Emergency medicine is exciting, at least, that is the story we tell. It is so exciting that there are entire television (TV) shows built around it. Resuscitations, critical illness. And medical mysteries we get the first crack at solving. That is what draws people in. It is what drew me in. But the truth is, real emergency medicine does not look like television. After medical school and residency, after the novelty wears off, the reality sets in. Like any job, it becomes routine.

Most days are not filled with dramatic diagnoses. They are filled with the same handful of complaints, over and over again. And our approach becomes just as routine. We take a history. We perform a physical exam. And then, more often than not, we order tests. Labs, computed tomography (CT) scans, X-rays, and ultrasounds. We send patients to what many jokingly call the “donut of truth” and wait for the answer to come back to us. Abdominal pain? Get a CT scan. Leg swelling? Chest X-ray, B-type natriuretic peptide (BNP), and duplex ultrasound. Check, check, check. Move on to the next patient. For the majority of patients, the diagnosis does not happen at the bedside. It happens after the fact, on a screen, in a report, interpreted by someone else. And while that system works, it slowly chips away at something.

The danger of diagnostic routine and burnout

Because if you are honest, part of what draws you to medicine, especially emergency medicine, is the act of diagnosis itself. The thinking. The figuring it out. And when that gets replaced by ordering and waiting, day after day, it can start to feel routine. Emergency medicine has one of the highest burnout rates in all of medicine. There are many reasons for that, such as metrics, protocols, alerts, and throughput pressures. But part of it is this shift away from the bedside, away from the process of discovery that made the field so compelling in the first place.

That is where point-of-care ultrasound (POCUS) changed everything for me. I first encountered ultrasound during my second year of residency. At the time, it was limited. But even in that limited exposure, it opened my eyes to something different, the possibility of making a diagnosis in real time, at the bedside. What really stuck with me, though, was not just the technology. It was one of my attendings. He was many years into his career and, like many physicians at that stage, feeling burned out. Then he learned point-of-care ultrasound. And his love of medicine came back. Watching that was incredibly powerful.

Bringing medicine back to the bedside

As I continued to learn ultrasound, my confidence grew. The number of indications I could use it for expanded. And with that came something I had not fully appreciated before, the satisfaction of bedside diagnosis. It changed my workflow. Instead of taking a history, doing a physical, and ordering tests to eventually arrive at a diagnosis, I could stay at the bedside and look inside the body myself. Immediately. It opened up an entirely new dimension of clinical medicine.

Even in cases that are not “emergent,” it changed how I practice. Take something as simple as a lump. In the past, I might tell the patient to follow up with their primary care doctor. It is not urgent. It can wait. Now, I can take a look. I can tell them what it likely is, or at least what it is not, right then and there. I can guide their next steps with more confidence. That is meaningful for patients. Even when I know I am going to get advanced imaging anyway, I will often still use ultrasound. There is something deeply satisfying about trying to make the diagnosis at the bedside first. A small bowel obstruction. A biliary issue. Pneumonia.

The measurable impact of bedside ultrasound

And it is not just about satisfaction. It reduces my cognitive burden. It gives the patient information faster. It allows treatment to start sooner. Ultimately, those are patient-centered outcomes. But there is another truth to it: It is also fun. Patients notice it too. They see the technology. They see you actively engaged at the bedside. They see you explaining what you are looking at in real time. It builds trust. It improves their experience. And for me, it keeps medicine interesting.

There is data to support what many of us feel intuitively. Point-of-care ultrasound has been shown to:

• decrease time to diagnosis
• improve care in critically ill and injured patients
• improve patient satisfaction

It saves time by accelerating diagnostics. It can save lives by directing care earlier. But if I am being honest, that is not the full story. The real reason I use point-of-care ultrasound is not because it improves metrics. It is because it brings me back to the bedside. In a field increasingly pulled away from the bedside, that shift matters. In a system filled with tasks that take us away from patients, such as documentation, orders, and alerts, ultrasound does the opposite. It anchors you there. And that is better for patients. But it is also better for the physician. Emergency medicine is exciting. But for me, the excitement is not just in the pace. It is in the moments where I can stand at the bedside, look inside, and figure it out. That is why I POCUS.

Joshua Guttman is an emergency physician.