EM Collective Wisdom: Pik Mukherji
Author: Pik Mukherji, MD (EM Program Director / Assistant Professor, Northwell Health) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)
1) Why still Emergency Medicine?
“Still?” Nothing has changed. I only had two thoughts.
1. I wanted to be a doctor. Capital “D” doctor. Not for this person or that one. Not only if they’re this old, or that gender, or with a problem below the wrist on their dominant hand. I wanted to be a doctor for anyone and everyone.
2. I wanted to make an impact. That means I wanted to be where I was most useful and available when someone needed me. The best argument for this aspect of EM is the counterpoint that is the general failure of screening as a strategy.
2) Most impactful case.
Discharging a patient from the ED after she’d had CTs of the head and chest and consults by the ICU and Neurosurgery. She was treated based on her imaging reads and MD intolerance for hypertension rather than her clinical complaint and exam.
“When the patient and the test disagree, the patient is always right.”
3) Most important career decision leading to satisfaction.
Leaving community medicine and urgent care work to be in a teaching facility. Realizing that career advancement is best attended to slowly, if you’re planning a long work life, or if you don’t want your wife to leave you.
4) What does future of EM look like?
Remember when Al Pacino is talking about how it’s the peak lawyer age and how many lawyers are coming up all around the world in “The Devil’s Advocate”? Like that, except with EM docs and Steven Stack instead of a literal devil as a cheerleader.
5) Greatest achievement / why giving back is important.
I’m not sure there is a single greatest achievement. I think it’s the sustained practice of getting through every shift with your best effort over a period of many, many years. The narrative in your head becomes the heroism of Sisyphus, rather than the glory of Achilles. You touch thousands of lives in ways you can’t really appreciate, and a few lives in ways that you can.
6) Favorite failure.
My favorite failure is the case where the crazy zebra thrown into the differential diagnosis by the resident turned out to be right, while my well-reasoned and strongly argued prediction made perfect sense but was so very wrong.
“It’s better to be lucky than good. It’s best to be both.”
7) One thing you would change about our field.
The idea that it’s possible to get to choose something about EM to change is strange to me. Our field is a product of necessity and circumstance. The EM that my residents are expected to learn has little in common with the specialty that the early founders practiced in, or the one in which I trained. As time marches on, I expect our scope of practice to only grow broader.
If I were to put something on the wish list, it would be a system that incorporated video recording of the patient interaction that could be viewed in real time by consultants and admitting physicians, as well as for personal review and feedback.
8) Something that you love that has indirectly impacted your EM career.
Books. I love books. Every time I read something that I think isn’t remotely medical, it somehow reaches my EM practice. I think it’s because we treat people at every walk of life, every occupation and socioeconomic level, so there’s always something relevant to one of my patients. Now I recognize the index finger of a baseball catcher as well as I do a STEMI.
3 people you’d like to see fill this out
1) Steve Smith
2) Steven Stack (short answers required)
3) Simon Carley (yes, I know he’s not in this country)