ER-no respect?

[EMDOC]

I have a 'friend' who is hard core surgury and gave me a smart ass comment when I told her that I am interested in ER, she said "ER docs are at bottom of the barrel, incompetent and are only capable of being able to refer when needed. It really pissed me off- any input???????

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[kungfufishing]

uh, who cares?

 

[EMDOC]

uh, who cares?

true, I really shouldn't, but from what I have heard ERdocs take a alot of s*&t from other areas

 

[docB]

Surgeons are among the worst for that kind of crap. The fact is that they don't like ER docs (most of the time) because we wake them up with consults and we call them when their surgical complications show up in the ER. They are also totally schizophrenic in terms of what work up needs to be done before they have to drag themselves down to the ED. It's not uncommon to call a surgeon with a fever, white count and RLQ TTP and have them scream about being called before the CT is back. When the CT comes back and they show up they scream about not being called earlier for an obvious appy. The times when they like they ER are when their pts call and they can just send them on in.

The bottom line is that lots of docs do feel like that but they are happy to dump on the ED like we're just thier afterhours and overflow clinic. I would say that if they truly think we're incompetent then don't they have an ethical duty to not send us their pts. Wouldn't that be like referring to a cardiologist that you think is dangerous? Isn't any doc that spouts that stuff obligated to keep his clinic open 24/7? Well they don't.

 

[melonque]

I for one time period was bothered by these comments too. But later I thought of this: If you think like a triage nurse, no matter what field you are in, you will be like triage nurse. But if I am good, no matter what field I get into, I will be damn good. I should care what my patients think of me instead of some other tools in the hospitals.
Not to mention, being a EM doctor, I will "control" their lives. Better not to piss me, or I swear to god, I will page at 5:58 am everytime I know s/he is on call.

 

[Homunculus]

IER docs are at bottom of the barrel, incompetent and are only capable of being able to refer when needed.

. . . and your point is???







oh wait . . yeah, most ER docs aren't like that. maybe back in the day it was where the leftovers went, but now it's where a lot of the more talented folks gravitate (well, except for maybe kungfu). anesthesia i think was once like that, too.

anyway, most of the "ED physicians are incompetent" feelings stem from them having to have such a broad knowledge base of acute illness. Even in peds, another primary care specialty, we find ourselves sometimes wondering about the "rocephin and DC" treatment sometimes given to kiddos (with no cultures of course). I don't blame them per se, it's the nature of their field. they have to be peds ID experts one moment then nephrologists/cardiologists/gastroenterologists the next. When they're done these specialists *do* come down and, after having the luxury of a tentative diagnosis and a slew of lab tests, can confirm the presumptive diagnosis or laugh at the ED doc for ruling out an MI "when clearly this is simply early depolarization and didn't warrant any further testing". not to mention when these services are consulted, they don't see the big picture-- for every patient they are consulted on, there were probably 20 or so that the ED doc handled him/herself and sent on their way.

a longwinded response, but honestly you should take kungfu's advice-- let it go.


--yuor friendly neighborhood cbc & culture, UA & culture, LPing caveman

 

[docB]

The caveman makes an excellent point. Part of the reason they think we?re incompetent is that we don?t think like they do. For us it?s stabilize and dispo. I get a lot of guff in the ED about how an admission could be ?saved? if I would just obs the pt for 8-12 hours in the ER. Nope, that?s the admitting doc?s job.

 

[Homunculus]

Better not to piss me, or I swear to god, I will page at 5:58 am everytime I know s/he is on call.

that'll help your image a lot,

--your friendly neighborhood brick wall caveman

 

[lawmd]

medicine is the same way to an extent-call them for a "soft admit" for chest pain an they get pissed. They fail to realize that or chest pain/obs center saves them 30-50 of these admits each month, if not more. Where I went to med school it was a constant war as to who the "dumbest" service was. Usually EM and IM, surgeons could do no wrong. They were the hardest worked, hands down, but that attitude rubs off on everyone and it is BS. When I started residency, I was expecting the same thing, so when I consulted surgery,my hands were sweating and I went off on a 5 minute speech/tirade on why they needed to come down. She finally stopped me and said-relax, we'll come see the patient. It is so nice working with happy residents.
For those who bash EM, screw em. There are bad seeds in EM, no doubt, and our workups will often be inadequate. But the role of EM is to rule out the bad things, which we do well. Then call the consult who will have the luxury of talking about the patient for an hour over breakfast and mentally masturbate about which antibiotic to switch to.
Most importantly, after I do my 15-16 shifts a month as an attending somewhere, I can take a week or so to go surfing in central america. We all choose which specialty we go into, I have a hard time listening to other specialties bitch and moan about their work, when they should have known the up and downsides that come with it.

