 YouTube that chronicle my experience, thus forward to my YouTube channel at Adana the PA and subscribe. And you can also follow me on Instagram at Adana the PA. So I'm really excited you guys about this particular video. So this is part of my true life series. If you have not seen it, I have a whole playlist on YouTube of different true life series. So be sure to check that out. But this will be another installment and it's one that I'm pretty, pretty like really excited about and really excited to be a part of and to hear it and learn and listen because this is the true life. I'm an ER doc. I know that there are many people who are kind of teeter tottering between should I become a physician, a PA, an NP, an OT, a PT, you know, the various different areas of healthcare that you can go into. And this will just afford you the opportunity to just get a little bit more insight. So Dr. MacLennan who is gonna be speaking in this particular documentary will just give you some more information on what his experience has been thus far as an ER doc. So without further ado, here is Dr. MacLennan. Hi, I'm Dr. MacLennan. I'm an emergency medicine physician and this is my true life. Typical kind of day on the job more or less. I get to the hospital, go through whatever entrance. You should not the ambulance entrance, but get on inside. I meet up with a scribe often, at least at the larger hospital I work at, who's somebody who helps me out with my charting, helps me stay more efficient. We find ourselves a couple computers and really start hitting the ground running. Long into the system, see what patients have been there the longest or who looks the sickest and we sign up for one, two, three at a time and then just start running around and trying to see as many as we can. Basically we'll go in, we'll see a patient, I'll do my history, my physical, typical kind of things, get an idea of what's going on. Then in my head I'm running through my differential for each patient and trying to sort out well what could this be, what test do I need to order, what labs, what imaging. And when I step out of the room I go ahead and put those orders in the computer and meanwhile while the nurses are working on lab work or the x-ray tests are getting imaging or whatnot then I'm already off seeing another patient and so each patient I'm in there for a few minutes and then I can see quite a few patients, five, six sometimes in the first hour, hour and a half and then you start getting things coming back and it kind of slows the pace of seeing new patients but at the same time you're seeing how patients respond to any medicines that you put in, you're following up on the lab results seeing with this test do I think I need to go ahead and move forward, get a CT scan or if you've already gotten that what are the results showing, that patient with the belly pain, did they end up having appendicitis, do I need to call a surgeon, do I need to work on getting them admitted to the operating room or does everything look okay, they're feeling great now and ready to go home and follow up with their primary care doctor and so that constant cycle of picking up patients, getting things ordered and then really the harder part of the job getting that information back and sort out well what do I do next with the patient whether that's admission or sending home or whatever it may be or sometimes just ordering more tests to help clarify things. The larger hospital I work at is kind of a more of a referral center and a bigger center itself there's always patients to see so there's never a spare moment you're on your feet, you're going the whole time, those are 10 hour shifts usually by the eight hour mark more or less I'm starting to wrap up seeing patients and more trying to follow up results, get patients, disbode and then catching up on my charting that I had been neglecting largely throughout the shift. Smaller hospital I work at is 12 hour shifts don't have a scribe there and you don't really have that option of slowing down towards the end of the shift because there's no other physician to see those patients so you're seeing folks all the way up to the end and hopefully more or less you're getting done around on time often it's not unusual either late half hour hour or so and I try not to bring the charting home so I just knock it all out there and then when I'm done, drive home and rest up, get ready for the next day. So working with the PAs it's different in the two places I work at the bigger hospital, the PAs are out front they're working kind of in an urgent care type situation or a fast track, whatever you want to call it and essentially they're seeing some of the lower acuity stuff they're seeing the wristbrains, ankle sprains, the lacerations, the abscess, flu-like symptoms, stuff that can come in can get out pretty quickly and really just they're chugging through those patients and getting patients moved quickly as opposed to, or I'm usually at in the main part of the emergency department kind of where patients can linger a bit more where they need to wait on MRIs or CT scans or whatnot every once in a while certainly a patient can get mistriaged or get sent to the fast track center so we rely on our PAs a lot to certainly help kind of sort those out as well and get those patients triaged appropriately and unfortunately in that situation I don't have as close of a working relationship with them unless I'm doing what's called a provider triage shift there where I'm actually out front they're not in the same room as them and that's when I've got kind of the dedicated role of working with the PAs but also triaging patients to the fast track or getting them back to the main part of the emergency department and that's really where I get to spend most of my time with PAs we'll bounce ideas off each other see what we think is appropriate for this patient so we need to order and what do we need to do moving forward but where I really get to work with the PAs closely is more the smaller