Top 3 Things an ER Doctor NeedsJul 2, 2014
Things are seldom dull in the ER, but just how valuable is a stethoscope? Dr. Troy Madsen describes: the frantic situations he is often faced with, the importance of keeping cool to avoid being overwhelmed, and why the modern tools used for making a prompt, accurate diagnosis are so vital.
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Interviewer: We're with Dr. Troy Madsen, Emergency Room Medicine at University of Utah Hospital. Dr. Madsen, I'm going to put you on the spot with this question. What three things do you absolutely have to have to do your job? If everything else was taken away and you can only have three things, what three things would you pick?
Dr. Troy Madsen: Are we talking tools or skills?
Interviewer: Either. I think that's interesting. Let's start with tools.
Dr. Troy Madsen: Okay so we'll start with tools first. So we're talking specifically emergency medicine.
Dr. Troy Madsen: Like working in an ER.
Interviewer: So is a stethoscope, would that be one of them?
Dr. Troy Madsen: You know it's funny. I'm not going to say it is.
Dr. Troy Madsen: Because I can do my job without a stethoscope.
Interviewer: All right.
Dr. Troy Madsen: But I need an x-ray.
Dr. Troy Madsen: I absolutely need an x-ray available to do my job and do it effectively because so much of what I see in dealing with fractures and injuries and you know I can look at it and I can say, "It might be broken," but knowing what kind of fracture is there I really need to have an x-ray available. So that is an absolute essential in emergency medicine.
The other one is a CT scanner. So kind of like an x-ray. This is what we take a lot of heat for because people are like, "Oh, ER docs just scan everything." But we do! You know you talk about head injuries and I can look at someone and I could say, "Yeah, you might have bleeding in your brain but I need a CT scanner to really tease that out.
The other thing is abdominal pain. That's the most common thing we see. And I can do some blood work on that and I can examine the patient and I can say, "Well, yeah, your risk of appendicitis is maybe 10 to 15% but, you know, oftentimes the only way to really tease that out is a CT scanner.
And then, you know, probably the third tool I need, the third thing I really need to have available is blood work. We need to be able to do lab work and that's a big part of what we do too in terms of teasing things out. Again with appendicitis I need to look at their white blood cell count. A lot of times I need to see their electrolytes, their kidney function.
So if I had to say, you know, what are the three things I really need to do to practice modern medicine and to do my job effectively as an ER doctor, those are probably the three most essential tools that I need to have.
Interviewer: Interesting. Everything else is just frosting for you. It makes life a little easier maybe.
Dr. Troy Madsen: It's helpful, you know. Ultrasound is very helpful. We use ultrasound a lot. But if I were just in a location and I said, "What's the one thing I need?" If I had to choose between an ultrasound and a CT scanner, and I know some of my colleagues who love ultrasound are going to criticize me for this, but I would choose the scanner because I cannot ultrasound someone's brain to see if there's bleeding in there.
Dr. Troy Madsen: So I'd choose the CT scanner.
Interviewer: What about skills? What are the three most important skills that you think you have?
Dr. Troy Madsen: That's a great question because in emergency medicine it really requires a unique skill set. And number one is multitasking. You know, I was working in the ER just two days ago and I looked at one point and I had had in the previous 30 minutes I had had eight new patients that were placed under my care. And I looked and I had 20 total patients under my care. And we're not talking just like patients coming in with coughs and runny noses. We're talking strokes, heart attacks, very serious abdominal pain, really complex patients. So you really have to be able to multitask.
The second one I think is just being able to kind of keep your cool. And that's probably one of the most rewarding things in my job is to be able to walk into a situation and I had one of these cases too just two days ago where people are just freaking out a little bit and kind of like, "Well, what are we going to do?" you know.
And you just walk in, you just kind of take control and not control like bossing people around but just very calmly say, "Okay, first let's do this. Next we'll do this. And here we'll do this." And when you can walk in that situation and do that it really makes a difference.
And then I think the third one is just, you know, just trying to keep your emotions under control and that's a tough one. And, you know, when I say emotions under control, you know, we're talking number one, don't get angry because there are some people who in other situations and even in the ER can make you really angry.
And when you have someone that comes in that's trying to get narcotics that you're talking to them and saying, "Hey, I'm concerned about this. You've got a pattern of going to a lot of ERs to try and get narcotics," they call you all sorts of names. And they tell you how horrible you are and they're going to call the hospital administration and that's something you learn over time. That's a tough thing and it's a tough thing emotionally.
Dr. Troy Madsen: And then there's the emotion associated with bad outcomes. You know, bad stuff happens and you do your best to prevent it. It can get to you emotionally and that's a really hard thing about my job but you do what you can, you try not to, you know, compartmentalize too much but you have to do that to a certain degree to be effective.
Interviewer: What one thing do you wish you did have to do your job better?
Dr. Troy Madsen: I wish I had more patience. Yeah, sometimes you need more patience and, you know, a lot of times, yeah. Sometimes, yeah. I wish I had more patience and my wife often reminds me of that too, so.
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