Is Emergency Medicine a Failed Paradigm: Scott Weingart and Simon Carley
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- Опубліковано 27 лис 2021
- #emergencymedicine #medicaleducation
Scott presents the argument that whilst Emergency Physicians are amazing, as it stands, Emergency Medicine is failing.
Scott presents the system as it should be.
This involves stabilising the critically ill before admission to the ICU, seeing sick patients in appropriate time and seeing the less sick patients as you can.
The issue as it stands, is when this system breaks down. He talks about the ‘boxes’ which now includes the ‘not sick at all’ patient. This leads to Emergency Physician’s not doing what they are trained to do.
Scott discusses the issues with the outcome measurements of Emergency Departments. Hospitals measure patient satisfaction and wait times.
Moreover, Scott argues that a trip to the ED should be the worst day in a patient’s life and measuring their satisfaction is misleading.
A good medical outcome should be the indication of success.
Scott also discusses the issue of Emergency Physicians not dealing with emergencies for most of their practice. This, in Scott’s eyes, leads to cognitive dissonance, where ED doctors are not doing what they are trained to do.
Simon argues that Emergency Medicine is not a failed paradigm. Emergency Physicians are trained to help people, when people feel that they need to be treated.
He claims that doctors in this speciality want to treat a wide variety of people across a wide spectrum of disease.
Evidently, Simon discusses a ‘revolution’ in Emergency Medicine. An increasing number of people are attending Emergency Departments across the world. The generalist approach of Emergency Medicine is critical in triaging, treating, and helping these people in their moment of need.
The skills, breadth of knowledge and wisdom and ability to work across a range of specialties and in uncertainty is what makes Emergency Medicine and the physicians who work in it special.
Join in the debate as Scott and Simon argue for and against the place of Emergency Medicine.
codachange.org/is-emergency-m...
Thank you Scott Weingart for summarising the core issues of Emergency medicine and the ones I have been struggling with as a trainee. The cognitive dissonance that I have had over the last 3 years are encapsulated in your arguments and explains why I experience daily micro-aggressions towards ED from other specialties, the laughs and complaints I hear re ED when I hang out in groups of doctors outside work. I will be looking to transition to another specialty to look after sick people and to work in an area that is respected by my peers - I got into ED for the reasons Scott stated and other specialties provide this.
As for a revolution, I think this is overly optimistic with no indication EM is heading in this direction. If a pandemic-sized stress cannot induce a revolution in the specialty, then nothing will. I foresee ED to take over more roles of a burdened primary care setting, more nurse practitioners, CMOs, GPs working in ED to take on more of the job and for medicine to take a larger chunk of the health budgets. ERs are not well suited for efficient screening of well patients. I foresee other specialties taking the interesting, sick patients more and more.
Kinda weak to let other doctors joke in their casual convos affect your career path
It was a great presentation. We, emergency medicine specialists who are part of the show, face difficulties all over the world and especially in Turkey, where performance anxiety is at the forefront. We definitely need a new paradigm.
Thank you very much for your guiding and eye-opening conversations. And I wish SMACC and CODA would continue...
Calling it "EDM" alone would be great marketing for sure. Break out the glow sticks.
👍
Emergency Medicine is a weak specialty, primarily because with a little bit of training in a few procedures anybody can do it to include internists and family physicians. Other than spending seventy percent of our time in front of computers as data entry clerks, the rest of our job is mostly minor care and routine exacerbations of chronic medical conditions.
There are relatively few high acuity ERs where the Emergency Physicians spend any significant part of their shift with really sick patients. I’m not saying we don’t handle emergencies, but as an example, I worked in a city of about 150,000 that had eight full-service Emergency Departments including a level one university trauma center. There are not enough real emergencies to justify that. Which is why every single one of them advertised for patient on billboards.
As a emergency medicine fellow that's definitely true
It depends where you live. More low-middle income countries see a wide range of emergencies. There is a large admin burden but in South Africa where trauma, communicable and non-communicable illnesses combined with the social realities…there’s much value in emergency medicine.
If I could post a shia Lebouf standing ovation meme, I would.