hospital I work at it's a place where I work just nights out there so I get to work with the PAs for two, two and a half hours or so as they're finishing up their shift and it's 12 hour overnight shifts in a small place where I'm once they're gone I'm the only provider there except for an internal medicine doctor who's kind of managing the patients upstairs on the floor but it's really the option that I get to work closely with the PAs where we're in a room together we're side by side on two separate computers and we're picking up patients and bouncing ideas off each other I'm learning from them, they're learning from me and we're just running through things and really get to work closely with them there and so that's a lot of fun you really get to know them well both personally and just on a work relationship as well seeing how things mesh and just learning the ropes and everything and how the process works with them certainly in training and I didn't get to work a whole lot with PAs and so since being out two and a half years now working closely with them has been a good experience and a learning one as well so I went to Loma Linda University for medical school and Wake Forest University and I went to Salem, North Carolina for residency in total after college I did four years of medical school and three years of residency most ER programs are about three years some are four years but the majority are three and so medical school, I enjoyed it wouldn't trade it for the world but not something I want to go back and repeat by any means the first couple years it's the grind of just day in, day out being in the books I feel like you got any free time because any free time should be used for studying really because there's just an endless amount of information to try to take in after the first couple years you take step one of boards and you start transitioning to more of a clinical experience to start getting to those rotations in the various areas of the hospital and that's really where I started to figure out what I wanted to do and that I wanted to be an emergency medicine doc and that I wasn't so interested in some of these other fields and that was the more fun part of med school certainly I did a couple of way rotations one was at Wake Forest that's how I kind of got my foot in the door there coming from California and then I got back and then started doing the interview trail we do a match day in March where we all as fourth year medical students find out we're gonna spend the next three, four, five plus years of our life for residency and that's when I matched to Wake Forest and finished up out in California made the road trip across with my new wife and we went to Wake Forest where we spent the next three years Honestly, I try to think about how much I really know about it before starting up with medical school and I don't think I really knew much about the opportunity to be in a PEA before starting out my father's in a position my older brother is as well it seemed like a pretty natural route for me I was interested in medicine and the sciences and that kind of a thing it always in my mind at least for as long as I can remember seemed like the route that I was gonna be taking not by any pressure necessarily for my parents or brother but just that's what I was interested in that's what I knew about I really started learning more about PAs and kind of their involvement with things in medical school and probably more so third and fourth year when I started getting out on the clinical rotations and I started meeting some friends that were in the PAs school and they're at Loma Linda and just kind of trying to find out more of what they did so it's hard to kind of think retroactively what I have been more interested in in PEA versus medicine or what I have done differently it's tough I think there's some awesome advantages of PEA one thing certainly that stands out to me one of many is the fact that it's a little more flexible as far as what you can do if you do a certain area for a while and if you get some burnout or just want to change you have that opportunity of kind of transitioning into another area whereas that's not really there for a physician who did this residency training for a long period of time they can't, you know, something go work in a dermatology clinic kind of a thing I think one of the tough parts that's got to be tricky for a lot of PAs is the autonomy I mean there are situations where you can get a lot of autonomy which I think is great certainly for those that want it and for those that are strong but even then it often takes some work and finding that right job or certainly earning that autonomy and so if you want, you know, a lot of autonomy then it seems like the physician route was a easier decision as far as going that way again not that you can't get it by being a PEA but certainly there's there's nobody else to answer for there's nobody else peering over your chart or asking you to do things this way or that way which I know as a resident that was kind of getting tough as I became stronger and stronger as a resident having intended having me work up patients that I didn't necessarily want to do a certain way can be a tricky road to walk you know, always want to do the right thing for the patient and sometimes physicians for better or worse depending on who you're working with may have a different idea of how best to do that so that can be a tricky position that PAs get in and I try to respect that when I'm working with the PAs as well try to be hands off best I came at the same time working together and trying to learn from each other no attending no backup that first day scary probably scary just driving to the hospital that day leaving home and driving in and getting out of my car thinking what in the world am I getting myself into I've got no backup I've got no attending looking over me I don't know any of these other doctors here or these nurses or any of the staff fortunately my job is very welcoming, fostering