Dear Doctor: Mary Mulcare
The emergency medicine doctor on educating the next generation.
Mary Mulcare, Assistant Professor of Clinical Emergency Medicine at New York-Presbyterian /Weill Cornell Medical College, has been practicing for ten years and is now the Director of Undergraduate Medical Education for the Emergency Department at the school. Teaching, Dr. Mulcare tells us, provides a research-based framework that only adds value to the resources necessary for staying on top of current changes in her field. She spoke to us about the fun parts of emergency medicine, how technological changes have altered her day to day in unexpected ways, and how she keeps balanced in a fast-paced environment.
“I decided on emergency medicine because in college I worked as an EMT and had some field experience. Then in medical school I truly enjoyed every rotation as much as the next, and in emergency medicine I was able to do it all. Why did I choose to stay in an academic, teaching environment? We practice evidence-based medicine, which means that it takes a lot of effort to stay on top of the most up to date literature and treatment. Being in an academic environment makes this a seamless part of my world. This also includes having the resources readily available to look up items applicable to your patient on the fly.”
On What Emergency Medicine Is
Emergency medicine doctors are masters of resuscitation, adept in handling the acutely ill. We also see a wide variety of patients with varying illnesses who have a safe place to go in coming to us. To get us through emergent situations, we train in the specifics of managing people in the first zero-to-four hours of an acute period, achieving a safe disposition for them, and getting them to a place where it is either safe to go home and continue being managed as an outpatient, or where they need to be admitted to an acute care hospital setting. Part of the appeal of our job is in the variety of pathology that we see. In one hour, I may take care of a multi-system trauma from a car accident, an 80-year-old with chest pain, and an 18-year-old with an itchy eye.
How Telemedicine Has Changed the ER
We have a telemedicine service called NYP OnDemand that’s run through the emergency department at NYP/Weill Cornell. It began in July 2016 and has been tremendously successful. You can log in through the app and access one of 16 of us who are senior faculty members and who answer calls via that platform. We also see patients in our own urgent care centers through a video platform, with our Advanced Practice Providers being on-site with the patients to help guide their care. One amazing thing about this is that we can turn patients around in as little as 15–20 minutes, including printing discharge instructions directly to the patient’s room. Low acuity concerns can easily be handled this way, and both the physicians and patients have responded positively to the change.
The interactions are devoted one-on-ones without the typical interruptions that come with working in an emergency department. There’s also more time for education and answering questions from the patient and family in addition to treating the underlying issue. The patients really like it because they get truly individualized attention. I’ve seen 99-year-old patients via this method, and they love it because for the first time in a long time, they are getting 15 minutes of face-to-face with a doctor in a controlled environment.
The Impact of Technology for ER Doctors and Patients
From a day-to-day perspective, electronic medical records (EMR) have made it vastly easier to access prior records and be able to rely on formal information instead of blindly trying to treat someone when we aren’t familiar with their baseline health. Technology has also changed what questions I ask during a history to try to understand a patient’s concern. People search their conditions on the internet and that affects what they think or even how they decide whether or not to come in. It used to be I’d ask the question: “What are you concerned about?” Now in addition, I ask “What have you read on the internet?” It’s open ended and meant to be non-judgemental. I do really appreciate that people are trying to find an answer. While some people become overly anxious in this setting, for many it makes it easier to articulate their symptoms and concerns, and thus it can be very meaningful for the conversation.
Demands of Emergency Medicine
Emergency physicians are multitaskers and enjoy the inherent (yet organized) chaos of our environment. Honestly, no two days are the same and there are times when I never thought a person could do X, Y, or Z to themselves and they manage to do it.
We have to get creative in how we treat problems that never have (nor probably will) appear in a textbook.
Another reason I love EM is that this type of medicine is very much a team sport. It is no coincidence that there are a lot of athletes among my colleagues. You have a team of providers — attending physicians, residents, advanced practice providers, nurses, techs — all working towards the same goal. And then you have additional support staff, including environmental services for example, who turn over the room between patients as fast and efficiently as possible to allow for the next resuscitation. Everyone is equally crucial to the team.
Lightning Round
Go-to way to keep balanced…There are definitely emotional hazards to dealing with very sick people on a daily basis.
I schedule yoga into my week — blocking it on my calendar — to ensure that that happens. In terms of yoga studios, I like House of Jai. I also prioritize family time, including spending time with my husband and daughter. The good news for me is that emergency medicine is a very social practice, and coming to work on a Saturday night is akin to hanging out with friends for 12 hours. So that’s great.
Tip for unplugging when not at work…I’ve never been very good at that, but I’ve gotten better. It is the advantage of loving what you do; it’s hard to truly step away from it.
Best thing about treating New Yorkers…In New York you’re actually treating people from all over the world. The millions of people who visit New York yearly aren’t plugged in to our medical system, so we’re the safety net for them. We get people from everywhere with various issues, including things we’ve never seen before in this country.
Favorites
Downtime read: The Widow Walk Series by Gar LaSalle
Irreplaceable tech: In relation to use of the EMR, we have wonderful scribes who literally chase us around the ED with a computer on wheels and help us fill out the documentation we’re required to complete. I read through and make edits and then hit submit. It really increases the speed and accuracy of how we operate.
Best meal: We’ve recently made a habit of trying to hit the different Omakase restaurants in the city — a recent fave is Tanoshi.
You can learn more about Dr. Mary Mulcare here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
