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Hospitals around the world always have an emergency room where patients may receive medical treatment that cannot wait for a scheduled appointment with a doctor. Among the many people who work in the emergency room are nurses, technicians, staff, and at least one emergency room physician. The job of an emergency room physician is one of the most stressful positions for a doctor, as there is no way to tell what type of injury or illness will come through the door at any time. An emergency room physician must triage the patients who enter the emergency room, be prepared to treat a broad range of injuries, as well as delegate authority to the nurses and support staff in the emergency room.
Hospital emergency rooms may treat everything from a common cold to a life-threatening bullet wound within the course of a shift. Many hospitals have a policy that no one will be turned away from the emergency room, which means that, along with life-threatening emergencies, many uninsured patients or overly-concerned parents with sick children will also come through the doors of an emergency room. One of the most important jobs of an emergency room physician is to determine who needs immediate treatment and who can wait.
Triage is frequently not as easy of a job as it may seem. While some serious or life-threatening injuries are obvious, others are not. A gushing bullet wound clearly needs to go to the head of the triage line, but people are sometimes suffering from internal injuries or illnesses that are not as visible, yet just as serious. An emergency room physician only has a few minutes, if that, to determine whether a patient's symptoms require immediate attention or whether he or she can wait.
Once triage has been accomplished, an emergency room physician must then be prepared to treat the wide range of symptoms he or she sees every day. Unlike doctors who specialize in a particular area of medicine, an ER doctor must have a working knowledge of all areas of medicine. An ER doctor must know at least enough to refer the patient to a specialist if one is needed, which requires a considerable amount of knowledge about many areas of medicine.
Aside from actual doctoring, an emergency room physician must also know how to delegate authority and work with the various members of the ER staff. Nurses, technicians, and staff all play a vital role in an emergency room and all look to the attending physician for guidance. For example, once the ER doctor has determined that a patient is not in immediate danger, he may delegate the patient's care to one of the nurses in the ER or may order a technician to complete diagnostic tests on the patient.
A good emergency room physician should also know how to contact most of the specialists in the area, in case something comes in that he or she can't treat.
Bedside manner is also important. Most people who are in the ER are usually very upset -- patients and families. A good doctor can reassure people and their loved ones that they know what they're doing and the patient is being treated appropriately. I've seen ER docs who are really good at this, and some who have all the bedside manner of a zombie.
An ER doctor is often going to be the first MD to put hands on a patient, and that person needs to be able to gain a patient's trust, and also to treat that person appropriately.
One important skill an emergency room physician needs is to know when to admit a patient and when to send someone home.
I found my mom on her den floor. She was hallucinating and couldn't walk, where she had been fine the day before. We called an ambulance and got her to the ER. The doctor checked her over, determined nothing was wrong and sent her home. She was still hallucinating.
We ended up taking her back the same night and staying in the ER all night. She saw a neurologist who said she may have had a stroke that just wasn't showing up on the CT scan. I think that's the most likely explanation. She spent five weeks in rehab after that.
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