EM Collective Wisdom: Anand Swaminathan

Author: Anand Swaminathan MD, MPH (@EMSwami, Assistant Professor of EM, Bellevue/NYU Emergency Department) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

1) Why still Emergency Medicine?

The simple answer is that I, like most of us in EM, am not trained to do anything else but, of course, we’re all bright people who could find other careers. The real question for academic folks is why continue to work clinically (or continue to work the number of clinical hours you do) when your non-clinical work is so rewarded.

When I chose to go into EM it was to take care of patients. I never imagined that I would be doing all of the non-clinical things I do. While there are many challenging parts of my work in blogging and podcasting and lecturing, nothing is as challenging as working up a patient, treating the critically ill or trying to figure out what lesion in the healthcare system has brought that patient to me in the first place (I learned this from Dr. Lewis Goldfrank).

2) Most impactful case. 

There are so many cases that have impacted me over the years. One that always sticks with me is a particularly difficult patient who signed out AMA from another institution where he was being treated for a UTI. I did a cursory assessment and admitted him to our hospital for a UTI only to find that the patient was found to have an epidural abscess.

There were more lessons in that case than I was prepared for at the time but reflection on it continues to bear fruit: being humble, early closure, momentum bias, blindspot bias, confirmation bias, allowing my perception about the patient to cloud by assessment…

3) Most important career decision leading to satisfaction.

Calling it a career decision makes it seem like it was well-thought out and calculated, but about 6 years ago, I cold emailed Mel Herbert about a piece I wanted to do for EM:RAP. That segment got me started in podcasting and helped me explore a whole new world of education. What I learned from that experience is that good things don’t magically occur; it’s up to you to go after them.

4) What does future of EM look like?

I’ve only been in EM for 13 years so I’m not sure I’m prepared to predict the future of our specialty. Over the last 3 years, I’ve seen more and more EPs emerge as leaders not only in our specialty, but in the hospital and on the national level. I hope that EPs continue to take on increasing leadership roles not only clinically but also in advocacy. Physicians like Steven Stack (@stevenstackmd), Esther Choo (@choo_ek), Hiral Tipernini (@hiral4congress), and so many more.

5) Greatest achievement / why giving back is important.

I’d like to think that I haven’t had my greatest achievement yet. Honestly, I don’t focus as much on my successes as the successes of those around me who I’ve been able to help in some way. I’m proud of my mentees successes and proud of the residents I’ve helped train.

Giving back for me comes in the form of teaching others. In my career I’ll see thousands of patients, and I may be able to have a real impact on a small group of them. By educating others, we expand our reach and effect. Instead of thousands of patients, it’s hundreds of thousands and, with a long enough career, millions. As educators, we are given a vital responsibility. We should embrace and revel in that responsibility.

6) Favorite failure.

Too many to name. See most impactful case above for just one of them.

As far as my career in academics, it’s run a twisting road. I’ve taken on many projects that fell flat before completion and have spent many hours on projects that went nowhere. This is the natural path of a career as an educator and the output, the achievement isn’t everything. Our journey, our discovery, and our ability to be resilient is just as important. Failing isn’t a problem; failing to learn from it is.

7) One thing you would change about our field.

This question is just begging for a rant. Right now, the bane of my existence is protocols and our over-reliance on them. Nobody ever became a doctor thinking, “I can’t wait to practice protocolized medicine.” Yet we all allow ourselves and our patients to be the victims of protocolized care. Protocols are for novices. They may form a base from which we should work but they should not be the pinnacle we strive for. Experts should strive to build upon protocols using the knowledge, experiences, and their accumulated skills. Whether this be in cardiac arrest care, sepsis resuscitation, provision of analgesia, or the care of chest pain we must move beyond protocols instead of allowing them to restrict us.

What would I change? I’d stop the protocolization of Emergency Care.

8) Something that you love that has indirectly impacted your EM career.

My family has had an enormous impact on my career as I continually find myself reprioritizing my professional work. It’s a trite expression: “no one ever lay in their death bed and said, ‘I wish I worked more,’ but many lament not spending more time with their loved ones.” However, it’s one thing to say it, and another to do it.

On a lighter note, my love of running has had a huge impact on my career in a positive way. It’s my time to think, reflect, and clear my mind. Wellness is different to everyone, but for me, it’s about running.

3 people you’d like to see fill this out

1) Salim Rezaie

2) Tarlan Hedayati

3) Meghan Spyres