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The last year has been eventful.  After 15 years of straddling the clinic, inpatient, obstetrics and the emergency department, I have moved to full-time in the emergency department.  I continue to systematically review the same primary care literature I have read and documented on fpnotebook.com for more than a decade – probably more-so now.  After 15 years of reading AFP (all the main articles), it has become a habit I can’t stop.  Prescribers Letter, Mayo Reviews, Minneapolis CME community… all continue. However, in the last 2-3 years I have doubled my reading/fpnotebook content updates to include emergency medicine – up to 40 hours/month total.

Despite the extra reading, conferences, and 15 years of broad spectrum practice, I have never been so clinically challenged as I have in the last 2 years in the Emergency Department.  One of my favorite resources has become EM:Rap, a monthly review of emergency medicine issues new and old. Critical Decisions in Emergency Medicine has also been fantastic for deep reviews of thorny topics.   I am humbled how much I do not know, and constantly reminded of this on acute case presentations I see in the ED. 

I’m a middle aged guy who moved from a well established practice of about 2000 patients to shifts of the unpredictable at the edge of my knowledge base.   I understand why the burn-out rate is high, but at the same time, I find it rewarding and re-vitalizing.   I start my next shift in 2 hours.  I wonder what I’ll learn tonight.

 

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