By Laurence Degelsmith, MD
October 26, 2007
Not a week has gone by in the last ten years without a patient inquiring as to my specialty, forcing me to promptly bite my tongue, pause, and take a deep breath before calmly giving my response, “My specialty is everything.”
Last night in the emergency department I was discharging a very nice woman in her fifties after diagnosing her bladder infection when she asked, “Do you have an office where I can see you again?”
My standard response on the many occasions when asked this question is, “You’re currently in my office and you can come at any time without an appointment.”
Not a week has gone by in the last ten years without a patient inquiring as to my specialty, forcing me to promptly bite my tongue, pause, and take a deep breath before calmly giving my response, “My specialty is everything.” I am a jack of all trades and master of none. That expression isn’t quite accurate since I believe that emergency physicians are actually masters of many specialties including but not limited to toxicology, cardiology, pulmonary medicine, pediatrics, geriatrics, trauma, critical care, neurology and even gastroenterology. We are often expected to diagnose patients sent by their primary care physicians with two years of symptoms and no diagnosis. Our colleagues in hospitals or offices often call upon us to give them advice about particular maladies that they are unused to seeing, since we have essentially seen it all and are expected to treat it.
Training for emergency medicine
So what is an emergency physician and what is our training? We are all board certified in the specialty of emergency medicine the same way that a cardiologist is board certified in cardiology. The specialty of emergency medicine has been in existence since the late 1960s. However, it was not recognized as a medical specialty by the American Board of Medical Specialties until the late 1970s.
Most of us in the emergency department have had specific training in the field of emergency medicine, including a three or four year residency program. In those three to four years we rotate through the departments of orthopedics, cardiology, gynecology and obstetrics, trauma, internal medicine, pediatrics, dermatology, surgery and many others. We learn how to perform minor surgical procedures and become experts in airway management. We are expected to become proficient in doing spinal taps, reducing dislocations, setting minor fractures, suturing lacerations and even delivering babies if the need arises.
In fact, last month I was called upon to deliver a baby in the labor and delivery unit because the obstetrician was not in the hospital. The young woman arrived at eleven at night and delivered fifteen minutes later. I was the only physician in the hospital with any obstetrical experience at that time. Yes, all went well that evening, but thank goodness for the calm, well trained labor and delivery nurses who probably could have delivered that baby without me.
Not exactly like on ER
Emergency physicians do have some limitations. We can’t diagnose every rash and we probably can’t tell you if your prostate is enlarged. We will not operate on you and we won’t manage your cholesterol levels. We will, however, refer you to other specialists who can do all of the above. While we specialize in emergency conditions, the majority of our patients are less urgent. Our day is often filled with eleven hours of routine headaches and stomach pains accompanied by one hour of excitement and life and death decisions with a motor vehicle accident victim or a patient with a ruptured aneurysm. This is the life we lead in the emergency department. I receive additional satisfaction working locally since I am fortunate to be able to treat friends, neighbors and sometimes even old high school acquaintances that still live in the area.
So the next time you venture to the emergency department of your local hospital, you may be sick or in pain, but at least you can rest assured that you will be taken care of by a highly specialized, board certified, caring and experienced emergency physician.
Laurence Degelsmith graduated from Horace Greeley High School in 1985, has an undergraduate degree from Washington University in Saint Louis, attended New York Medical College and did his residency in emergency medicine at the University of Michigan. He is an emergency department physician at Northern Westchester Hospital in Mt. Kisco and a member of the Chappaqua Volunteer Ambulance Corps.
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