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Emergentology: A Thankless Job Gets a Little Less Thankless

Walker, Graham MD

doi: 10.1097/

Dr. Walker is an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc, a medical calculator for clinical scores, equations, and risk stratifications (, and The NNT, a number-needed-to-treat tool to communicate benefit and harm ( Follow him on Twitter (@grahamwalker) for daily thoughts on emergency medicine.





Let's be honest. We often have a pretty thankless job.

We take damn good care of patients despite the constraints of time, resources — and frequently — information.

We can make 99 correct diagnoses, but only hear about the one that we missed.

We can perform life-saving procedures or make life-changing diagnoses, but many patients don't remember our names or faces once they're admitted.

It can be draining. It can be daunting. It can be depressing.

Luckily, I've had a few interactions recently that really made me feel good about my practice as a physician, and it's these little things that make all the difference.

“Will you be my primary doctor?” Usually this is from a patient with whom we just seem to be on the same wavelength automatically. I get them, they get me, we're cool with the plan, everything is in sync, the stars have aligned. It's always flattering to hear this, but patients are typically surprised by my “Oh, God, no” reaction. “That's not really what I'm trained for. I only take care of people in the emergency department,” is my canned response, which, in my head, translates to “You could not PAY me enough to be a PMD.”

“I really appreciate your time and effort today.”

I'm part of the “most praised generation,” which means our parents and teachers were always encouraging us and giving us attention. I will bend over backwards for you, do cartwheels and somersaults, for just a little praise, for just a minor compliment.

That's ironic because I honestly don't feel like emergency physicians receive many genuine compliments or much appreciation. We're on the receiving end of yelling, vomiting, pain, anxiety, and anger up front when we're trying to take a history from a patient who can't stop vomiting from his sixth small bowel obstruction. And I get that people regress, and that pain and fear can make the nicest Dr. Jekyll into the meanest Mr. or Mrs. Hyde. And I get that this is my job. But it's absolutely miraculous how good I feel when someone simply acknowledges that I'm working hard, or that I'm really trying my best, or that I really took the time to help him (which I obviously attempt to do with every single patient).

“I feel so much better. Thank you!”

With a smile. I'd say this is most commonly the patient with acute gastroenteritis who looks absolutely miserable after having worshipped the porcelain gods for the past several days and just can't keep anything down. Two hours later with two liters of saline and some Reglan, Zofran, and a little nap, he is smiling, his color is back, and he has gone from absolute despair to feeling almost back to normal. Amazing how much a smile or a laugh can tell you about a patient's general condition.

“You figured this out. No one else could!”

Probably the most elusive of compliments because — let's be honest — if you're in the ED for any condition that starts with the word “chronic” and ends with a sign or a symptom instead of a disease process, (chronic abdominal pain, chronic constipation, chronic headache), we're probably not going to get it diagnosed today. I consider myself a pretty decent physician, and I've made a few clutch diagnoses in my short career so far, but I doubt I'm going to be getting to the bottom of your belly pain that's been worked up 18 times already, ma'am. (I've occasionally had some luck with making diagnoses like narcotic bowel syndrome or cannabinoid hyperemesis syndrome, but those are few and far between. But I always give it the old college try.)

“Thank God, you're here.”

Also known as The Doctor You'd Most Like to Have with You During a Busy Shift Award, you certainly feel appreciated when you walk into your morning, afternoon, evening, or overnight shift and people smile. It's either busy or full of patient rocks, and some of the staff believes you to be the true savior. The One. Neo from the Matrix. You can dodge bullets, stop time, and fight blindfolded with one arm behind your back. You will get the ED cleaned up by the end of your shift.

“The nurse requested that you see her son. Is that OK?”

I don't think you can get a bigger compliment. We all try to remind ourselves of what kind of doctor and what type of care we'd want for our own family member, especially with those particularly challenging cases or particularly difficult patients. This is that abstraction in reality; a nurse that knows everyone well, and wants you to evaluate her child. (There's always a little added pressure to make sure you get things right, but at least you know they'll follow up and know the warning signs and reasons to come back if you happen to be wrong.)

Now remember, as my mother always said, “It takes two to tango.” You have to give some compliments to get some back. Appreciate your coworkers. Show them your gratitude. Treat your patients with kindness and respect, and recognize their pain and suffering and patience. It can go a long way to simply say, “I'm so sorry you're feeling sick,” or “I'm so sorry that this happened to you.”

Attitudes and perspective are one of the rare positive feedback loops in nature: positivity breeds more positivity; negativity breeds more negativity. You get to pick which one you want to promote. We already work in an environment that has so much difficulty built into it, why give it more?

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