RS: Well, that’s not easy to answer, Kevin. It was certainly fly by the seat of your pants for sure. That part was exciting. I had no idea of what I didn’t know; none of us did. Going back to that perspective of the ’70s, we would do things that would be unthinkable today. If someone was really nasty, we paralyzed them and talked to them, “You know, when I bag you, you breathe. When I don’t bag you,” you’d stop bagging for a while, “you notice you don’t breathe. So I’m going to wake you up in a little while, and I want you to be really nice. Got it?” When they woke up, they were always nice.
Today, the rules are entirely different. The expertise we bring to the bedside today is much more exciting. Back then, we didn’t have ultrasound, CT, or MRI. We had an IV, some blood, and that was about it.
KK: Zach, which world would you like to work in? In yesterday’s emergency medicine or today’s?
ZJ: Great question. I think it’s comforting to hear people who’ve been around for a while saying that they’re just as happy to practice today as they were initially. The entrepreneurial side of me thinks that it would have been advantageous to have been around 40 years ago. I think that starting your own group is challenging in today’s environment. At the same time, I think a lot of the major battles have been fought, so it’s certainly easier for folks to walk into emergency medicine today and be a respected member of the hospital and be respected as a specialist. I certainly thank everyone that came before us in terms of fighting all of those battles. In terms of where emergency medicine is headed in the future, I think that we’ve heard a lot more talk about being part of this acute care continuum and looking at how emergency medicine can get more involved in the prehospital environment, doing more things in terms of community paramedicine, keeping people out of emergency departments, how emergency physicians are more well-positioned to deal with unplanned episodic care, and looking at how new technologies are going to enable telemedicine to allow remote evaluation of patients.
JS: In the early ’70s, a resident we helped train in the community told me that a leader, Don Thomas, told him that there were three things you needed to know in emergency medicine: Was the patient alive or dead? Are they going to live or die in the next 30 minutes? And did they need to be admitted, or could they go home? Like Richard was saying, there were times I did things I was never trained to do as a rotating intern, but it saved people’s lives. Instead of having somebody to show you how to do something, you did it first, then you showed somebody else.
The entrepreneurial side of me thinks that it would have been advantageous to have been around 40 years ago. I think that starting your own group is challenging in today’s environment. — Zachary Jarou, MD