AMA with Deborah Diercks – SAEM President & UTSW EM Chair – 2/2/15

The first is that we all will burn out, the second is that we are just “triage” doctors and the third is the perception by the lay public that we will someday pick a real specialty

I think the most important advice I every received is to set my priorities and keep them in mind at all times. The other was never be afraid to take a chance.

I think my biggest career highlight is being able to raise 2 great daughters and maintain an academic career. I think having a great peer group in academic medicine has really helped me keep being productive even when things got tough to balance.

When you go into a job offer you really need to have decided what is important to you. Most of us choose between time and money. Know the job market in that area and what you will offer to the institution. T

I think my best mentors have been Brian Gibler because he showed me what academics was about and supported me as I tried to get involved. I think Judd Hollander has been a great mentor. He is my go to guy for career advice and is a great person to bounce ideas off of.

I think the best advice I have received was to not define balance based on my perception of what others expect. We all define our own balance. I think that is a great lesson for junior and senior female physicians. We have to be happy with ourselves. Defining success based on others expectations makes you always feel like a failure.

My best advice would be to first get involved in some of the professional societies. It is a great way to see if you like the people, show you are really serious, and make contacts. The next thing would be to define a niche that really interests you.

I am fairly new at this chair thing, but I definitely don’t think hour long didactics work anymore. Didactics need to be brief with a focused message. Case based interactions seem to keep people interested.

Meetings, meetings, meetings. I got some great advice from the Dean when I started and he told me to block off time for myself. I have 2 4 hour blocks a week to do research and work on things that interest me. I have an open door policy so even some of that time fills up.

I think as female EM docs our biggest challenge is having our voice heard. That can clearly be a problem in traumas. I have learned that it is often more effective to whisper in the ear of the “trauma” leader what needs to happen and they usually do the yelling. Being in control isn’t being the loudest, it is being the one listened to.

I read PREP (goes over peds topics), review cardiac topics for my research, and then look at all the journals that cross my desk. Usually, I learn the most by looking things up on shift. It is one of the things I love about night shifts. I have a little time to read up on topics.

I think they are concise and great ways to learn. I actually like looking at twitter and such. As long residents use them to supplement some more in-depth learning they are great tools.

I was at a conference today and concussion was a big topic. There is a lot of work being done on post-concussion syndrome and I hope in the next 5 years we will be able to predict who will have long term side effects from the injury.

Resident wellness is always something we talk a
bout. I am not sure we have it right at this point. Our current practice of focusing on wellness days seems to miss the mark as it needs to be a daily focus.

I think we will be a lot more specialized which will place EM docs in practices outside the ED. As this occurs we will have an increased presence with hospital leadership.

I usually look at Annals and AEM. It is really tough to read everything. I appreciate the FOAMed and social media that review some key articles because I also miss some good stuff.

I do think it is valuable. I decided to get a MSc after working 6 years. It really has helped me speak to statisticians and provided me with much more skills to use when I do research.

I think the clinical cases I struggle with are the ones that I am on the fence about admission or discharge. It is so much easier to admit a pt, but that isn’t always the best for them. This requires me to think about every risk and aspect of the care of the patient.

Tha is a good question. I think that the ADAPT trial on rapid cardiac rule out has strengthened my views around serial cardiac testing. I also like the study from Ottawa on clinical prediction rules for SAH.

Great question. I think that a making sure your mentor understands what you expect from them and understanding what they expect from you is essential.

Networking is key. Talking to people that you respect can inspire you, clarify your academic goals, and perhaps gain future collaborators. I have met all of my research collaborators through SAEM or ACEP research forum.

The hardest thing is worrying about the finances and not being able to have the funds needed to help the faculty succeed.

The rule that I have been using lately is pretestACS consult from Jeff Kline. It provides a post-test percentage risk of ACS and I can easily enter that into the chart.

I think the thing I took away from that was the utility of a D-dimer + a low risk assessment is pretty good for excluding the disease. I was really surprised though by the lack of good data about any of the treatment goals in terms of blood pressure that exist.

I have a bunch of cases that I collected over the years. I like to have the residents take a breath, sit down, and go over a brief case for 5-10 minutes during the night shift. It is a great way to relax and learn.

This topic was big and the conference I attended today. I have not given up on them, but realize that there is not much data to support their use. I don’t reach for high dose epinephrine.

I learned log ago to make sure I am closest to the door. I make sure I say the “bad” words like cancer and died. People usually stop listening at some point and I try to make sure they hear the key message.

Laughter and appreciation. Having fun keeps everyone moving and saying thank you makes people want to work with you. On those terrible shifts when things get bad, I make sure I say thank you to the nurses, tech, and residents for how hard they worked.

In traumatic arrest if there is a wide complex rhythm, I usually don’t code the patient and don’t put central lines in. I think junior residents should put in lines and do procedures during codes. The reality is most will not survive. We have alternative methods of giving medications in most cardiac arrest patients. I really encourage residents to try a “pocket shot” subclavian line during codes.It is good to do during CPR and you can run the code as you are facing the right way.

< span class="replyText" style="width: 100%;">I am reading a book about “coaching”. It is a good way to help talk to patients, nurses, and residents to try to help them work through issues. It isn’t about being a doctor but can help improve the work environment by enabling people to address challenges.

First I make sure that I have gotten past any emotional issues with the event. I try to identify the issue. When I give feedback I make it clear I want to discuss the action or issue at hand and not the resident as a person. It is like not telling the person “you didn’t treat Ms x correctly”, instead I try to say ” I was disappointed that Ms x did not get antibiotics in a timely manner” That focuses on the action and not the person.

I try to make sure I consider them and then make sure I reconsider them if my usual high risk disease work-ups don’t reveal an alternative cause and I have some concern labs, vitals, or an exam. Bottom line, I try not to be so dogmatic that I don’t consider the improbable.

I really like when a resident isn’t afraid to say what they think the patient has and what they want to do. It is so much more fun to have a discussion around the “art” of medicine. I am not sure that there are things that residents do that I hate. As long as they are working hard and doing the best they can it is my job to help them take care of patients and learn.

A great EM physician has the ability to think outside the box of what is expected.

I knew someone would ask that and I don’t have it in from of me. Robert Hicks in the author.