The 3 A.M. Reality Check: The Appeal of International Emergency Medicine


It is three a.m. in the emergency department.  You have spent the last several hours of your shift wading though the pediatric fevers and chronic extremity pains stacked twenty high in the waiting room when you arrived.  You have stabilized and admitted the few sick patients with respiratory distress, chest pain, and GI bleeding.  For a moment, everyone is neatly tucked away.  And as you finally sit down to bite into the dinner you never had time to eat, you hear a call come across the EMS radio headed to your hospital.  “ In bound to your facility with a 43 year old male with three weeks of…dental pain.  ETA five minutes.”


These are the moments that make you question yourself.  Eight years of higher education, three to four years of specialty training, and a mound of debt…for this?  As a young emergency medicine physician with only a few years out of residency training, I have to admit that I am afraid.  There is not a week that goes by that I don’t experience this three a.m. reality check.  I have thirty some odd years left to practice and I already have seeds of bitterness and frustration growing inside me.  How will I be able to do this job in ten or twenty years?  And more importantly, what will this job do to me?  There has to be something else.  Enter Global Health.


In recent years, more and more physicians are getting involved in global health projects.  Emergency Medicine Physicians in particular, seem to be increasingly drawn to these types of projects and there are now more than thirty international emergency medicine fellowships.  The appeal of global health to emergency medicine physicians is not surprising.  The diverse skill mix of emergency medicine translates nicely into the international setting and acute care training is lacking in most low-resource settings, creating a much-needed niche.  But more importantly, global health projects are filling a gap in the satisfaction department that our regular ER jobs seem to leave behind.  The reason for this is simple.  Global health projects take all the reasons we went into emergency medicine in the first place and magnifies them by a thousand.


ER docs like to take care of sick people.  I recently worked a twelve hour shift at home where I saw about three patients an hour and did not admit a single patient.  The last time I worked an ER shift in Haiti the healthiest person I saw all day (and the only patient that was discharged) was a five year old with a broken arm.  It’s refreshing to feel like it mattered that you showed up to work on a particular day.  And don’t get me wrong, we absolutely make a difference and save lives working in the emergency departments of the developed world…it just often doesn’t feel that way.  The inherent gratification of our job gets buried under a pile of impatient fast track patients, piles of medical-legal driven documentation, abuses of the system, and bad Press Ganey scores.  Oh, and did I mention that in the developing world there are very few, if any of those things?  Care is documented so that there is a record of the patient’s care, not so you can defend yourself in court in the event of a lawsuit.  People will walk for miles and stand in line for days to see a doctor.  Of course not everyone in the developing world is satisfied with his or her care, but there is an overall level of gratitude that I rarely experience in the United States.


But what amazes me most about participating in global health projects is the positive effect it has on my patients back home.  After a few weeks working in a low-resource country, the three a.m. dental pain coming by ambulance doesn’t bother me so much.  I am able to treat my patients with more kindness and patience.  Instead of seeing a waste of resources, I see an opportunity to educate.  It’s all about perspective and global health has given that to me.

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