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Viewpoint: The Curious Phenomena of EM Residents and Global Health

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000428938.55232.19

    So, I'm in the middle of interview season, and I am talking to a guy who is at the top 10 percent of his medical school class. He went to a prestigious undergraduate school, blew away the medical board exam, and in his spare time in medical school got an MPH. (Of course, this would be a ridiculous story if it weren't true. There really are people like this going into emergency medicine.)

    This is my 12th year as a residency program director, and like all emergency medicine residencies, we have the fortunate problem of having a whole bunch of losers like this guy who want to go into our specialty.

    Now I hit him with one of my favorite questions: “Tell me three facts you learned from a professor in a class during your undergraduate degree that influences how you think today.” At first blush, he is probably thinking, “This is easy. After all, I spent four years there and a small fortune in student loans. I'm gonna kill this one!”

    Guess what? No one has ever been able to answer the question completely. Oh, they might come up with one fact, but that's it. Don't believe me? Try it. It's all a blur.

    So, I hit him with the follow-up question: “How many patients that you treat during residency do you think will you remember 10 years from now?” Some fall for the trap. “A lot of them!” they say. Of course, if you have been out of residency a while, you realize you can only remember a few of them (usually the ones you mistakenly killed). All those patients you have treated during your career morph into one type of patient or another (chest pains, drunks, traumas, seizures, peds fever, etc.).

    Now, it just so happens that this particular applicant also spent time in Tanzania and India on medical missions as an undergraduate and in medical school. So I ask him, “Tell me about when you stepped off the airplane in Africa.” He remembers every detail. You would think he was calling you from the airport after he arrived.

    There is a saying that an emergency physician is someone you want to sit next to on an airplane. (PLEASE, not a radiologist!) It's not uncommon to find folks like us not only headed to a lot of different places, but we are actually going there to see patients! In a day and age when our society is seemingly consumed with self-indulgence at every turn, why would physicians who routinely care for the most challenging patients in United States want to fly thousands of miles to take care of people with exponentially more difficult challenges?

    My answer is relatively simple: Folks like us love adventure and life-changing experiences. My point of asking the question about college facts you might remember is that all the stuff you tried to cram into your brain during school does not move you to action or change you in any meaningful way. It's the experience and the emotion that goes with it that really changes how we perceive the world. That's why we went into this specialty in first place. Most of us are “experience junkies.” (In fact, every decent story any physician tells starts with, “This guy came to the ED….”) But after a while, we get so used to the patients and their relative agony that we do not get the fix anymore. Even worse, many of us become cynical.

    In this academic year alone, nine of our 20 residents who are not interns will travel to seven countries to help patients, and they are not just hopping on a plane for a few hours to Latin America. China, South Korea, Samoa, and Sudan are on the itinerary. What gives? Why not moonlight, for crying out loud? You could pay off that huge student loan debt.

    I think many medical school graduates look at residency training as some kind of penance they must pay to get the big paycheck and start living like an adult. (“Just a few more years of delayed gratification, and I will get all the stuff I have dreamed about.”) But I have discovered over the past decade that residency for many of them is their last opportunity to explore things that they will not likely be doing the rest of their lives (unless they get a taste of it now). And before they know it, they'll be 50 years old and pulling shifts not for the adrenaline but for the mortgage, the pension, and the kids' college tuition.

    All I need to do is tell them that the barriers are not really that big, and if they want to go, I will make it happen. I know you are thinking that money and time are HUGE barriers. But if you can get out of the box that you're thinking in, you will see that the real barrier is how we think about residents and global health to begin with.

    Billions of people want to see a doctor, and emergency medicine residents want to go there and experience it. Don't think so? Well, 30 percent of the applicants we will interview this year have already done this. That's one in three! Give them a reasonable chance, and they will do it.

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