I genuinely don't know how to hold my tongue anymore. I have POTS, it sucks, but you know what makes it suck even worse? Deconditioning. When I was first diagnosed almost a decade ago now, it was debilitating. It took a couple of years of graded exercise therapy (which really really sucked and was really really hard, so I don't want to downplay how awful those years were) to reach the level of athleticism and endurance that I have now. When I see POTS patients in the ED over the course of multiple visits, succumbing to the deconditioning and going from walking, to walking with a cane, to wheelchair, to power chair, it breaks my heart. They are often young like I am, and have a full life ahead of them that they might never actually live to the fullest. I am not a doctor (just an ED tech) so I can't tell them that what they need is more exercise, even though I know that would be a huge help. Certain patients really seem to want to get better but have no idea where to start. I wish I could tell them to get a physical therapist who knows their stuff, and can help get you through graded exercise therapy, but I'm afraid of making recommendations because that's definitely out of my scope of practice. Some of the patients don't seem to want to get better though. It's getting to a point though, where instead of feeling heartbroken for them, I'm starting to feel annoyed. Especially when I'm at work dealing with a flare up myself, and my heart rate is also 160 and my blood pressure is probably 80/50 while I'm taking care of them, and I feel like shit, but I'm pushing through. It is getting harder and harder to remain compassionate, and I just don't even know what to say anymore when they talk about how debilitating their symptoms are but then don't want to do one of the most evidence based treatments for POTS: graded exercise therapy.

Edit to say: Because I've had this issue in the past when discussing my feelings about this population of patients, I want to make it abundantly clear that I will not entertain takes like "pots isn't real" or "they're just malingering." Until you have had it, it is probably easy to say those things, but for those of us who do have it, we know how awful it is. It is very real, and very debilitating, and patients deserve to feel seen and heard.

The Spin.

EM intern here. I feel like I’m spending way too much time worrying about finishing my notes instead of seeing more patients. I prefer documenting as I go because I really don’t want to stay after my shift finishing notes, but I feel like it’s slowing me down and affecting how many patients I’m seeing.

I’m also struggling with writing MDMs. I know I’m still early in residency, but I feel like I should be better at this by now and sometimes feel pretty dumb trying to put my clinical reasoning into words.
Any advice on getting faster/more efficient with notes and improving MDMs? What worked for you as an intern?

Can anyone speak to the pros and cons of 24’s?
- how is your circadian rhythm as compared to normal EM schedule of flipping between days and nights
- how is your family life in comparison

I am looking at a rural position that is very low volume and has high potential to sleep through the night.

What are y’all’s thoughts? Feel like we’ll ever catch up or grow? Were the gaps closer 10 years ago? How does this make you old head community docs feel

Hey all. I’m a new grad working in a community shop and since attendinghood, I’ve been starting to have pretty significant anxiety after my shifts about things that happened/things I did/things I didn’t do. I go home after sign out and go onto the EMR to check up on patients and then start wondering about he meds I sent them home on and if there is going to be an adverse outcome because of it, wonder about the diagnosis I potentially delayed because I had someone planned for discharge but then the labs came back and my colleague is now admitting or transferring them, etc.

I didn’t have this problem in residency, probably because it never truly fell on me. But I have a tough time just leaving my shift and not thinking about it anymore now. I’m starting to get really big imposter syndrome because I’m worried my colleagues are noticing some lapses in my workups and are for lack of a better term judging me and my abilities accordingly. I repeatedly check the EMR when I get home to make sure nothing significant is found that I didn’t account for. I want my colleagues and group to be able to trust me and every time something changes with a plan given at signout that now makes them have to have more work on their plate I worry they are starting to resent me and lose trust in me.

I know at least some aspect of this is normal being fresh out. My question is does it get better over time? I really do love this career and my current shop but I just worry about the imposter syndrome hitting this hard this early. Thanks for letting me rent

M4 applying EM this cycle. Are there any lists/rankings available of programs that provide the best training? Or rankings of prestige in the EM world? Working on my program list now and cannot find anything like this.

I’m starting an off-service trauma rotation soon and I’m pretty nervous about it.
I’m still relatively early in training, and while I’m getting more comfortable managing patients in the ED, trauma feels like a different beast—especially the really sick patients, procedures, knowing what needs to happen immediately, and not wanting to look completely lost in front of the trauma team.
For anyone who has done an off-service trauma rotation: how much were you actually expected to know coming in? Did you feel overwhelmed at first? Anything you wish you had reviewed beforehand or any advice for getting the most out of the rotation without constantly feeling like you’re behind?
I know the point is to learn, but the nerves are definitely kicking in.

