From Over The Horizon

heyworth.f1_defaultJohn Heyworth, former President of the College of Emergency Medicine, provides his perspective looking back at a career in Emergency Medicine.

Herewith summary reflections from the further end of the career spectrum.  I left my post as a Consultant in Emergency Medicine in Southampton (UK) 18 months or so ago to enter my career “next phase” and absolutely clear that this is not retirement, a concept far too senior and implication laden.  In this capacity I diverted from my GP friends who have embraced retirement fully, committing themselves commendably to even more bridge, tennis and travel.  I also joined a number of my peers from Emergency Medicine who, as befits the EM personality trait, remain restless and jolly active with a range of medical interests, often including some continuing part time ED work.  The key difference in all our lives is that we now have control over our diaries (mostly) and we sign up for activities largely voluntarily.  A good place to be.  I have no idea when the basic physiological need of any EM doc to be busy changes, but not just yet.

So what are the key learning points from a career in Emergency Medicine?  First of all, my evidence base is categorically certain that Emergency Medicine is THE most important specialty in Medicine.  We know that the public (22 million patients a year in England alone can’t all be wrong) and gradually those in power of influence around us are having individual and collective damascene moments.  It is undoubtedly tough, physically and emotionally draining, but no other specialty offers the fulfillment, satisfaction, and reward that Emergency Medicine provides every single day. Choosing EM was a good idea at the time  and, unusually for that portfolio, remains so on completion.

Obviously there are daily challenges.  The four hour standard (love it or loath it but without some time related incentive Emergency Departments would rapidly regress to the warehousing of patients for several days function which was extant in the early 00’s) can be hassly ++, and yes I know that some docs from other specialties aren’t always fully appreciative of the quality of our referrals as they should be, and we are constantly provided with advice by those in positions of power or influence who may not have been in an Emergency Department either at all or this century…but it’s worth it and time after time we are shown to be right.

The public – our patients and their relatives – put their wellbeing in our hands at their time of greatest need.  This trust and confidence puts us in a position of immense privilege and responsibility.  It also allows us the opportunity to do great good on a spectacularly frequent basis.  Every single shift – no matter what incoming hassle there may be – provides the opportunity to do something fabulous for patients in our care.  This may not be chest unzipping heroics every day, and may be significantly below the general radar, but it happens consistently throughout our career.  Compare and contrast with most other specialties (conflict of interest and bias declared).

When the ED is completely heaving and you are bombarded, it is tempting to believe that the grass may be greener elsewhere.  My lifetime experience is that this may be true from a distance but closer inspection often reveals muddy brown bits.  The simple fact is that Emergency Medicine in ingrained in our DNA and soul; resistance is futile.  Having said that, it is essential to work hard to develop one’s career and diversify; a portfolio of activities continues to make it even more interesting and fun throughout your career.  Emergency Medicine is a particularly suitable specialty to allow such variety and have a truly organic career.

Would I do it all again? Indubitably!  Having left the ED, there are a number of things which I miss (not in order); patients (who would have thought it?); the ED team (obviously); the Emergency Medicine family (we have a unique common bond); cake (and more cake). Have fun!


John Heyworth,

Former President of the College of Emergency Medicine

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