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- Jul 14, 2015
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So I think ER doctors pretty much fall into one of two camps - the big worker-uppers and the with minimalists. Obviously there is a spectrum to it and there may be certain things certain doctors workup more than other things (ie abdominal pain vs headache vs rashes, etc) depending on one's interest in the topic, comfort level in dealing with a certain complaint and or history of lawsuits or missing things based on a certain organ system.
I think the goal of all of us should be to try to be somewhere left (towards the minimal side) of centre - where we don't order tons of unnecessary, expensive crap but know when to workup certain complaints in certain patients more thoroughly so we don't miss something bad (like in aortic dissection or SAH to name a few obvious examples).
Anyway, since residency I was always more of a minimalist - basically I have always felt our job was to rule out bad stuff, not make diagnoses (of course we make some along the way) and thus if something is not emergent, it can be done as an inpatient or outpatient but not in the ER. I think big workups are a huge reason that patients stay here so long (besides the lack of inpatient beds) and cost our health care system tons of wasted $$. With my 13 years of experience now I have only become more so - I proudly accepted the stat that of all the attendings at my old hospital, I had ordered the fewest CT scans and my patients have not done any worse and I have not been sued since my 2nd year out of residency (which I was dropped from luckily).
I think with experience this is where we all should be heading - nothing drives me nuts more than getting sign out from a big worker-upper or signing out to one and having to cancel stuff (or discharge patients) or have them add all this stuff on and gum up the works.
What does everyone think? What are you??
I think the goal of all of us should be to try to be somewhere left (towards the minimal side) of centre - where we don't order tons of unnecessary, expensive crap but know when to workup certain complaints in certain patients more thoroughly so we don't miss something bad (like in aortic dissection or SAH to name a few obvious examples).
Anyway, since residency I was always more of a minimalist - basically I have always felt our job was to rule out bad stuff, not make diagnoses (of course we make some along the way) and thus if something is not emergent, it can be done as an inpatient or outpatient but not in the ER. I think big workups are a huge reason that patients stay here so long (besides the lack of inpatient beds) and cost our health care system tons of wasted $$. With my 13 years of experience now I have only become more so - I proudly accepted the stat that of all the attendings at my old hospital, I had ordered the fewest CT scans and my patients have not done any worse and I have not been sued since my 2nd year out of residency (which I was dropped from luckily).
I think with experience this is where we all should be heading - nothing drives me nuts more than getting sign out from a big worker-upper or signing out to one and having to cancel stuff (or discharge patients) or have them add all this stuff on and gum up the works.
What does everyone think? What are you??