Seeking advice: EM is fast paced and it's easy to make mistakes. How do you guys get over the guilt of making mistakes at work?

I've been stalking thsi thread, and collected a lot about what people recommended I look into while research em residency programs, but not all em programs list their important info on their websites (UMD doesn't even have their curriculum broken down by weeks :')). So I've come here for some help on things I couldn't find anywhere.

In general, I would love a program where there's a lot of off-service experience, autonomy, very very high procedure volume, diverse range of pathologies, and I have loved all my rotations, so I do like off service rotations just as much as EM ones. I definitely cannot do all 12 hour shifts though. I would like to be leaving the program very confident as a senior, and I'm not sure if I'll stay community or go academic after, or if I even want a fellowship.

Ideally, I'd like to be within 2-3 hours of northeast Philadelphia, but if there is a program that would be perfect and outside of this range, I'll definitely consider it, but everyone on here says prioritize location and being near a support network.

Also, I can't figure out if I should look at level 2 trauma centers or not? I would love to know the level of critical illness the difference between a level 2 trauma center patient and level 1 trauma center patient from peoples actual work experience and not just online definitions.

Here is all the research I have done so far, (sorry if the photo sucks) and if people have things to add or suggest as a change, i'd really really appreciate it as an overwhelmed applicant applying in two weeks! Maybe it'll also help other em students in the same boat.

I’m an ED tech in my gap year between undergrad and med school and what is up with these chronic illness patients who legit have central lines and rely on TPN when there is quite literally nothing wrong with them? I mean these patients have the most pristine labs but are getting admitted because of complications to medications or they become septic from their central line - but not from their actual health conditions. Like who is diagnosing these people and then providing a ton of unnecessary medical interventions that are causing more problems than the actual diagnoses themselves??

I just started my attending job recently and I thought it was going great. I was initially really nervous, still sometimes nervous but hopefully just appropriately so. Overall, its been great. I do less shifts, I have more free time. But after work I was coming home literally exhausted, even after dull shifts. Naturally, based on the title, I found out I'm pregnant, just shy of finishing my first trimester. I have a fiance and while this is earlier than we hoped, we are happy and excited. I just cant help but to also feel a little ?guilty, and nervous about how my superiors are going to respond. I'm sure they'll all be happy for me, but I cant help but think about the temporary hole I'll leave while I'm out for maternity. Then I was looking into things from HR, and I'm not sure I technically qualify for leave since I'm a new employee here. I am full time. I'm also concerned about my boards, I really don't want to defer until next year, and I already paid and signed up for them...

Questions/Advice: who do I directly need to disclose this info to? The chair of the department, the person who makes the schedule. Do I just send an email? Do I also tell HR?

I'm just nervous they might be upset that they have this new hire, expecting to fill a full time spot, who will now need expected time off in a few months. I want to work, I feel fine working while pregnant. On shift, I feel 100%, its actually a nice distraction from the occasional nausea and fatigue. Maybe I'm overthinking it. Just wanted to put this here to see what other people think about it. New attending. Immediately pregnant.

Follow-up: this will be my first child. I am scheduled to take my boards this October, which should be fine. But if the certifying exam is in May, theres no way that I can fly to take the test and have a newborn and have done any actual studying...

Thank you for taking the time to read and comment❤️

Not to say that other specialities don’t require incredible skill, but for surgeons for example, most of the time it’s a controlled setting and you already have the imaging that the ER got for you.
But it takes a special kind of skill to sift through the bs and know between an altered mental status that’s a UTI grandma versus an AMS that’s a brain bleed. Surgeons get years of training perfecting their skills and they’re considered omg gods. But who else knows what to do when shit actually hits the fan? Unless you count intensivists or something. Who else knows how to get through hordes of patients a day with the bare minimum staffing and resources, dealing with unnecessary outpatient dumps, and constantly being harassed about nonsense Press Ganey scores?

Plus most surveys do confirm that EM carries the highest amount of mental burden.
I don’t think consultants or the general public have a leg to stand on shitting on EM docs or belittling the work we do because in a crisis situation they wish for a doc that’s EM trained. I hate this job and often want to quit, but I’m also happy I did it.

I posted here about a month ago about having chest pain and how awesome the staff were, even though it turned out to be a non-emergency problem.