 

[Sessamoid]

that'll help your image a lot,

--your friendly neighborhood brick wall caveman

As has already been made clear, "image" isn't something that we're overly concerned about. I definitely hit the offensive consultants harder when I was in residency. If they want to make my life harder for no good reason, I can do the same in return. At the same time, we were very kind to the consultants that treated us well in residency. What goes around comes around.

 

[Whisker Barrel Cortex]

I think EPs are in a position where everyone that they consult has more knowledge about that specific field. You call the IM doc, they know more about the long term inpatient management of a certain condition. You call the surgeon, they know more about operative bellies. You call the neurologist, they know more about stroke, etc. You call the cardiologist, they know more about cardiology. This leaves you guys in a position to be critisized if the work up wasn't done in the way the "experts" would have done it. Where EPs are expected to excell is the acute managment and evaluation of patients, kind of stuck in a place between outpatient and inpatient medcine. Unfortunately, admitting services don't see all of the discharged patients.

I'd say the majority of ED docs in our hospital are reasonable. However, there are 3 that are well known to order many more negative radiologic studies than others. Pretty much every radiology resident agrees on these three attendings over-ordering. I know that at least one of these is known for admitting more "soft" patients. It is these ED docs that draw the ire of residents in a wide range of fields. I'm not sure if these guys have been sued in the past, have less clinical judgement, or are just inexperienced. Whatever it is, it shows. Plese try not to be one of "those" EPs.

 

[Pilot Doc]

I think EPs are in a position where everyone that they consult has more knowledge about that specific field.

W.B.C. hits the nail on the head. The ER's job is to be 2nd best at everything - sort of a medical swiss army knife, and as such, you are the best to see undifferentiated, acute patients. The downside is that almost every consultant you call could have better managed a particular patient. The other services never see your saves, only your mistakes. That, combined with the occasional truly incompetent attending, is why everyone loves to hate the ER. It's an occupational hazard.

 

[doc05]

don't forget that you are shift workers. The surgeons in particular are baffled by this sort of existence.

 

[Sessamoid]

don't forget that you are shift workers. The surgeons in particular are baffled by this sort of existence.

Except the trauma surgeons. At the trauma center I used to work at, the trauma guys there were essentially shift workers with really long shifts. When they were off, they were off. One of their partners handled all the inpatients and new traumas.

 

[EctopicFetus]

I think a lot of it is jealousy. ER docs give up some $$ and get to enjoy their lives a little more. Surgeons are also annoyed because their field is getting cramped by other specialties taking their jobs. GI guys do the colonoscopies, ERCP and as a last resort the surgeons get some lap choles. with the better medicine and management less surgery work for them and I imagine many arent happy about it..

That being said a nice surgeon is a great surgeon.. its the nasty ones i cant stand.

 

[doc05]

Except the trauma surgeons. At the trauma center I used to work at, the trauma guys there were essentially shift workers with really long shifts. When they were off, they were off. One of their partners handled all the inpatients and new traumas.

yes, but the trauma surgeons actually follow their patients over the course of their hospitalization.

 

[ERMudPhud]

yes, but the trauma surgeons actually follow their patients over the course of their hospitalization.

No, you miss the point. In some systems, like what Sessamoid was referring to, whichever trauma surgeon is on that day rounds on everybody. So yes you might "follow" your patients but you may go days between seeing them if you don't happen to be on for those days. The hospitalist/intensivists where I work do much the same sort of thing. As their shifts bring them back around to the same patients they may end up rounding on the same patient they admitted a few days ago but they could easily go days between rounding on "their" patient. Its really not that different from me seeing the same frequent fliers who are in the ER more than I am when I come back on for a shift.

Anyway, there are plenty of more important things to base you sense of pride and self-worth on then who spends the most hours in the hospital. After all, when I was doing Q2's for a few months in the units I clearly had the most hours in the hospital but I was far from the best or most important doc in the place.

 

[Sessamoid]

No, you miss the point. In some systems, like what Sessamoid was referring to, whichever trauma surgeon is on that day rounds on everybody.

At the last trauma center I worked at, the trauma surgeons' PAs did most of the routine rounding on floor patients. A couple of them also worked for us, so I'm not knocking them at all.

