicine.