As a 5th year (intercalating) medical student, who is nearing the end of his time at university, I am often asked by doctors, friends and family members what I am eventually going to specialise in. Frequently, when I respond excitedly with: ’emergency medicine (EM)’, I receive negative remarks or horror-stricken faces. The media portrayal of EM definitely doesn’t help. I often have to answer questions such as:
‘But won’t you just get burnt out?’
‘How will you balance the night shifts and unsocial hours with family life?’
‘Aren’t emergency physicians just gloried triage nurses?’
Doctors, especially those not in acute medicine, will sometimes try to persuade me to rethink my interests or career options. At first, this used to really make me upset and question if I truly was capable of succeeding in a career that is notorious for being brutal and stressful due to the sheer workload, lack of resources and unsocial hours. But now rather than getting upset, I feel confident in my choice of pursuing a career in EM and attempt to combat any myths people have regarding it.
The reasons I am so confident that EM is the career for me are numerous but include the following:
- I’ve had placements in literally every other specialty
At my university, we get the opportunity to rotate through every single specialty from pathology and microbiology to neurosurgery and cardiothoracics. As such, I believe I am ideally-placed to comment on which specialties I am best suited to. Out of all the different departments, however, I have spent the longest time in the Emergency Department. By the end of this academic year, I will have spent a total of nearly 11 months in the ED – all as a medical student! This year has really highlighted my passion and love for EM. Why is that?
We all know variety is the spice of life and EM offers me that. In a single shift, I can go from seeing patients presenting with stroke-like symptoms or chest pain to those presenting with poly-trauma or full-blown cardiac arrest. But at the same time, there is always periods of ‘down-time’ where the workload consists of less severe conditions such as a common cold! I could never see myself specialising in one area, e.g. cardiology, as I could not bear the thought of seeing the same conditions day in day out. Every day I learn and see something new in the ED. Cognitive stimulation is really important to me.
I have said this time and time again but there is no better team in a hospital than the ED team. Even as a medical student, I can walk around the department and nurses, porters, doctors and receptionists will say hello to me and ask me how I am. It’s this sense of family and support that makes EM such an amazing specialty. Everyone looks out for one another’s well-being. Period.
In EM, the priority is always ruling out any life-threatening conditions and making critical life-saving decisions and interventions accordingly. Being able to do this opens up many doors into other exciting ventures. For example, pre-hospital emergency medicine (PHEM) has recently been recognised as a formal sub-specialty and this is an area I hope to pursue as it involves taking life-saving care to the roadside. These skills can be used anywhere in the world, whether it be during humanitarian crises, on the front line in battle or even on a navy boat. I plan on taking full advantage of these opportunities!
Other opportunities include attending national and international EM/Trauma conferences where you can meet doctors at the forefront of EM and partake in high-fidelity simulations. This year I have attended several conferences and EM/PHEM courses, all of which have inspired me tremendously. EM is ever-improving and it’s very cool to see this change and be an active part of it.
- Practical Skills
EM requires a great deal of thinking. As soon as the patient walks into the room, the assessment begins. You judge their gait, their facial expression, the strength of their grip during the handshake etc etc. Long story short – you have to be like Sherlock Holmes. Nonetheless, along with this, there are lots of practical skills involved that EM doctors must learn and perfect – a lot of which are really cool! The basics involve cannulations and ABGs but as your exposure to EM increases, other more intricate, invasive and adrenaline-stimulating procedures can be learnt such as thoracotomies, intubations and REBOA. It’s this perfect blend of knowledge and clinical skills that makes EM so attractive.
- Shift Work
Although shift work has its obvious cons such as meaning ED doctors have to do some night shifts and weekends, it also means that once your shift finishes, somebody will be there take over for you so you can finish as close to the right time as possible. Furthermore, the 4 nights on, 4 days off work schedule is common too meaning you can use those 4 days off to go abroad without having to use your official holiday leave. This is definitely a big plus of shift work.
This academic year has given the opportunity to spend almost an entire calendar year in the busiest major trauma centre in Europe. I have been involved in cardiac arrests, numerous stabbings, countless traumatic brain injuries and some drunk patients! All of this has confirmed for me that EM is for me and I am for it. I have some very exciting opportunities coming up in 2018 in Johannesburg’s ‘Bara’ hospital as well as an upcoming attachment with an air ambulance service. I cannot wait and aim to make full use of these INCREDIBLE opportunities. I am also currently organising a highly-anticipated two-day regional conference in EM, PHEM and Trauma.
By no means am I disillusioned, however. I am aware of the downsides of EM such as the scary burnout rates but believe as long as I keep up my hobbies outside of medicine, seek support from those around me and live a healthy lifestyle, these downsides can be mitigated.
I urge all medical students to find the specialty that really suits their character, interests and skill set and to pursue it no matter what the naysayers tell you.
What are your favourite specialties? Do you already know what you want to specialise in?
As always, thanks for reading and keep smiling! 🙂