ER: general stuffs

So the ER. Still a thumbs up on my end. But its hard to be positive. There is so much I don't know, so many questions I get wrong. I wish I was one of the students who just remembered everything somehow. That's not true because half of this wasn't covered anywhere. How the heck do they know this stuff? I don't know it.  I feel quite a long ways from being ready for intern year. I know nowhere close to what everyone else seems to know.  Anyhow, I suppose I should say its easy to be discouraged when I put lots of pressure on myself. And this is my first rotation in the ER.

Lots of people have been asking, how did you pick this program to put so early in your schedule? This ER is one that is a program in the middle of my list, something I'm not broken hearted if i don't get but something I'm excited to get a letter from. I've heard most of your rotations should be at places like this because inevitably your first several rotations you aren't that amazing-- at least I'm not. So I put places I'm really keen about last or not at all. I'm pretty happy about the way this worked out because as I'm discovering it is a slow learning curve to learn the way they want you to do your job. And even if some doc somewhere says you're really good at it, another doc at another place will say "WTF, you suck at this."  Its a little frustrating.

So in ER, the letters of rec(LOR) are not the same as they are everywhere else. Most LOR are from one doc stating how long they've known the person, and what they think they're skills are. In ER, skillz matter more than someone liking you or not. They have developed something called the 'standardized LOR' also known as SLOR.  SLORs are just a sheet with different categories of skills listed and numbers behind them.  Things like ability to handle stress, ability to think on their feet, suturing ability, where that candidate resides on your match list, etc. Its almost an evaluation. And its LOTS of pressure.

Enough about that.  So I'm not seeing super crazy stuff here. Again its not a trauma center so its just general everyday stuff.  Although, I did see this lady who was a diabetic and had high blood pressure and she was only 30.  This is her foot.  Craziest amount of edema i have ever seen.  And so you know, she was thin not obese and her foot isn't broken, its just CRAZY swollen.  I undid her bandage and stared asking over and over are you sure this doesn't hurt?  She also has and ulcer on her ankle, that has been there for 3 years. Diabetics heal slower than everyone else.  You can see her toes and how her heel sticks out more.  It was super weird. And yet neat.

I must admit there are times when people come into the ER and I wonder why we can't help out the family practice/internal med people and start them on some BP or diabetes meds. Especially when their blood pressure is over 200/110 and climbing.  It makes me a bit nervous-- i always ask if we can send them home with some meds. Maybe this is more of a family practice/internal med mentality but come on!  You can just kick them out and say good luck..... Maybe this is the difference between primary care and specialist mentality.

So since I've no special stories, I'll take this time to quickly say, in ER its all about the presentation. You have to use your presentation (which should be under 30sec) to cleverly display your knowledge. Like use your negatives to show what you are ruling out. Report only the peritent findings and be sure to only address 1 complaint. This all sounds not too hard, but in the ER is quite a skill and something I don't have yet.  Try taking a crazy patient or homeless or any weird case you got, so and so who is allergic to their roommate, was hoping to get a CT on their heart because they missed their cardiology appointment for their heart murmur, is totally out of their meds, they get beatup by their boyfriend, and are 4weeks pregnant and were hoping for an ultrasound.  SO kids what is it exactly that they are in the ER for?  Oh yeah you only get about 10 minutes while they talk to decide and then examine them because you have 8 more people to see? In someways i envy the FP/IM people. They can have their whole visit concentrating on getting all of those things done for them, but in the ER you can't. You rule out what will kill them in the next 5 min and then kick em out with a "go see your FP"

Sometimes medicine is so flawed. I feel as if no particular field has everything I want. So how do I pick the best one?  Why am I still feeling so undecided and unconfident?