The fast life in the ER?

The past week I ‘worked’ in the Emergency Room. My expectations: patients being rushed in, fast thinking, quick treatment. Reality: none of that. First, I must admit that it wasn’t that busy, and that there haven’t been any vitally threatened patients. So that may have influenced my observations.

This is how it works:
1. The patient is announced to the specialist on duty through the ambulance team, GP, etc.
2. The specialist on duty calls the assistant on duty to announce the patient
3. The assistant on duty calls the secretary to announce the patient
4. The assistant prepares himself by reading the patient’s records
5. At some point the patient arrives
6. The patient gets screened by nursing staff
7. Vital parameters and short history are taken by nursing staff
8. An ECG is made
9. Patient goes to the radiology room for chest x-ray
10. Doctor can go see the patient.

There are NINE steps to be taken before you, as a doctor, can go and see the patient yourself! Of course, when the patient is vitally threatened, the doctor is called way earlier. But this doesn’t sound like the fast life, does it?

I did my exam this week, and my patient was announced at 9.30am. Guess when I could finally go and see my patient? Three o’clock!!! Of course all these steps didn’t take 5.5 hours; the patient only arrived at 2.30pm. But still.. My expectations before I started where that when a patient was announced, you would sorta rush over. Well, that’s not really the case!

Nevertheless, I really liked my time in the ER. I was finally able to see patients for myself (not really possible on the wards) and think of possible diagnoses and treatment plan. My exam went well, and I noticed that I have gotten a lot better at history taking and physical examination than 4 weeks ago. A LOT better. It feels pretty natural now. I also feel comfortable enough going to a patient and doing what I need to do there. I notice that I’m good at making contact with the patient (I’ve seen many psychiatric patients) and that communication and conduct goes really well. I’m slowly improving at differential diagnostic thinking and direct your questions and examination based on that. There’s so much to learn still but it’s good to notice that you are actually learning as well!

Edit: this was my ER-time with Internal Medicine. I had a completely different experience with Surgery.

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One comment

  1. Welcome to doctor world.
    I remember similar thoughts crossing my mind as i was going to ER for first time. Ofcourse things dont happen as we see them at Mercy West Hosp on tv. but still ER is much quicker than wards are.
    And in Pakistan we dont realy get to see patients at no 10. its way earlier all the time.

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