95 | Drs. Sean and Adam | Emergency medicine vs Internal Medicine | Mindset differences | Good storytelling | Advice on admission requests

New panel with Adam and Sean. Emergency and IM medicine physicians 

There is a study from 2023 called Battles to Burnout. Studying the role of inter-physician conflict in burnout. Primarily the conflict between emergency physicians and internal medicine physicians. A better relationship leads to less burnout

Sean moved from primary care to hospitalist medicine when COVID was at its peak

Adam, EM physician, returns to the show

Sean enjoys solving problems and that is what drew him to IM and hospitalist medicine, he did a 3-year residency

He brings up an important distinction of our mindsets in patient care. In the ED we are looking more to find the problem, but he looks to solve the problem in the hospital

In some ways, in the ED, we are a glorified triage. But more importantly, we are expected to be the second best in every specialty - the second best cardiologist, second best GI etc

We do still do a lot of problem solving in the ED as well, but we usually do have the skill of a lower cognitive switching cost, we can move between tasks quickly

We to have to take efficiency into consideration

Sean talks about the superpower of IM being storytelling – one of his struggles is finding the best story to explain to everyone involved what is going on with the patient – sometimes the ED does not give the best story

We need to help start the right story to help the IM physician on the back end to set them up for success

Our limitations using a text platform to communicate does make it hard to read the intent behind questions

With admission requests, Sean likes to hear what we think is going on. Not just a bunch of data points but rather the start of that story

Sean also likes to hear the chief complaint first, similar to what I like from our EMS crews

A 5- or 6-line paragraph max is sufficient, they start to worry when the paragraph gets longer that we either don’t know what’s going on or so much is going on its going to be a difficult case

As APP’s we don’t get a ton of training in admission request story telling so it’s an art we have to develop

An admission request is a great time to slow down and really think about all the details

Being an ER APP can be a difficult position when working as a team with a physician. We tend to adapt to the physician we are working with. We share tasks and sometimes don’t get all the same details on a given patient

Patient hand-offs are a big source of information loss and errors. We can tend to turn patient stories into a game of telephone in the ED before the story even gets to the hospitalist

Support the show

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.