There is a bunch out there in social media and FOAMed lately about "dogmalysis," or the idea that some of the things we do have no evidence base, and should not be done. I love it. Being quite cynical and skeptical myself, I love to see us start to question our practice's evidence base to try to come up with the best care for our patients. But new EM residents and new EM attendings may want to take some of this content with a grain of salt.
Here's my take:
- New EM Residents: Before you go quoting advanced topics and dogmalytic principles (the "I heard it on a podcast" phenomenon), make sure you are well read and understand the basic concepts first. I think it is great people are questioning things like Kayexalate for hyperkalemia, but make sure you know how to diagnose and treat the condition otherwise. Lay the foundation before you spend too much time on advanced topics.
- New EM attendings: Get the lay of the land for the first 6-8 months. You are not going to change an entire hospital system in one day, and you may in fact hurt your chances of effecting change in the future by being known from day one as the guy who pitched a hissy fit about protonix for an upper GI bleed on your first shift out when that is the standard of care across all practices at your place. Remember change takes time, and educating your colleagues, both within your specialty and without, takes time and trust.