"Your County is Showing"
Early on in my attending-hood during a critical case, I was told by a colleague "your county is showing."
Initially, I didn’t know what he meant or how to take it. But over the past year, I think I've been able to embrace my county side.
As a medical student, I was told there were 3 types of Emergency Medicine programs- Academic, County, and Community. My understanding was that most places would fit into one of these three categories. I decided to spend my 3 EM rotations at the 3 different types of institutions to find where I belonged. During my month at a county style intuition I finally felt at home.
While thinking about this, I've asked myself, what defines a county programs?
I've been known to describe the county institution where I trained as "under resourced, and over utilized." I spent some time researching the definition, and all I could find was a list of county programs.
It seems we know a county program when we see it, but we don’t know how to define it.
So I turned to Twitter, and here are some of the responses I've received.
To me, being county means:
Watching out for each other- the patient, their family, the nurses, your co-residents, and anyone else you can think of
Printing your patient a coupon from goodRx to help them pay for their medications.
Knowing that a meal and a place to nap can sometimes mean as much as antibiotics and a ventilator
Attending the funerals of your "frequent fliers" because you've spent more time with them than your own families.
Performing the roles of everyone in the Emergency Department. Placing your own IVs, transporting your patient to x-ray, performing your own EKG, placing your own splints, etc
Recognizing sometimes the cause of your patient’s abdominal pain is hunger, and not appendicitis
Giving back to the community that you serve, both inside and outside the hospital.
Truly taking ownership of your patients.
Realizing that sometimes service may take precedence over education, but knowing that you are truly learning from each and every patient encounter.
Acknowledging that your struggles likely don't compare to the struggles of those you serve.
Sometimes prioritizing patient care over policy.
As I look back on my year at an academic institution, I've realized more and more that you can take the girl out of the county environment, but she'll always be a county doc. I'm proud of my Emergency Medicine roots, and wouldn’t change the doctor I've become. I'm proud that when I'm standing up for what I believe is right, my county shows.
I'm anxiously looking forward to heading back to a county institution where I hope to teach future generations of EM docs how to let their county show, and be proud of it.