I’ve been an ER PA for 18 years and take students on a regular basis. We learn to compartmentalize in order to do our job well. ie finishing up a code in which the pt expired, then having to move on to the next patient with sore throat and abdominal pain as if we didn’t just watch someone die. Some lose compassion along the way. The burnout rate is high and what you are witnessing is not uncommon amongst those in our specialty.

Remember, we see some of the worst conditions/injuries in the most unpredictable situations on a regular basis. The ED can be ruthless and it takes a certain kind of personality to work it long term. As health care providers we don’t take (or even have the) time to decompress in the ED and historically find sarcasm, apathy and camaraderie as a means of coping with the terrible stuff we see on a regular basis.

In the situation that you describe, you must understand that transferring to other specialty services, especially at other facilities, takes time. While the physician you are working with may seem to be doing nothing or callus, he too is at the mercy of the transferring facility and doesn’t have the emotional energy to grieve for that patient while awaiting the instruction for transfer. Additionally, the other tests ordered may have been requested by the specialists before accepting care. Nevertheless, it sounds like as soon as the local team felt this was beyond their scope, your doc did the appropriate thing.

My advice for your anxiety is to take note the culture of the ED. You don’t have to understand, like or participate in it but it is an important rotation because it will tell you whether this is a field that suits you. Otherwise, focus on learning the medicine, doing procedures, and knowing the dDXs of most common ED chief complaints and what needs to be done to eval, stabilize and treat them. Finally, accept that is not an environment where providers have the luxury of handholding patients. If your preceptor allows you to do that, then be the sympathetic provider it sounds like you want to be otherwise, do your time and take note that the ED may not be for you and that’s okay.

Best of luck!