EM Mindset: Amy Kaji – The ED is the Equalizer

Author: Amy Kaji, MD, PhD (Associate Professor of Clinical Medicine and Vice-Chair, Department of Emergency Medicine, Harbor-UCLA Medical Center; Research Methodology Editor, Annals of Emergency Medicine; Board of Directors, SAEM) // Editors: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

What comprises the emergency medicine mindset?

To answer this question, I look back to 1999 when I made the decision to change careers from general surgery to emergency medicine. The mindset of a surgeon differs greatly from that of an emergency physician (EP).

In the quiet of the operating room, there is the ability to focus only on the task at hand and the patient before you. In the emergency department (ED), you must focus on the patient before you as well, but you must also be cognizant of the many patients who are waiting to be seen – in the waiting room, in the ambulance bay, and those who are being transported. The quiet of the operating room is replaced in the ED by the incessant phone calls, interruptions from nurses and techs, requests to answer a pharmacy question, or a request to acknowledge an abnormal radiology reading. In essence, the EP knows how to work within the confines of a chaotic cacophony of noises, which sits in stark contrast to the silence and orderly, sterile nature of the operating room.

My most important interactions as a surgeon were arguably with the patients and their families. In the ED, there are many other interactions that are often equally important, if not more so. As stated before, the consultants become an integral part of the treatment and management plan for the patients, and we must therefore know how to build and maintain these professional relationships to provide the best possible patient care. Not only do we have to convince the patients about the diagnosis and the management plan, an EP must also articulate coherently and “sell” an admission or a reason for a consultation to a specialist.

If you are interested in reading the rest of this and other EM Mindset pieces, please see “An Emergency Medicine Mindset,” a collection evaluating the thought process of emergency physicians. This book is available as ebook and print on Amazon.