EM Mindset: Mike Stone – Don’t Be A Lazy Jacka**

Author: Mike Stone, MD (@bedsidesono – Assistant Professor of Emergency Medicine, Harvard Medical School and Division Chief, Emergency Ultrasound at Brigham and Women’s Hospital) // Edited by: Alex Koyfman, MD (@EMHighAK) and Manpreet Singh, MD (@MPrizzleER)

We work in an incredibly hectic and high-stakes environment where we routinely make tough and consequential treatment and disposition decisions with limited information about patients who we have just met. Take into account the increasing overcrowding and inpatient boarder problems ubiquitously felt in our health care system and it becomes hard to see how we ever manage to get it right. And yet, in an astounding majority of patients, we do. As a good friend and mentor once told me, “Emergency Medicine isn’t rocket science”. It is, however, very much an art, and I find my practice continually evolving and (I hope) improving. I currently work in an academic Emergency Department for the majority of my shifts, with 30% of my clinical commitment spent in a community ED without trainees. After years of clinical practice in urban, rural, community, academic, County, and University practice settings I have developed a universal approach to EM that can be summarized in 5 words: don’t be a lazy jackass. But for those who want the longer version, here are a few common sense tips to enjoying a happy and successful career in emergency medicine:

  • Don’t be lazy. I know I said it already, but that’s because it’s the most useful tip I have for the Emergency Physician. In our environment it’s not just easy to cut corners, it is part of what defines our specialty. But while I’m a big fan of omitting whispered pectoriloquy from my physical exam, I can’t count the number of times that I have provided better care by taking 5 minutes to contact the patient’s primary care provider, or to get a hospital certified translator, or to return to the room when a family member is present to get more history. And I want to be clear that I know I am far from perfect, and just as (or maybe more?) susceptible to taking the easy way out when things get busy.  As a result, when I find myself in the ED contemplating if there’s a way to avoid doing something I really would rather not do (a phone call to the outpatient psychiatrist, a time-consuming procedure, a pelvic exam, an important but inevitably painful interaction with a patient with a personality disorder, etc), I make a conscious decision to do that thing immediately. Like right this second. Otherwise it’s just plain too easy to procrastinate and ultimately fail to do something that needed to get done.

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.

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