Chris C. Feier M.D., Pharm.D. is an Assistant Professor of Clinical Emergency Medicine at the Keck School of Medicine at LAC+USC Medical Center. He started writing the “USC Survival Guide” for himself and other residents while in residency. It is now available publicly as The Chief Complaint.
What is your new book The Chief Complaint about? Why did you write it?
The Chief Complaint was born out of my frustration with the educational process in medicine. The origins of this book date back to my first year of emergency medicine residency. It was my first few days as an ER intern and my first patient in “C-booth” (the critical care section of the emergency department) had altered mental status. I tried to perform a history and physical like we were taught in medical school. I asked him pointed questions about his altered mental status and probed him with the PQRST pain assessment method, but the only response I got back was non-sensical yelling, expletives, or obscene hand gestures. So, the standard H&P (history and physical) didn’t work, but what about a mnemonic? There’s the AEIOUTIPS method for altered patients. I couldn’t remember all of it and it just seemed like random diagnoses strung together.
That’s when it hit me — patients present with a symptom, a chief complaint. Our profession is chief complaint-oriented but we are taught in a disease-based fashion. This works well when we know the patient’s diagnosis, but how do we get there? This question started me on a 7 year-long journey of writing this book and hopefully adding something to the field. The goal is to structure algorithms in a way an emergency physician would approach a patient’s complaint. They are very simple in their structure and comply with the EM mantra of “worst first.”
How has technology affected emergency medicine and are there any Health/Web 2.0 tools you would recommend to other ER physicians?
We live in the age of “I need to know now”, and if any field of medicine exemplifies instant gratification it is emergency medicin If I need to know something quickly, I like uptodate.com, but it is not as geared to emergency medicine as I would like. I also use Dr Google, which is what I see most residents use when they have a question during a shift. Of course, I also refer to my own notes and actually use my book on almost every shift. YouTube is my go-to for reviewing procedures.
For the deep dive at home, I use lectures whenever possible: EM:RAP, Essentials of EM, CMEDownload, Resuscitation conference etc. I use primary articles for research, and for that I use the Papers app. This app was a lifesaver when I wrote the book because I could store all my papers and easily retrieve them whenever needed. Whenever I don’t understand the papers I am reading, I go to theNNT.com. Dr David Newman runs the site and breaks down seminal papers into a format even I can understand. We also just started having a Figure 1 module at USC grand rounds where we identify the disease process based on the picture. This is great because patients do not present to the ER with a description of their rash on paper- they present with the rash and ask you what it is.
How do you think healthcare professionals should continue education once they’ve started working in the field?
The difficulty in continuing education once you are working in the field is that you don’t know where your gaps in knowledge are. I try to do daily personal M&Ms (morbidity and mortality conferences) on myself. I like to see what patient(s) I struggled with and why. Then I look up all the information I can in primary journal articles and EM:RAP/Essentials of EM lectures. I may be somewhat biased because I worked with Mel Herbert during residency transcribing EM:RAP lectures, but he has done something phenomenal. CME and medical education is no longer boring or something to be done grudgingly. These TED style talks are short, informative, and entertaining. These lectures have been the cornerstone of my emergency medicine curriculum since I was a resident.
It is easy to become complacent once you have graduated and think “I know enough to get through the day.” But do we just want to “get through” the day or do we want to provide our patients with the best care they can get?
You can purchase Dr. Feier’s book (which includes images from Figure 1) here: The Chief Complaint
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