Jack of All Trades

My emergency rotation helped me realize emergency physicians are quite amazing as jacks of all trades. As I see what they handle in the ED, I am impressed by the diversity of illnesses and injuries. Of course they handle the bread and butter of internal medicine - pneumonia, congestive heart failure, COPD exacerbation, heart attacks, gastrointestinal bleed - and basics of surgery - appendicitis, pancreatitis, wound infections, abdominal aortic aneurysms. But I was impressed by how much other stuff they handle - strokes, vertigo, migraines; suicidal ideation, hallucinations, psychosis; broken bones of all sorts; eye complaints of all kinds; vaginal bleeding; and all the pediatric cases I don't see. The procedures they do span a gamut of specialties: incisions and drainage, slit lamp exams, sutures, cardioversions, thoracentesis, lumbar puncture. There are also all the things no other doctors know how to handle: snakebites, dental problems, unusual overdoses. They are the only physicians that consistently cross over from surgery to medicine lines of thinking. During traumas, I've seen great attending switch from trauma mode (looking for CSF in the ears, palpating all the bones, getting X-rays and Foleys and calculating GCS scores) to code mode (calling out for epinephrine, slapping on pads, starting compressions) smoothly and without fail. Emergency medicine physicians really feel comfortable with any presenting complaint or symptom.