EM Collective Wisdom: Michael A. Gisondi

Author: Michael A. Gisondi, MD (@MikeGisondi, Associate Professor and Vice Chair of Education, Department of Emergency Medicine, Stanford University) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

My mother was an ER nurse and my father was a firefighter… I like to think that I was destined for a career as an emergency physician. It’s in my DNA.

I was originally drawn to emergency medicine because I enjoyed the approach to the undifferentiated patient. I distinctly remember an overnight call on my 3rd year internal medicine clerkship at Loyola, when I was asked by my senior resident, “to go admit the CHF patient in ER room 5”. I replied, “Stop giving me the answer!” I learned then that my favorite part of medicine was diagnostic reasoning, so emergency medicine became a natural fit.

Still EM today… because I get to consider a wide range of disease processes as I make diagnoses throughout each and every shift. It never gets old.

2) Most impactful case. 

Those who have heard me speak about improving end-of-life care know that my most impactful case was the death of my mother, not in the ED, but in our home on hospice. She died of breast cancer in 2007. Her almost 5-year journey with cancer taught me so much about doctoring that I didn’t learn in medical school or my first few years of practice. Mom made me a better physician. I recognize the natural process of dying with a much deeper understanding, respect, and call to action. There is so much that we can do as physicians to better care for patients and families dealing with progressive, terminal illness.

3) Most important career decision leading to satisfaction.

I think this question relates to identity and purpose. Self-identity is loosely defined as a sense of knowing one’s self – in the workplace, this translates to professional identity. We commonly reflect on professional identity formation during medical training as a journey, or transformation, or transition, to becoming a professional – a physician. Obviously the decision to go to medical school was an important career decision that led to much personal satisfaction.

However, my professional identity continued to mature during my first 10 years of my practice – into that of a medical educator, university faculty member, and education leader. I enjoy working in the field of medical education, conducting education research, and challenging myself in a very traditional professoriate line.

My career decision to deeply engage in medical education was, and remains, somewhat of a risk. It has required a great deal of additional, non-linear faculty development and personal study. Funding for education research is limited and education study design is challenging. These obstacles have forced me to explore a variety of paths in medical education; including most recently, social media. The community of practice that I have developed through social media has led to great professional growth and satisfaction in the last several years.

4) What does future of EM look like?

I’ll give my perspective from the ivory tower of academic medicine. EM has a mixed future in my opinion, but I am optimistic.

The Good. I am encouraged by the deep commitment to formal research training that has taken hold in our specialty in the last 15 years. Emergency physicians are now better prepared than ever to lead clinical and health services research. I believe that the NIH and major funding organizations will open more seats at the table for EM physician leaders and policy makers, in addition to funding more acute care research led by EM investigators.

The Bad. Our clinical environment is only getting more complex. We have seen a rise in regulatory requirements that promote poorly-derived clinical metrics. The electronic health record is not iterating to make our jobs easier, despite remarkable advancements elsewhere in the digital world. Reimbursement has leveled off and will likely downtrend as bundled payments become a reality.

The Ugly. The indicators above suggest that physicians have lost control of their profession, not just in EM, but throughout medicine. It is no wonder that physician burnout is such a hot topic. It will take many years before we see a meaningful change in the practice paradigm we find ourselves in.

The Future. I believe that emergency physicians are some of the best positioned to understand these complex practice issues and affect change, as we interface with all clinical services in the hospital. We must seek opportunities for mid-career leadership training that can enable us to reshape our practice environments.

5) Greatest achievement / why giving back is important.

I have benefited from the kindness of several talented mentors and sponsors throughout my professional life. I will never take them for granted. For me, giving back – or paying it forward as a mentor or sponsor – is the best way that I can celebrate all the individuals that were catalysts for my career.

6) Favorite failure.

So, so many failures to choose from! Let’s say that I try to learn from every mistake that I make. My colleagues offer support, context, and feedback to process learning from failure. I draw on them more regularly than when I was junior in my career. I suppose I was less apt to admit mistakes then; today I recognize the importance of seeking advice. I’m especially grateful to my colleagues/friends on my research team (secret name), as well as those within ALiEMCORD, MedutopiaICE Blog, and Stanford EM.

7) One thing you would change about our field.

Our schedules! We aren’t smart about the way we schedule our teams, our time for productivity, or our personal time.

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

I enjoy reading books about leadership, management, efficiency, self-help, and positive psychology. I discovered these sections of the bookstore in the last five years and they have transformed my approach to getting things done. For instance, I’m writing this blog post during my normally scheduled morning writing time, an efficiency best practice endorsed by so many authors and artists. I probably read one book from these genres per month. (The problem: I buy more than one book per month on Amazon, so my reading queue continues to outpace my ability!).


3 people you’d like to see fill this out

1)  Matthew Pirotte, MD – Northwestern University

2)  Lainie Yarris, MD, MSCi – OHSU

3)  Angela Mills, MD – Columbia

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