EM Collective Wisdom: Judith E. Tintinalli

Author: Judith E. Tintinalli, MD, MS (Chair Emeritus, Professor, Emergency Medicine, University of North Carolina at Chapel Hill) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

Hey, I just really really like it! I worked last night: we were running from one sick person to another, shift flew by.  EM is still diagnostically challenging. I learn something every shift. I try to do new treatments, new techniques. It’s a stimulating environment.  And I amaze myself at the things I just don’t know, things I have forgotten, things I think I should know…

2) Most impactful case. 

It was at Beaumont Hospital in Michigan. Busy shift, lots of kids, I went to see a little kid who had fallen off his bike. Looked good.  I checked in on him maybe an hour later – mental status deterioration! I called Alexa Canady stat, I said Alexa, this kid has an acute epidural. I’m taking him myself to CT, and I’ll meet you in the OR.  After CT (which I didn’t have time to look at) I met her in the elevator with the kid on the stretcher; we were both on the way to the OR.  He indeed had an epidural hematoma, and Alexa’s rapid evacuation saved him.

Now, you should know about Alexa Canady. She was the first African-American woman neurosurgeon, and as such, first to be certified by ABNS. Famous. Expert. Devoted to her patients.  And at that time, as a pediatric neurosurgeon, she covered all the major hospitals in SE Michigan.

Impactful case because it reinforced to me how observation, clinical judgement, and a team approach can really save a life. And I was so proud to work directly with Alexa! I ran into the child and his parents at a local store later on. He was a normal, active, happy kid. Wow. I was smiling for days.

3) Most important career decision leading to satisfaction.

A couple of decisions.  I loved EM, but with a child and family in Michigan, and as part of the Bruce Janiak generation, there was nowhere to train for EM. Yet. After IM residency at the University of Michigan, I threw my cards in with Detroit General Hospital to work under the mentorship of Ron Krome. I took every opportunity he made available, and of course that led eventually to presidency of ABEM and editorship of The Study Guide.

But my second important decision was to go back, years later, to get my MPH at the University of Michigan. That opened my eyes to a new world of possibilities.  I wished I had done it sooner. I am so pleased to see medical students and young faculty getting advanced degrees so they will be better prepared than I was for EM of the future.

4) What does future of EM look like?

Popularity is growing, and EM is firmly established as a great part of medicine. I remain a bit skeptical about the emphasis on burnout though. Emergency Medicine is a great specialty. One can work overtime; full-time; part-time; locums; in telemedicine; suboxone clinics; doing clinical, educational, or basic science research; moving up the corporate ladder. The opportunities are endless. Our specialty gives us a lot more control over our lives and our practice than most other specialties (ok, maybe dermatology does that better… but who can look at skin all day?)

5) Greatest achievement / why giving back is important.

We have to keep the fires burning. EM was so exciting in those beginning years!  Us against everybody else!  Sometimes it is easier being a starter-upper than a maintainer-improver.  We have to maintain our dedication to patient care, our enthusiasm for the specialty, our commitment to participating in our societies so we can impact the political and administrative issues that stand in the way of improving the health of the public.

6) Favorite failure.

These are sure contradictory concepts. I was schooled by Ron Krome, and I always think of his approach as a ‘serrated knife’ when some other early leaders were smooth like a ‘carving knife’.  It has taken me years to develop a less politically aggressive style. The practice of EM means rapid-decision making and speedy change when you know how to make things better.  But institutions plod along and require ages of consensus to move forward.  Today’s EM leaders have learned how to mix these styles so they end up more in the middle.

7) One thing you would change about our field.

We have to change our MESSAGE about our specialty. EM IS A SYSTEM OF CARE. Not just a box in the hospital where some of us work.  Journalists, science writers, politicians, legislators, still do not understand what EM is and why it is important.  Every time someone makes a mistake about EM, or mixes up trauma surgery with EM, or says the ED is the most expensive part of our health care system, or says we are just a ‘safety net’ (that is a bad bad message, it is negative not positive), our specialty leaders need to jump in and educate them. This is a world-wide problem.  (If anyone reading this has a better catch-phrase for our message, let me know).

8) Something that you love that has indirectly impacted your EM career.



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