The End of Toxicology

Jason Hack, MD, FACEP
Editor-in-Chief, ACEP Toxicology Section Newsletter

Jason HackWhy would anyone need a medical toxicologist? I’ll just Google the answer!

In the modern age of spoon-fed education—pod casts, summary mailers, open websites that make complex medical problems into catch phrases—why would the bedside ED doctor ever have a need for a Medical Toxicologist?

Don’t worry, I’m not about to talk us out of a job, or income, or our vital role in the management of saving intoxicated, exposed or poisoned patients. Instead, I’m going to applaud your correct decision to take on the world of Toxicology as a career choice and reinforce the important role we play in patient management.

While, yes, there is an APP for that, and it’s a very good one to get the things started on the right treatment path [full disclosure: this section produced it!], these are often very, nuanced and ill patients. And while Google is sometimes sufficient to get things started, these patients’ care requires the synthesis of tremendous amounts of information. Because no electronic decision making tool can do so, your Toxicology training allows you to knowledgeably act within a unique intersection of patient care. We have been taught to confidently and expertly juggle, sort and consider aspects of the patients’ care from multiple viewpoints including emergency medicine, critical care, pediatrics, industrial hygiene, social milieu, addiction medicine and epidemiology. It is with recognition and address of these complexities that your training as a Toxicologist can make a difference in patient outcome and safety every time you are involved.

Can you remember the last time you did a shift or had a week when an overdose patient didn’t present? Or you didn’t have a patient with drug interaction, or therapeutic misadventure, or needed a reversal agent? When was the last time you went a week without a colleague approaching you with “I saw a cool case of…” or “hey, can I ask you about this…?”

For those of you with an interest in a career in toxicology, I salute you! You are making the right choice. You will be able to provide advice and life saving information for patients and communities at risk.

My sense is that as long as there are thousands of medications and people who are on more than 4 at a time, as long as there are people who’s need for new and interesting way to intoxicate them selves is greater than their innate sense of self protection, as long as there are people who want to hurt themselves, as long as there is industry involving the use of injurious chemicals—there will always be a critical need for the specialty of Toxicology. I wish it were otherwise, but this is our Job Safety.

I’m sure all of you are excited as I am for ACEP’s Las Vegas Meeting coming up in October. It’s a chance to catch up with new and old friends, learn about new and interesting Tox things that can kill you and how we can save people (often from themselves).

Have Fun and Be Safe!


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