environment at least at my hospital and so I didn't have the demand of seeing high numbers of patients the first day and half the battle was just trying to figure out the computer system and I'd like to think of myself as somewhat technologically savvy but even then it's just a battle to figure all that out but shoot out every patient you're thinking so deeply about is that the right dose of tonal is that the right dose of motrin I had a baby that was constipated and I was trying to think all the different things to make sure that I wasn't missing in this simply just constipated baby and you just really scared that first day that first week I mean I'd be lying if I said I didn't have any apprehension even now going into shifts two and a half years after residency five and a half years after med school you never know what's gonna walk in and my first day is just a lot of questioning as far as each and every thing that you do each and every order that you make you know a separate first day event was the first day at the smaller hospital I work at the larger hospital at least had other other physicians I could turn to that could kind of help me and there's actually a physician who was working with me that day to help train me into the system not train me medical-wise but just help me with the computer system and so I at least had him to kind of bounce ideas off I really was struggling with something but then I went to the smaller hospital for the first time a few months later and that there's just not many resources at all so of course about 15 minutes after walking in on the new job there is even before the PA got there so it was truly just me as a provider once you know it a lady 38, 39 weeks pregnant comes rolling in in labor and here we're delivering a baby just within minutes of me starting out my first shift out there and fortunately no no issues, no significant bleeding baby came out nice he was healthy and we got an ambulance to take him over to a more appropriate facility but it's jumping in quick and it's it's a nerve-wracking nerve-wracking experience jumping in to something like that your first day at a small hospital but since then you just start getting more and more used to all the chaos that comes in the emergency room there's so many experiences throughout working in the ER that changed the way that you look at life that affected your life and how you see things in general we all take life for granted those of us that have been healthy and haven't had to spend time in hospitals and emergency rooms and what not throughout our lives really take for granted the health that we have granted certainly so much of what we see these days is you can say is self-inflicted from baddie and smoky not exercising but there's plenty of patients that by nothing they did wrong ended up getting a bad handout so I will always remember the first time that I was doing compressions on a kit doing CPR on a kit and that was when I was still a medical student actually doing a way of rotation at Wake Force where I ended up doing my residency later on but I remember I was doing compressions right next to the mother who would come into the room and the physician tells me to stop doing compressions we were calling the code and I got this balling mother next to me and talked about it as an emotional roller coaster it's terrifying the things that we see and it impacts you quite a bit after any experience like that you go home hug your family hug your wife, hug your kids and just try not to take for granted all that you're blessed with each day of life there are just so many experiences throughout any field of medicine but I think especially with emergency medicine that you go to the ER and it starts getting repetitive for you this is your job, this is your office it's what you're used to is a comfortable environment to some extent when you're used to working there but for the people that come in it's the worst day of their life often and I think it's always important to remember that when you're dealing with patients don't forget about a lot of things and I don't know how many of you are watching are Christian and I am and I've got an opportunity to pray with some patients and I know that's been something that's hit home with me a lot and that patients and their families have really really appreciate it and you have an amazing opportunity to be there for somebody to help hold their hand to pray with them to guide them to teach them or instruct them as far as what's going on and to help them through this emotional roller coaster that they're going through and this worst day of their life is a humbling yet incredible opportunity that we shouldn't take lightly by any means so work life balance I feel pretty fortunate that emergency medicine really allows you to have a good work life balance I don't carry a pager on me, not one in my house in my car, never do I wear a pager and never do I want to it was one of the nice things about going into emergency medicine is when I go to work I work hard, I'm running, I'm on my feet all day long, I might take a break to throw down a granola bar or shut them but for the most part I'm just working my tail off but when I go home I'm done I'm being with my family being with my wife and kids and not worrying about hospital work or worrying that my pager might go off and I have to go in and now certainly I'm doing shift work I have to work my share of holidays, weekends and overnight shifts but full time can be 12, 13, 14 shifts depending on how long your shifts are and that provides a good amount of time the rest of them wants to be with family I'd rather be with family more than the hospital need or how much I love my job In medical school I really tried to do my research to get a good idea of what I was getting myself into although it's always hard to know exactly what it's going to be like when you're on the other side of things by nature I'm not a super confrontational person but in the year sometimes you just have