As our EM-bound future colleagues embark upon their sub-internships this month, it is prompting me to reflect on what I love about EM.
Fifty years ago, emergency medicine consisted of interns in a single room in a leaky basement (the “pit”), with no residents, no specialty status, and plenty of staffing struggles. How did we evolve into a specialty of innovation that cares for patients 24/7/365, from everyday problems to a global pandemic? How did we become the front-line specialists patients hope for when they ask, “Is there a doctor on board?”
Emergency medicine is about adrenaline-pumping, trauma-based critical care. In an exciting, almost poetic, sendoff of my last Critical Care Trauma residency shift, I took care of patients with GI bleeding, traumatic arrest after a fall, stroke symptoms, TB symptoms, diabetic ketoacidosis, painless jaundice in shock, status asthmaticus, new-onset AFib with RVR, and penetrating trauma to the neck, extremity, and torso.
But emergency medicine is also about the “small” wins, like reassuring the first-time mom who thought her newborn was breathing funny at 3 am, the patient with abdominal pain who said, “Thank you for explaining that so well,” and the patient with end-stage cancer whom you steer toward a path of dignified death by establishing goals of care and home hospice.
Here is what unites all of these scenarios: Emergency medicine is about serving our patients, all of them. We are the only specialty legally and ethically bound to the principles of EMTALA — no choosing or dumping of patients. Our specialty emerged from patient demand as patients kept showing up to the “Accident Room” at all hours despite long wait times, nonexistent emergency care systems, and questionable care. We meet our patients where they are, in sophisticated hospital-based emergency departments, freestanding emergency centers, and increasingly in virtual and home-based settings.
This spirit of adaptability and innovation is also reflected in our adoption of bedside ultrasound and FOAMed. Our unique window into our patients’ needs drives our leadership and advocacy for them, whether it’s pushing for a consult, admission, or follow-up within the hospital, or addressing policy issues and supporting social emergency medicine beyond hospital walls.
As EM-bound medical students, you will receive a lot of solicited and unsolicited opinions about your specialty choice. I'd like to pass on some advice I received as an MS-3: Don’t let anyone who is not in the specialty tell you what it’s about. This might be difficult if you don't have mentors in EM, but now that you’ve read this article, you have at least one. EMRA can help you find you even more.
The only constant in our specialty’s future is change. To say otherwise would miss our entire history of evolving with the needs of our patients. Every specialty faces challenges and the unknown, but not every specialty shares our story, ethos, and potential to shape our future. I believe emergency medicine will continue to be an amazing specialty to work in because of the EM community you are about to join, and our willingness to be there for anyone, anything, anytime, 24/7/365.
- 24|7|365: The Evolution of Emergency Medicine https://www.emra.org/about-emra/publications/legacy-documentary/
- A Brief History of Emergency Medicine Residency Training https://www.emra.org/about-emra/history/history-of-em-residency-training/
- Impact of EMTALA. EMRA Advocacy Handbook. https://www.emra.org/books/advocacy-handbook/impact-of-emtala/
- Year 2068: The Next 50 Years in Emergency Medicine https://www.acepnow.com/article/year-2068-the-next-50-years-in-emergency-medicine/?singlepage=1
- Anyone, Anything, Anytime: A History of Emergency Medicine by Brian Zink
- Missing Square to Shining Star https://vimeo.com/user29005187/review/698166798/9fe799b804