While I posted a picture of this podcast earlier on the Kinnetik Medicine Instagram account, I think it is well worth a revisit and actual blog post with the link and some notes. The podcast is a lecture recorded at a Social Media and Critical Care (SMACC) conference in Berlin. I have now listened to this podcast half a dozen times, and have loved it every time. Throughout residency I developed my own theories about our practice in EM, but it was not until I listened to this podcast that many of those ideas were validated. Dr. Mallon is slightly rough around the edges, but hilarious, so enjoy.
Below are some “quotables” and notes from the podcast.
- For an EM Physician, the sicker the better. We prefer sick patients, the decisions are already made.
- The ED receives a variety of patient demographics, we enjoy the undifferentiated sick and the undifferentiated well.
- The ED is a decision rich environment. No matter what you are doing in EM, you have to “move the meat.”
- The ED is the great equalizer, it does not care who you are, everyone gets sick and injured.
- Remember, as an EM Physician, the patient does not get to choose you.
- We must maintain a nonjudgmental stance, we cannot care why the patients are there.
- We do not think like intensivists, internists, or surgeons. But if you must choose between them, then we think most like surgeons.
- The sicker patients get, the more procedures are needed.
- We are procedurally biased despite most of our patients being medical patients.
- We must see NEW patients, we must not leave procedures undone, we must know the rate limiting step.
- We love bedside testing, because decisions must be made.
- We are early adopters and innovators.
- Our differential is disconnected from everyone else in the hospital. We think worst first. But we can’t work up everything, there must be a balance. If you chase too many zebras, you can’t “move the meat.”
- Weird stuff is concentrated in the ER. Patients present to the ER because no one else figured out their problem.
- We must be comfortable with uncertainty.
- Straight A students don’t do well in the ER, they perseverate.
- We are more test averse than risk averse. We are gamblers, we will roll the dice. If you are going to see thirty in nine hours, then you can’t be a test lover.
- We must not miss surgical disease. When people need a knife and don’t get a knife, they do badly.
- We take care of patientS, with an S, not patient.
- We must not be perturbable.
- We make deals with patients and consultants.
- All arrhythmias eventually straighten themselves out.