Noticed this thread is way out-of-date and wanted to bring it back up again and see if some of the questions that haven't been addressed could be tackled:
"Do you feel like there is any time for connection with the patients required in EM since the time you spend with them is so brief? Also, how much intuition is used in the ER? Is it so evidence-based that you feel like a protocol-following machine or is there still some creative thinking that goes on?"
"To the EM docs that love what they do, I am curious as to what your meyers-briggs (sp?) result is."
"Also, what is it about outpatient medicine that you dislike?"
If I wasn't doing Anesthesiology - I'm almost certain I would have chosen EM. Paging Popcorn - she's our EM doc on the board. I bet she has great insight for you!
I can tell you from a soon-to-be graduated fourth-year, I absolutely loved EM. I didn't even realize how much I liked it until I did my EM rotation fourth-year, so if you are on the fence, plan a very early on EM rotation as soon as you can fourth year so you can apply. It's gotten quite competitive - definitely more than Anesthesia this year for sure.
I thought it was a great field. Although, I am very certain my heart is Anesthesiology - it was nice to enjoy a rotation and field so much like EM. It's fun to DO things, isn't it? I felt like I got to do a lot of different things in EM. No shift was ever the same (fourth-year perspective again).
As far as connections, my philosophy is that I have to form an immediate, deep connection, especially with my very sick ones. In fact, I often am making life or death decisions having only know pt and family for a few minutes. I think that the best EM docs are able to really tune in with our patients. I run into people in my small town, and they often remember me. (Which is always awkward, because inevitably it will be "you took care of my mother." "Oh, really? And..." "Oh, she died." Oh yeah. This happens in the produce aisle to me all the time.)
Intuition is another word for gestalt, which is really the phrase we like to use. Part of it is pattern recognition. ("Crap, last time I saw a G1P0 at 36 weeks with a BP of 160/100 she had HELLP... better check this one's reflexes")
Protocols, although they are becoming more commonplace, are for midlevels and nurses. I am a doctor, I did a residency and have spent years honing my skills. Yes, I use ordersets, but everything should be tailored to the patient. Otherwise, you miss stuff. Pattern recognition. Listen to your gut. My gut likes to scream things like "aortic dissection" and "PE" and "mesenteric ischemia." EM docs think differently that most docs - we create a differential not based on what is necessarily most likely, but what is most fatal. I explain to people all the time that while their chest pain may not be from their heart, I can't prove it, and MIs kill people. GERD just makes people miserable. Therefore, I can't just say "aw, it's just reflux." It's a different way of thinking. I feel like it's MORE creative than most jobs. For example, I had a 2 year old with a kitchen pot stuck on his head once, thrashing around. We have to think outside the box sometimes. This case involved a nurse running out to his car for some aviation snips to cut the blasted thing off. We do fly by the seat of our pants sometimes.
We have the best stories. (Sadly, we also sometimes have the worst.)
Our patients also are a higher risk population, as they have self-selected for emergency care. Granted, there is overuse of the ED, but if I see a 70 year old farmer complaining of 2/10 pain, I generally have 30 minutes or less before he crashes.
As far as outpatient medicine, I hated it. I hate clinic. I guess I don't like well people. Bring me the sickies, the pressors, the arrhythmias. I tolerate whiny people, and generally enjoy reassurring parents that their baby's fever isn't dangerous, but I do enjoy a good adrenaline rush. Unfortunately, the more I see, well, it doesn't happen all that often anymore. I like the variety. For example, my first 4 patients last night were:
90 yo respiratory arrest, intubated by EMS but was a DNR (= can of worms), Myasthenia gravis crisis, 18 day old choking episode, and a 4 month old vent dependent infant with a neurologic syndrome with fever and bradycardia. (Of course, after that fun series, the drunks started to roll in and my night went to hell.)
Anyway, I'm an ENTJ. I usually enjoy what I do, but sometimes I hate it. At least it's not the same-old-same-old.