I am a critical care physician and spend a good amount of time in the emergency room seeing consults. As an internal medicine resident, we were often in the ER, admitting new patients. In my three years of residency, we spent only two to four weeks working in the emergency room. It was the one time I had an insider’s view of life as an ER physician. And, man, was I blown away — by the pace, variety, efficiency and organized chaos that is emergency medicine. Many of my classmates and later trainees would find a way to skip or slack on this rotation. My experience with emergency medicine has given me a valuable perspective which I’d like to share.

The emergency room triages, manages, admits and discharges a number of patients. ER physicians are highly versatile, quick on their feet, trained to respond to emergencies and a common cold with equal finesse and ease. They can help a patient with a dislocated shoulder and a heart attack simultaneously. They hold down the fort and are the gatekeepers to hospitals, which are perpetually busy and usually struggling to keep beds open.

Yet, many physicians treat the ER docs with a good dose of disregard, often questioning their decision making, treatment choices and blaming them for the extra workload they apparently thrust upon us. What we look past is the workload they have, going through about 30 patients during a shift, on an average. And that they discharge a lot of patients, the ones we never come across. They shoulder the immense responsibility of sifting through the pile of patients charts to triage effectively. ER physicians face the unique job of being the first set of physicians encountering a patient within a hospital system. They have to decide what to focus on if the problem list is huge.

When they discharge a patient, they risk sending home a potentially untreated fatal disease masquerading as a simple headache or cough. When they admit patients, they are met with disdain and skepticism. When attempting to give sign out, they usually have to deal with multiple unanswered phone calls. When they try to justify treatment provided, they are usually interrupted rudely by consultants and admitting physicians, hinting how inadequate their job has been. When they try to be as thorough as possible, their attention is being constantly challenged by beeping alarms, belligerent patients or family members, nurses who need orders entered or a nervous resident trying to get a signature on a consent form.

The intensive care units and the operating room can seem similar; however, they receive a filtered kind of patient population. The emergency room has to deal with patients that visit the ambulatory care or need the operating room, general medical Ward or intensive care unit. It is a unique place where all kinds of patients can show up without prior notification in the majority of the cases. The rest of us receive our patient seen by at least one other physician.

Let me tell you why ER docs are fearless trailblazers, often at the forefront of cool and cutting-edge developments in medicine. They were amongst the first to embrace bedside ultrasound, demonstrating the utility, ease and efficacy of using point of care ultrasound. Today, bedside ultrasound is an integral part of intensive care units, operating rooms, inpatient wards, and even outpatient clinics, previously confined only to radiology. The emergency room was the first to develop an ultrasound fellowship for their graduating residents who wanted more time to master this useful technique.

The field of medical simulation, adopted initially by emergency medicine and anesthesiology, is now making its way into all aspects of medicine. In situ simulation has become a popular way of teaching in the emergency room, given the number of ER doctors now trained in the technique. Again, emergency medicine was the first to offer a medical simulation fellowship after an ER residency compared to most other specialties.

FemInEM, an online community for women in emergency medicine is the first of its kind, building a collaborative voice to work for gender equity, outside of any formal medical organization. FIX18, held in NYC, was their first conference idea exchange and brought the online community to life. Very well received, it has now become a yearly conference. Thanks to them, women in other fields of medicine are beginning to do the same.

SMACC — Social Media and Critical Care — has mostly ER physicians in their organizing committee. They are hosting their next conference in Sydney in March 2019. They make it a point to have an equal number of male and female speakers every time. And strive to create a vibe that is informal, attempting to break the silos rampant within traditional medicine.

Since emergency medicine physicians are at high risk for burnout — just as intensivists are — many have started a side hustle. They have successfully found ways to merge their creativity and passion with medicine to create lives that are gratifying. Emergency physicians create many of the blogs and podcasts I follow. I have learned a lot from these physicians. I have been inspired, motivated and embraced many of these new aspects of medicine they brought in.

Yes, as doctors, we all work hard. And most of us are overworked, stressed and sleep deprived. This is simply an attempt at providing a tiny bit of perspective to the world that is the emergency room by a physician who often visits the place as a consultant. I have learned far beyond medicine from them. Many of my close friends work in the ER and are a part of my trusted inner circle.

So, emergency physicians, we do appreciate what you do, and we thank you sincerely, even if that gratitude isn’t apparent at times.

Sonali Mantoo is a critical care physician.

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