Nosce te ipsum

Nosce te ipsum, know thyself. Self-knowledge seems so obvious. Look in the mirror, et voila! We  have all seen people on the beach or in the workplace who made us wonder if they even owned a mirror. Being self-aware is much more complicated than mirror gazing. How do others view us? Coworkers, family, friends may all contribute to the portrait we carry in our mind. Check list: man, middle aged, thin, tall, husband, son, brother, uncle, cousin, friend, ER doc. The shading in my portrait contains experiences, education, books, music, art, travel...life.

Why the existential angst? The new job and my place in the medical community. What is an ER doc? The American College of Emergency Physicians would define an ER doc as one who has completed an approved residency in Emergency Medicine, been board certified by passing the written and oral parts of the American Board of Emergency Medicine examination, and who works in an Emergency Department. Paying your yearly dues is also important to ACEP.

I have met the above criteria and have recertified every 10 years to maintain my status with the ABEM. When I worked at LGH, I never questioned my professional self as an ER doc. I saw lots of patients from neonates to the very elderly. I treated patients in labor, having heart attacks, in respiratory failure, with traumatic injuries, suicidal depression, psychosis, and life-threatening infection at both extremes of age. I supervised PA's, taught PA students, mentored young ER docs, and tried to impart some of my thirty years of ER experience to the nurses, EMT's and paramedics who worked on the patients in the ER. Arriving at 2030 hrs for my 2100 hours start time, I would scan the lists of 20-30 patients waiting up to 5 hours for treatment. After a ten (shortened to 8 just before my forced exit from LGH) hour slog, the waiting room would be close to empty.

Tonight I will leave my house at 2230 for my 2300 hour start time. There may be a few patients waiting. I will see an average of 5-6 patients during my 8 hour shift. In the month since I began working at NMC, I have treated few children and very few infants as NMC has no in-patient pediatric beds. I have seen so major trauma patients. Pregnant patients do not use NMC as there is no obstetrical services. NMC is a small community hospital in a somewhat isolated location.

Am I still an ER doc? The nurses, secretaries, (lab, radiology, and respiratory) technicians and other physicians in the ER, the hospital and in the community are smart, hard working and dedicated to providing great patient care. I have been welcomed with friendship and respect. My patients look to me as an ER doc. They wish relief from their pain and answers to their questions. The slower pace and lower acuity allow me to spend more time talking with and examining my patients. Maybe I am still an ER doc.

Whether in a 9,000 per year ER in a small town or a 250,000 visit per year ER in a large city, if you provide care to ER patients, you are an ER doc. Listen, empathize, comfort and use all your self knowledge to be the best ER doc you can be.