Bill Klaproth(Host):  You’ve seen the TV shows, the movies, the glamour, the drama, the tears, the heartbreak, the last minute life-saving procedure, the team of doctors feverishly working on the patient. So, is that what it’s really like to work in an emergency room? With us is Dr. Michael Ratliff who is an Emergency Room physician at Tidelands Health and he’s here to give us the inside view. Dr. Ratliffe, thank you so much for being on with us today. So, what is it really like to work in an emergency room?

Dr. Michael Ratliffe (Guest):   Thank you, Bill, for having me on. Working inside an emergency department, frankly, sometimes is about as crazy as you see it on the television. Typically, it’s a very chaotic environment and there’s, typically, a pretty high flow of patients that, over the long-term you can sometimes predict numbers, but on an hour or day-to-day basis, surges of patients certainly make it very challenging.

Bill:  Is it as glamorous at times as TV and movies make it look?   

Dr. Ratliffe:  I think it is definitely as fast-paced and chaotic as it appears. I’m not sure that glamorous is always the right word but, typically, it is an extremely fast-paced environment and there is, typically, a lot going on at one time that requires quite a bit of coordination between the multiple staff members.   

Bill:  Is there a certain type of person who is well suited for work in an ER?

Dr. Ratliffe:  I think with medicine, in general, probably particularly with emergency medicine these days, you need to certainly be able to multi-task. I believe you have to be a reasonable confident person. One of the challenges with emergency medicine, besides dealing with surges of patients and a variety of different conditions that may be cardiovascular, respiratory, orthopedic, etc., is we don’t know these patients ahead of time. We have very little information about them and, typically, we have to start managing and treating these patients, frankly, without a lot of information or the amount of knowledge or pre-existing relationship that may be there with their regular doctors.

Bill:   There are many career paths for physicians to take. Are there physicians that say, “The ER is my career. I want to do that for my whole career in medicine.” Are there people that choose that? Is that a path that people take?

Dr. Ratliffe:  There are. Historically--meaning 30-40 years ago--emergency medicine was a practice that sometimes was a stop-gap before someone chose a different path in medicine. These days a lot of people are choosing it as their career. That’s what I’ve done. I’ve been out of residency training for about 10 years now. Right now, I don’t have any desire or plans to choose any other path of medicine. I do think you have to pace yourself, so to speak. You have to schedule your career in such a way that you don’t have burn out because, again, it is a very challenging, fast-paced environment and it can be very stressful at times. You do have to be cognizant of that as you go forward with the specialty.

Bill:  If someone wants to work in an ER, then what would be the right path to take?   

Dr. Ratliffe:  Typically, in this day and age when you are choosing your medical career, you’re going to want to choose an emergency medicine based specialty. Go through the residency program training to get a good base of knowledge; to get a good understanding of the skill set required. As difficult as it is, typically, in the single or small number of centers that you have in residency training, try to choose the type of environment – whether that’s going to be academic and community, and whether that’s going to be rural area, or more inner city type of environment, because they’re all very different and they do require slightly different skill sets in some circumstances.   

Bill:  We can switch gears a little bit. I want to ask you when is the right time to bring someone to an ER? As parents, we struggle with children with high fevers. “Gosh, is it too high? Should we go to the ER?” Or, somebody has fallen and their arm is hurting for a long period of time. Should we go to the ER? Should we just wait to call the doctor in the morning? Can you give us some tips on when is the right time to go to the ER?

Dr. Ratliffe:  Sure and that really is a very good question. My wife and I have two little girls of our own. My wife is in the medical field as well. When it’s not your child, when it’s not your family member, it’s pretty easy to stand back objectively and criticize someone when they choose or choose not to take someone for medical care. Having been there when it’s your own child or family member, objectivity and good decision making a lot of times go out the door because you are, frankly, so worried about your family member it’s difficult to do. That being said, if there are questions about whether to take your child or family member, the first thing I would think of would be, frankly, how long have they been sick and how long has this particular thing been bothering them? If it’s been going on for some time and, certainly, if it has been going on for weeks or longer, you probably have time to a least make a phone call or chat with the person on call for your physician. If it is something that is more acute that just happened in the moment or just happened in the very near past, that’s probably a little more indication that it may be an acute issue; it may be an emergency. That would probably be my recommendation. That being said, the default answer is if you’re, frankly, just not sure, then bring them in and we’re going to do our best to take care of them and help you through that situation.

Bill:  Is there any other thing we should know about the ER that the general public just doesn’t know about? Obviously, our perceptions are based on what we see on TV and movies and our own experiences.

Dr. Ratliffe:  Sure.

Bill:  What is it that we don’t know that we should know?    

Dr. Ratliffe:  Just be aware that emergency departments, just like all of medicine in the country, we’re there to take care of the individual patients and to do our best to make them well. Although, in the grand scheme of things, medicines and hospitals in general have to make decisions on staffing based on numbers and based on revenues coming in. As I kind of touched on earlier, emergency departments can have pretty wild surges in patient populations where you can go from, frankly, having a very nice, easy going day and, in a matter of 20 or 30 minutes, the staff that is there can be quickly overwhelmed with a large number of patients. In addition to what you may see coming in the front door, if you’re lucky enough to be able to do that, remember that there is ambulance flow and patient flow coming in the back door as well. Different from your primary care office where you may have a scheduled time and you anticipate waiting for a certain period of time, we have a constant flow of patients where we have to kind of do our own triage. If you or your family member are in the emergency department and someone comes in that, frankly, is sicker, whether they are in cardiac arrest, or they are not breathing, or they are having a stroke, I’m going to have to stop what I’m doing taking care of you and go manage that patient to make sure that they don’t die. I know sometimes that’s very frustrating for families to have to deal with.

Bill:  That is interesting. Thank you for that perspective. That is really good information. What is it that you have learned in your years in the ER?  What is the biggest take away that you can share with us about being on the line in those frantic moments and craziness and trying to help people? What is your biggest takeaway from your time in the ER?

Dr. Ratliffe:  That’s a good question. I don’t know that it’s any one thing. I think, personally, for me the takeaway would be that I did make the right choice as far as my medical specialty. I certainly enjoy the variety of issues that I have to deal with. I don’t focus on any one particular problem and it’s always something new and different every day. I think all physicians--not just myself--but over time as you learn to practice medicine and as you work with more families and more patients, although you can get depersonalized to the business aspect of medicine, usually all of us are lucky enough to meet a person or a patient or family member that kind of brings it all back home to you, that kind of brings it back to why you chose medicine where you actually do get to make an impact in somebody’s life or in an emergency medicine’s case literally be able to save their lives. That really kind of gets you through the job and gets you through the day, sometimes. I do appreciate those moments.

Bill:   Dr. Ratliffe, thank you so much for sharing your experience in the ER today. It’s been fascinating talking with you. For more information about Tidelands Health’s physicians, services and facilities, visit TidelandsHealth.org. That’s TidelandsHealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.