Why Can't Emergency Medicine and Trauma Surgery Just Get Along? This is a question we often ask in the USA given our unique Trauma system. It seems custom built to create conflict in the trauma bay. To explore this issue, I got to talk with Joe DuBose and Bill Teeter. This discussion originally was recorded for Joe's new podcast on Trauma Surgery, Tiger Country. Tiger Country has a bunch of episodes that are worth a listen for ED and ICU folks as well.
Joe DuBose
Trauma and Vascular Surgeon at the Shock Trauma Center. Professor of Surgery. Research leader on all things REBOA.
Started as a surgery resident, switched over to EM residency and then Crit Care Fellowship. Now an EM Intensivist down South.
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not for nothing scott, I think its all the same thing. If you want to own trauma, you have to be able to do all three (the resuscitation, the intervention and the icu care and recovery). Ownership of the domain is key philosophically and otherwise. I can honestly tell you surgeons who do acute care during their residency, are better surgeons even if they become oncologists or breast surgeons. Every surgical field has some type of shock. Look at the data from the UK and south east asia, trauma outcomes do not compare and that trend in general continues in… Read more »
Saud
Thanks for writing! Not sure your conclusions follow from your premises. Would happily come on your show and debate it with you.
S
What a great topic! I have worked with individuals and institutions on both of the extremes of this spectrum, and not just in trauma and acute care surgery. I work with some of the best cardiac surgeons in the world (objectively), who are very collegial and buck their specialty’s reputation as well. I’d repeat an important point that was mentioned only briefly, that defensiveness (usually from a lack of knowledge/experience, and thereby confidence) is the sine qua non of these struggles, and it “takes two to tango.” If you find yourself in these situations, take a moment to consider what… Read more »
so good to hear from you, brother!
Territoriality exists but in smaller hospital people work together a bit better. However I do believe beyond ATLS (or other trauma training), we need more Trauma Team Leader simulation courses which focus on working together.
Terrific talk. And…
…sigh. Not a single female pronoun heard during this entire talk. I guess the default for surgeons & EPs is still male.
Or maybe that’s good – maybe the XX surgeons & EPs don’t fall into the stereotypes. ♀️
Thanks so much for raising this as an issue! It prompted me to relisten to the entire episode to ascertain the exact situation.
When we strip out pronouns that were specifically speaking of actual rather than hypothetical people (where the use of he/him was referring to people for whom those were their actual, preferred pronouns) there were three instances of the use of he/him for hypothetical people and one instance of she.
So there definitely was not equity and we on staff will learn from this unfairness.
Great Podcast thanks Scott. The ER vs Trauma surgery (and others) goes back to probably Egyptian times! I remember taking an elbow to the ribs from an anaesthetist in the UK as I endeavoured to manage a trauma airway! You mentioned reading the same literature which is good but we took this one step further in my ER in Pietermaritzburg South Africa where I was clinical lead of the ER. Not only was the head of Trauma Surgery a good buddy of mine but we nurtured this friendship by having regular catch ups over coffee to discuss tactics and issues.… Read more »
yep, when we are friends all the problems go away, Sandy
Great topic. Something we all need to improve on no matter which side we wall on. Everyone was maybe a little too nice to each other and missed out on maybe the least productive (but common) caricatures. EM Doc – ‘Triage Monkey’ does not do any actual medicine but simply triages patients based their best guess of a medical service in hopes the patient will be able to see a ‘real doctor’. Occasionally tries to steal procedures from said ‘real doctors’. Trauma Surgeon – ‘The Seagull’ flies in from nowhere makes lots of load noises of unclear purpose, steals your… Read more »