retracted

Why are you bashing EM? What mistakes have you made lately?

Admitting a patient doesn't alleviate any work for the ED.

I think the OP meant to post this in the Surgery forum :laugh:

Are ER Physicians arrogant idiots as a whole, or is it just my institution? Is it necessary to bolus every person with 1 liter of Normal saline (even if they have an EF of 25%), check a BNP, X-Ray, and CT-Brain of every person who walks through the door? Ooops.. that liter just put them into Failure.. gotta admit them to Medicine now! I sometimes wonder whether they should just abolish the ER Residency program, and have Medicine and Surgery just run the show.. What are your thoughts?

Don't be an idiot.

Are ER Physicians arrogant idiots as a whole, or is it just my institution? Is it necessary to bolus every person with 1 liter of Normal saline (even if they have an EF of 25%), check a BNP, X-Ray, and CT-Brain of every person who walks through the door? Ooops.. that liter just put them into Failure.. gotta admit them to Medicine now! I sometimes wonder whether they should just abolish the ER Residency program, and have Medicine and Surgery just run the show.. What are your thoughts?

Wow, harsh!!!

I think the OP meant to post this in the Surgery forum :laugh:

He's obviously in the wrong forum.

This is the only warning I'll give. If you have legitimate complaints about the EM docs at YOUR institution, you have the right to voice your frustrations, but if this degrades into a specialty pissing match like occurs in the Surgery/Internship/etc forums, the thread will be locked and infractions will be issued.

This is the only warning I'll give. If you have legitimate complaints about the EM docs at YOUR institution, you have the right to voice your frustrations, but if this degrades into a specialty pissing match like occurs in the Surgery/Internship/etc forums, the thread will be locked and infractions will be issued.

Wow. Just Wow.

And I'm glad I'm not going into internal medicine.

Foolish statements... and a hypovolemic pt with an EF of 25% can easily handle a liter.:idea:

Are ER Physicians arrogant idiots as a whole, or is it just my institution? Is it necessary to bolus every person with 1 liter of Normal saline (even if they have an EF of 25%), check a BNP, X-Ray, and CT-Brain of every person who walks through the door? Ooops.. that liter just put them into Failure.. gotta admit them to Medicine now! I sometimes wonder whether they should just abolish the ER Residency program, and have Medicine and Surgery just run the show.. What are your thoughts?

My thoughts are that medicine and surgery did actually used to run the show... some of your attendings may remember those days.

My thoughts are that medicine and surgery did actually used to run the show... some of your attendings may remember those days.

You mean run the ED?

You mean run the ED?

Still do at Southwestern to a degree. In the medicine ER, the pit boss is a senior medicine resident that determines who gets admitted and what service the patient goes to.

In the surgical ER, it's a bit more of a rodeo but the surgical residents are always there and handling the bulk of admission issues.

Still do at Southwestern to a degree. In the medicine ER, the pit boss is a senior medicine resident that determines who gets admitted and what service the patient goes to.

In the surgical ER, it's a bit more of a rodeo but the surgical residents are always there and handling the bulk of admission issues.

It's nice when the decision to admit or not is actually left to the service that will have to do all the work . . . but I still don't know if that was the point of the poster to whom I responded.

One of the hospitals I went through third and fourth year left the decision on admission to the medicine senior - a lot of responsibility, but I think the resident's appreciated it. Most places these days though only the attending can block an admit from the ED, and who's going to bug an attending unless it is super-ridiculous.

I'm not hating on the ED or EP's

One of the hospitals I went through third and fourth year left the decision on admission to the medicine senior - a lot of responsibility, but I think the resident's appreciated it. Most places these days though only the attending can block an admit from the ED, and who's going to bug an attending unless it is super-ridiculous.

It would be nice if we had some say in actually admitting the patients. If we're going to take the ultimate responsibility as far as discharging them, then let that start from the minute I walk into the room. I should be able to say this patient does not need to be admitted.

It would be nice if we had some say in actually admitting the patients. If we're going to take the ultimate responsibility as far as discharging them, then let that start from the minute I walk into the room. I should be able to say this patient does not need to be admitted.

I agree. I think MOST EP's do a really good job of knowing who needs to come in, but sometimes . . . I don't know . . . maybe it's a difference in philosophy sometimes, but I def agree. The service who will ultimately be responsible should be making decisions about admission.

I'll change the thread up a bit...on a more positive note =)

I love EM. I work in the ED as an extern all the time and have learned some great practical skills (ENT stuff, Ophtho stuff, putting in IV's/lines/intubation/ultrasound stuff). I love sewing lacs and doing I&D's.

As an IM resident and hopeful future cardiologist, I'm sad that I'm going to forego a lot of these procedures. Can I, as an IM trained person still staff an ED (with other ED physicians) or work under an ED physician once in a while to keep this up?

The reason I decided not to do EM is because it wasn't in depth medicine enough. All the academic studies/research was not found in EM and I loved cards...but alas EM and FP are the most practical of specialties to serve the general public.

You mean run the ED?

Before emergency medicine became a specialty, the internists, surgeons, family physicians were the ones staffing the ED's. There were no Departments of Emergency Medicine and the ED's were under the Department of Surgery or Department of Internal Medicine. In fact, there are still a few places where EM is still a division under the surgery or internal medicine department.

Somewhere along the way (at least at most teaching hospitals), it was decided that EP's should have the final say in who gets to be admitted. An argument in favor of EM is that it is the ED who sees them again (sometimes in worse condition) if they are inappropriately discharged. I can see how sometimes the decision to admit is a difference in philosophy.