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It's always amazing reading these threads on SDN because all the ER people always go both ways. Half of them act like they're superstars, where it's like:
- We're not allowed to order labs or scans on a "fishing expedition" and if we did that, we'd expect to get chewed out.
- The only time I ever call anyone is AFTER I've read the EKG, diagnosed an RCA stenosis, begun all of the interventions, called in the cath lab team, and walked the dog for the Cardiologist. And I'm the sucky ER physician, where the other ER guys razz me for being incompetent.
And then the other half of them are like:
- Oh, by the way, that being said, diagnosis has nothing to do with our profession. We strictly stabilize patients. Not that we don't actually do what those other guys said. Just that if we don't, it's because we choose not to that one day and you can't blame us because we're not responsible for work-ups or diagnoses.
First of all, that's the biggest cop-out of all. "We're not responsible for diagnosis." You aren't? Then you're not a physician. You're an EMT who happens to work in a building. The ER, in actuality, if we cut the crap, doesn't even stabilize patients. They actually only identify unstable patients and BEGIN to stabilize them as they call someone else, be it the ICU, Medicine, Surgery/Trauma, or Ob. So now we're down to "go into ER: we can tell when someone is unstable." OMG, REEEALY?? Can you imagine the boards for ER, then? "Someone comes in with a HR of 156, BP of 74/49, and is unresponsive. Are they (a) stable or (b) unstable?" "Oh, crap, I knew I should have studied this part."
Second of all, why is it that NOBODY has interactions with these mythical amazing ER physicians? I mean, would you guys say your ER physicians DO or DO NOT:
(a) order the same set of labs (i.e., every single lab) on everyone;
(b) drastically over-use CT scans, even when told they aren't needed, as happened to me -- I told an attending they didn't need to perform a head CT on a patient and they did it anyways, so me and the Radiology attending just made fun of them for about thirty minutes;
(c) manage to at the same time NOT order a CT scan on the ONE person who does need one "because you keep telling us not to order CT scans";
(d) call you before they've examined the patient and sometimes before the patient is even in the room;
(e) call you after the patient has been sitting in their room for up to sixteen hours (that's my record) without any intervention other than a one-time order of morphine fifteen hours ago -- best part is when you walk in and the patient is like "is there anyone who works in this place?";
(f) start showering consults on you seemingly just because you reminded them you were around by walking through the ER (e.g., "oh, wow, hey, I have two consults for you!" "me, too!" "did someone say Surgery was down here?" "do you manage PEs?" "I have a patient here for something, but I don't do diagnosis!!")
Really, I don't even get how a physician could say AND THEN STAUNCHLY DEFEND not having to diagnose things. That's an outright admission that you just shotgun and pray, if you don't have a diagnosis. I'd frankly be embarrassed to say something like that, but that's just me.
- We're not allowed to order labs or scans on a "fishing expedition" and if we did that, we'd expect to get chewed out.
- The only time I ever call anyone is AFTER I've read the EKG, diagnosed an RCA stenosis, begun all of the interventions, called in the cath lab team, and walked the dog for the Cardiologist. And I'm the sucky ER physician, where the other ER guys razz me for being incompetent.
And then the other half of them are like:
- Oh, by the way, that being said, diagnosis has nothing to do with our profession. We strictly stabilize patients. Not that we don't actually do what those other guys said. Just that if we don't, it's because we choose not to that one day and you can't blame us because we're not responsible for work-ups or diagnoses.
First of all, that's the biggest cop-out of all. "We're not responsible for diagnosis." You aren't? Then you're not a physician. You're an EMT who happens to work in a building. The ER, in actuality, if we cut the crap, doesn't even stabilize patients. They actually only identify unstable patients and BEGIN to stabilize them as they call someone else, be it the ICU, Medicine, Surgery/Trauma, or Ob. So now we're down to "go into ER: we can tell when someone is unstable." OMG, REEEALY?? Can you imagine the boards for ER, then? "Someone comes in with a HR of 156, BP of 74/49, and is unresponsive. Are they (a) stable or (b) unstable?" "Oh, crap, I knew I should have studied this part."
Second of all, why is it that NOBODY has interactions with these mythical amazing ER physicians? I mean, would you guys say your ER physicians DO or DO NOT:
(a) order the same set of labs (i.e., every single lab) on everyone;
(b) drastically over-use CT scans, even when told they aren't needed, as happened to me -- I told an attending they didn't need to perform a head CT on a patient and they did it anyways, so me and the Radiology attending just made fun of them for about thirty minutes;
(c) manage to at the same time NOT order a CT scan on the ONE person who does need one "because you keep telling us not to order CT scans";
(d) call you before they've examined the patient and sometimes before the patient is even in the room;
(e) call you after the patient has been sitting in their room for up to sixteen hours (that's my record) without any intervention other than a one-time order of morphine fifteen hours ago -- best part is when you walk in and the patient is like "is there anyone who works in this place?";
(f) start showering consults on you seemingly just because you reminded them you were around by walking through the ER (e.g., "oh, wow, hey, I have two consults for you!" "me, too!" "did someone say Surgery was down here?" "do you manage PEs?" "I have a patient here for something, but I don't do diagnosis!!")
Really, I don't even get how a physician could say AND THEN STAUNCHLY DEFEND not having to diagnose things. That's an outright admission that you just shotgun and pray, if you don't have a diagnosis. I'd frankly be embarrassed to say something like that, but that's just me.