The Emergency Department

This week, I started my emergency department rotation. We staff the Stanford Emergency Room for 5-6 shifts each week, each shift about 10-12 hours long. I see any adults who come in, and I tend to focus on non-trauma patients. At a rate of 1-2 patients an hour, I can see around 15 patients each shift, each with varying levels of complexity. The emergency department is very different than anything else I've done before. It's really busy. Things move incredibly quickly, and the pace is occasionally exhilarating, occasionally mindboggling, occasionally exhausting. Patients are triaged by acuity and chief complaint, and I try to see a diversity of problems. Within a few minutes of seeing a patient, I try to come up with a tentative diagnosis and put in orders to prove or disprove my idea. It's different than internal medicine where I spend half an hour getting a story; in the emergency department, time is a premium. Unfortunately, this leads to high medical costs. While in the culture of internal medicine, I might spend an hour locating an outside hospital report, in the emergency department, I just repeat the study. This is not good for patient care or our society, but it is the culture of the rotation I am in. The stakes are also high; while many patients have non-acute issues such as chronic pain or a sore throat or a sprained ankle, there are always those who have a stroke or heart attack or other emergent pathology. We will see how this month goes.