Spotlight On...
Raquel M. Schears, MD MPH, Assistant Professor of Emergency Medicine, College of Medicine, Mayo Clinic
Dr. Schears graduated from the University of Wisconsin, Madison, in 1987 with degrees in the History of Medicine and Zoology. She attended medical school at Washington University School of Medicine in St. Louis and graduated in 1991. She completed her residency in emergency medicine and a Masters in Public Health at Johns Hopkins University in Baltimore, MD, in 1994. She remained at Hopkins for two more years where she was the Assistant Chief of Service. She then moved to Philadelphia where she was on the faculty of emergency medicine for five years in their then-new emergency medicine program, the Hospital of the University of Pennsylvania. In 2001, she moved to Rochester, MN, where she is now an Assistant Professor of Emergency Medicine at the Mayo Clinic. She was interviewed by Dr. Keith Allen on Wednesday, January 16, 2008. The text of the interview has been edited for length and clarity and should not be taken as a precise transcription.
Keith Allen (KA): What is it about emergency medicine that attracted you to the discipline?
Raquel Schears (RS): I think the variety of the patient presentations, the pace of the environment and some of the research aspects of the clinical practice and the patterned thinking of an emergency medicine physician where you can't focus on ten things; you have to narrow your list down and you have to be more of a thin slicer when it comes to a medical evaluation.
KA: More than one person has observed the personalities that go into different disciplines tend to be fairly stereotypical, and one of the comments that's been made of emergency medicine people is that they tend to be a little "attention deficit" in the sense that they constantly need a new stimulus. Do you think that applies to you at all?
RS: Oh yes. I think we all live for the adrenaline rush of a new case that we get to test our skills against and to take care of people. Yes, I agree. But in that same attention deficit, I do think we're able to focus and help our patients.
KA: In some people's minds, emergency medicine is a relatively young discipline still trying to find its place in this world. The EMTALA law that was passed has changed the way emergency medicine is practiced in large part. In what ways have you seen emergency medicine change as the result of EMTALA?
RS: I think hospitals are more worried about the impression or the perception that they may be dumping patients on public and county hospitals. So, I think the transparency that's been provided with this legislation is good, because it forces private hospitals to take care of patients or at least stabilize them and take care of perinatal emergencies. So, I think it's a good thing. It's forced some transparency onto practices which were transferring patients. However, it's come without any kind of money or any kind of federal funding. So, it does create a lot of problems for those who are trying to work in overcrowded emergency departments and can't really deflect transfers and things of that nature.
KA: Do you feel that the influence of the EMTALA law will mean that emergency medicine will be practiced more as an academic discipline rather than as a component of community hospitals?
RS: No. I think that the world wants to have an emergency department they can go to. Some people may prefer an academician as their physician and maybe a broader range of hospital specialists under the same hospital umbrella. But, I don't think we'll ever divorce the EMS transfer to the ER from the American public's mind: if you have a serious problem or a crisis you are transported to an emergency room. I don't think there are enough academic centers to cover the breadth of the country; so for that reason, I think the community hospital emergency department will always have a place.
KA: Emergency medicine people at their very best have been characterized as folks who have a broad understanding of medicine and can answer a lot of important questions on the spot, even to the point of diagnosing unusual or rare conditions that have escaped the notice of other practitioners. In your opinion, what do you think emergency physicians do best?
RS: I think we do the paradigm best, which is that we worry about the life-threatening and limb-threatening diagnoses on a differential, and we don't necessarily bother with all the details of other less relevant past medical history in making the diagnosis of our patients. And, we have the resources associated with the emergency department that can actually get things done a lot quicker. So, I think treatments can be started more rapidly, and the diagnosis can often actually be arrived at more rapidly than through a clinic or office setting.
KA: It does seem that people bypass the normal procedure of going to a clinic when they know that things can happen a bit more quickly through the emergency department.
RS: That's kind of a blessing and a curse sometimes in terms of overcrowded emergency departments and also the legislation that has allowed patients to decide when they are having an "emergency." That is also a difficult concept for our future.
KA: If you were granted one wish to have one unknown issue in medicine answered, what would it be?
RS: I guess the one unknown that bothers me most is the uncertainty of predicting death. I worry with... the demand for organs far exceeding the supply that as we go into these areas we may be faulted for not being more able to predict the timing of death. There are just so many variables, and the human body is so resilient that when some people are talking about criteria to initiate evaluation for organ donation, others are using those same criteria to go to the wall and save the patient. I think there's a difficult terrain that emergency medicine has to stand and defend what may be potential donors in other people's minds. It's an uncomfortable position to be in.
KA: Do you have any advice for new emergency medicine residents with regard to the way they should embrace/envision their role in their residencies or future careers?
RS: I would encourage residents to get involved in their national structure, whether that's ACEP, AAEM or SAEM. I would advise them to try and be on sections or committees to get a broader perspective of what our specialty does - there are free opportunities. As a resident in ACEP, you're allowed to pick a free section. So, there are many disciplines that don't have such a benefit. Through the lens of others who are more experienced in the field and the administration of it, I think there's a lot that a resident can gain. I put a plug in for them to be in the Humanities section of ACEP, because at least that also reminds us of our human sides and why we practice emergency medicine.
KA: Dr. Schears, thank you so much for your time. It's been a pleasure speaking with you today.
RS: You're welcome. Thank you.