What are the qualities of a good emergency medicine doctor?

DEAR DOCTOR K:

My son is in medical school and is thinking of specializing in emergency medicine. What are the qualities of a good emergency medicine doctor?

DEAR READER:

When I was a medical student, I was attracted to work in the emergency department (ED). (EDs are also called emergency rooms, or ERs — as in the TV show.) It was really exciting. So many of the patients were very sick, but if you made the right diagnosis and gave the right treatment, you could save lives — every day.

Ultimately I decided to go in a different direction, but I understand your son’s interest in emergency medicine. I recommend that your son — and you — read an enlightening new book written by my Harvard Medical School colleague Dr. Michael VanRooyen with John Hanc: “Code Blue: The Making of an Emergency Physician.” In the book, Dr. VanRooyen, who is himself an emergency physician, reflects on the traits that characterize a top ED physician.

ED doctors must think fast and be able to make decisions quickly, but they also must be calm under pressure. When it’s crunch time, ED doctors must tune out all the distractions and noise around them. They must zero in on a problem and make quick, aggressive decisions.

A big part of what makes emergency medicine unique and compelling is the variety of patients and problems ED doctors care for. That’s another part of emergency medicine that appealed to me. You might see a person with terrible abdominal pain — then someone who suddenly can’t move his right arm and leg — and then a person who is seeing and talking to people who aren’t there. And all that is interspersed with people with bad colds, or twisted ankles, to give you a little breather.

You have to know just what to do, and fast, to handle a remarkably wide range of problems. Make the right decision, and you save a life. Make the wrong one, and the patient may get even sicker. And sometimes, you have just minutes to make your decision — or nature will make it for you.

Emergency medicine is the purest form of rapid diagnosis. Emergency doctors don’t get a patient with a diagnosis; instead, they get a patient with symptoms. It’s up to the doctor to make the right call.

ED doctors must be fast-paced, but able to stop on a dime; able to grasp the big picture, but detail-oriented; well-trained but flexible; able to make a decision, and often to lead a team of health professionals to provide urgent care for a patient.

If this sounds like the skill set required of a commander in battle, that’s because it is. And if it also sounds like the role of a point guard on an NBA basketball team, that’s because it is.

That’s a lot to ask from any physician, and it’s why emergency medicine is not for everyone. But it is exactly the right choice for the right kind of doctor.