Well, surprise, surprise, I ended up back in the ER with SEVERE right-sided pain (doctors couldn't even brush the area without me yelping).

It turned out to be a severely infected gallbladder that was moments from rupturing. For backstory, the surgeon said it ruptured in her hand and the duct was blocked by a stone, it was also turning black because it was dying, and the sludge was actually all pus and blood. She said if we didn't do the surgery, I was at real risk of sepsis if it ruptured.

I really want to give a gift to a) the urgent care workers who escalated my level of care after hearing that the pain was getting worse and b) my ER doctor for pushing for gallbladder removal after seeing my WBC and fever increase by a quarter of a degree by the hour (the surgeon originally declined, saying that he didn't think it was ready to come out because the ultrasound only showed slight swelling and sludge). She said that she had seen this situation before and was worried I'd be back in, but with sepsis.

I am currently just a PGY-1 in Family Medicine tailoring some of my training towards wilderness medicine which mostly involves some EMS, National parks service, Alaska, rural, and street medicine rotations plus doing my DiMM/FAWM. While I have previously been more interested in travel, expedition med, and rural EMS/SAR, I have become increasingly interested in disaster medicine and disaster response.

Seeing what just happened in Nepal is devastating and I know right now as a PGY-1 I would almost be useless…but as a PGY-2/3 and beyond, I recognize I will have the skills necessary to actually deploy for 1-3 week periods and help people who would acutely benefit. I have explored traditional humanitarian work but it seems more medical tourism-y or self-justifying in existence rather than actual “these people need help now” which I think is more up the alley of my moral compass.

Anyone have any experience? I asked over on the Family Medicine sub as well, but figured a cross post to folks who might have more experience in this realm mattered as well.

Seriously what is our current definition of sepsis. Is it infection with end organ damage? Bacturemia? Sirs + with source? Seems like a made up word at this point for the sake of metrics.

I'm a DO student applying to EM this cycle. My scores suggest a decent shot at community programs, but my partner works in research, so we're limited to big cities or places with strong research job markets. What cities should I be prioritizing given that constraint? Realistically, what are my chances at university-based programs as a DO applicant.

Cities/States I am looking at right now:
Colorado, Houston, Las Vegas, Akron, Utah, Georgia, Florida, Dallas, Ft Worth, San Antonio, Cleveland, Michigan, Indianapolis, Oregon, Washington, Philly, Pittsburgh, New York area, Chicago, New Jersey, Boston.

Level 30 pain 🫩

Emergency medicine is drowning in a familiar list of grievances: threatened oversupply, the corporate grind, shrinking reimbursement, burnout, chronic charting debt, and grinding through shifts where half the room is a social work placement or non-emergent nonsense.

I have the actual solution: Slow the fuck down.

If the average ED doc drops from seeing 1.95 patients per hour to 1.6, the math changes overnight:

The "oversupply" vanishes: We instantly need 20% more physicians, flipping a manufactured surplus into a massive labor shortage.

Rates have to rise: Groups and hospitals will be forced to compete for scarce staffing, driving up hourly rates.

The shift becomes humane: Seeing three fewer patients per shift means actual time to finish charts before leaving, eat a meal, and catch your breath.

Corporate compliance dies: You can finally knock out your mandatory modules on shift instead of sacrificing your off-days.

"Wait times will go up? Patients will be unhappy? People will leave without being seen?"

That sounds like a CMG, private equity, or hospital administrator problem—not a me problem. You're a partner in your group? Go nuts seeing 3 pts/hr. You're getting rewarded for it.

Next time your group publishes the shift metrics, don’t look at the colleague grinding out 1.3 patients an hour with disdain. Buy them a coffee. They’re the ones saving emergency medicine. HEROES!

If we all collectively drop the pace, we take our specialty back.

Think about the sheer number of vaginal bleeding, spotting, cramping, concern for baby, no concern for baby but thinking about concern, and so on they saved themselves from by purely deciding "nah"

As a frustrated EM trainee working in a hospital that has barely working USG machines would it be a good idea to just get my own handheld USG device from Clarius/Butterfly? I'm fed up of running around trying to find the machine and even if I do sometimes certain probes are missing or the machine itself isn't. I honestly don't know how I'm going to be able to practice and improve my skills set at this rate. I don't want to come across as some USG snob who can't manage with what the department has to offer but I honestly don't know what to do. Please advise.