to have to be able to be that sometimes unfortunately we have the opioid epidemic you have patients that are drug seeking or are there for secondary gain of whatever it may be and it can put you in some tricky situations I've had patients paint their bodies red to make it look like they had infections or septic joints to get pain medicine I've had patients intentionally harm themselves and that can always be a very difficult thing to deal with when you have to battle being appropriately nice to patients and taking care of what their true underlying illness may be but at the same time dealing with some of the very difficult personalities that come across in the ER because you will see a whole lot of different kind of people that come into the ER it is a wide range of interesting personalities that being said one of the sweet things about the ER is it doesn't matter who you are we're not going to turn you away one of the beauties of emergency medicine were the safety net for the society certainly at this point with where healthcare is any private office can turn a patient away because of lack of insurance or lack of funds we're going to see everybody we're going to take care of everybody and it's a privilege and not a burden to us final thoughts about working in the ER you know P.A. or a physician be the best you can I mean there is a stark difference between the P.A. who stays up on the literature who listens to podcasts who really knows his or her stuff and the one who is there to put in their time and get their paycheck and is going to see the minimum amount of patients that they can it's so much fun when you're working with somebody like in P.A. or a physician who is knowledgeable fun to work with and works their tail off like you should be working your tail off and seeing patients together doing the grind together when I get these sick patients at the smaller hospital and I'm working hand in hand with the P.A. out there you know took the time to learn how to do ultrasound to do a fast exam on a trauma patient to see if there's you know any bleeding in the abdomen or who can look for a pneumothorax with the ultrasound and not have to wait on chest x-ray while I'm working on intubating the patient doing these things is it makes the job fun and enjoyable but it does take work to get to that point you know with that comes more autonomy more of an opportunity to do things on your own without somebody overshadowing you and questioning every decision that you make but put up the time on the front end keep up strong work ethic no matter again P.A. physician work hard do your very best then when you're done with the shift go home be with your family and enjoy not being in the chaos that's the ER Amazing time with Dr. McClennon and then also the whole physician P.A. relationship and how important it is to actually like be on one accord as a P.A. in a physician or P.A. in your attending in the hospital when you're working because that is like it's literally life or death so I want to say a great great thank you so much to Dr. McClennon for taking the time out to talk to me about it and to also make this documentary for you all to just give you all a whole lot more insight on what it means to be an ER physician I hope you guys really really enjoyed this and I hope you guys got a lot more information than you had before I know I learned a ton I did not realize how much flexibility I guess you could say you could have as a physician more specifically an ER physician or a physician that has a more shift life with respect to their work which is interesting to me I don't think it would have changed my decision to become a P.A. at all with respect to going to med school or going to P.A. school but it is very very important to make sure that you have all the possible information that you can get to make the most informed decision and you know I always tell you all that so definitely really really appreciated him and his insight that he brought if you guys have anything else with respect to my true life series go ahead and leave that in the comment section below I love getting you guys feedback so definitely please go ahead and do that and if you haven't done this already go ahead right now and subscribe to my channel and follow me on Instagram thank you guys so much for watching I really really love doing this for you all so stay engaging with me stay talking to me and we'll continue on this journey together I hope you guys enjoyed it bye I never really understood that aspect in terms of being a physician and being able to spend as much time with your family that's why I chose the P.A. route so that's really interesting to hear that you're able to have a stretch of week like the week that you're working a lot but yet still have a whole lot of time for the rest of a month to be with family there's not a whole lot of medicine that's pure shift work whereas emergency medicine is and it gives you more of that flexibility there's a couple other options out there but not to be against surgeons but a surgeon is often on a pager and they've got to work longer hours usually and I think that although it's very possible to get that nice work family life balance I think it's just a little bit more natural a little easier for that to happen when you're in a shift work kind of environment which the ER is and just like a quick break for those of you who don't know what a nursemaid's elbow is it is a dislocation of that elbow so I'm like really really excited and geeked out a little because I just learned about that last semester in my ortho module so I really I was like ahh I know what that is so just a little heads up you guys that's what you'll learn when you're in P.A. school and med school and I guess NP school as well you think you're so cool right now cause I'm like oh my gosh I know what that is like it's good because then you get to actually make sense like when you get to recognize things and the fact that I know and it's coming from a position I feel really good