 

[jpgreer13]

They can call me incompetent all they want.

And when I collect my $225K a year to work 30 hours a week with flexible scheduling and early retirement, my incompetent self will still sleep like a baby. While their beepers explode all night long.

 

[MS05']

They can call me incompetent all they want.

And when I collect my $225K a year to work 30 hours a week with flexible scheduling and early retirement, my incompetent self will still sleep like a baby. While their beepers explode all night long.

Hi jpgreer13...I just sent you a PM

 

[roja]

almost every consultant you call could have better managed a particular patient.

Until the patient becomes unresponsive... then they come running for us. (Has happened enough times already.......


And yes, surgeons, especially the residents (I think you find a different experience with privates and their personal patients...). But you have to cut them slack. They are crazily overworked, and thier life gets no better when they get out.

And so I try not to rub it in when they tell me my drunk assaulted patient is fine because he is talking and can cross his legs, despite the subdural bleed AND SAH AND the posterior globe fracture.... and the fractured humerous with 1 L of blood in the shoulder. oops.

 

[evillagedoc]

Give me a minute to explain. I am surgical subspecialist, and actually deal with the ED "physicians" a lot. To be clear, I do not consider them physicians, nor do I value any of their clinical judgement, or hold in any esteem any skill sets they claim to have. Lets just start by defining what a physician is. They are an individual that is involved in the diagnosis, prevention, and management of systemic manifestation of pathology.

Lets just take the first part in diagnosis: They do not really diagnose anything. They may be equipped to recognize certain diseases and manifestations of those diseases, but they are rarely involved at a point in patient care in which they are the diagnosing physician. They may have clinical suspicion of an underlying disorder based on a finite, limited differential diagnosis- however, they quite often enlist consultants in the final diagnoses and management of patients that present. The second part- prevention. I think we can safely say that these individuals do not play a role in any disease prevention. Finally, management- they are not involved in the continuous care of any patients. They may find a lump, mass, etc- but ultimately the care of the patient is relinquished to a real physician.

People go into ED medicine because they think their lives will be like that 90s TV show ER- a glorified depiction of physicians doing chest compression, aortic cut downs, and chest tubes. Anyone who has worked in a hospital, will tell you, that traumas are handled by in house trauma surgeons. Walk into any ED in the country, your ED doctor will be sitting at a desk, typing a note, with a phone in their hand calling a consult. Most of the time, their physical exams are lacking (if they do it at all).

This is all coming from someone who has worked in the ED as part of my training. I can confidently say that was the worse time of my life. I could not take pride in any of the work that I did. It was a dark time, and I had zero job satisfaction. I felt like I took no responsibility or ownership of any patients. I was simply a triage system designed to babysit patients until the real doctors showed up. Do not think the field is anything more than it is.

Also- there is something that should be said when most of the people that have posted in defense of ED physicians site "Good Money, with Good work hours". Id like to tell you this- ED physicians consistently rank lowest in terms of job satisfaction of all physicians, and have the highest burn out rate. So there is some truth to the fact that they really don't do much, and after a while I think they realize it.

A final thought, if a job can be done by an NP out in the middle of nowhere or an ED can hire on an internist, general surgeon, urologist to moonlight in their department- that probably means that the "speciality" is a sham. Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)

Nobody respects ED docs, most of all, other physicians.

 

[namethatsmell]

A delightful example of how lack of wit tends to accompany lack of wisdom.

 

[TooMuchResearch]

Give me a minute to explain. I am surgical subspecialist, and actually deal with the ED "physicians" a lot. To be clear, I do not consider them physicians, nor do I value any of their clinical judgement, or hold in any esteem any skill sets they claim to have. Lets just start by defining what a physician is. They are an individual that is involved in the diagnosis, prevention, and management of systemic manifestation of pathology.

Lets just take the first part in diagnosis: They do not really diagnose anything. They may be equipped to recognize certain diseases and manifestations of those diseases, but they are rarely involved at a point in patient care in which they are the diagnosing physician. They may have clinical suspicion of an underlying disorder based on a finite, limited differential diagnosis- however, they quite often enlist consultants in the final diagnoses and management of patients that present. The second part- prevention. I think we can safely say that these individuals do not play a role in any disease prevention. Finally, management- they are not involved in the continuous care of any patients. They may find a lump, mass, etc- but ultimately the care of the patient is relinquished to a real physician.

People go into ED medicine because they think their lives will be like that 90s TV show ER- a glorified depiction of physicians doing chest compression, aortic cut downs, and chest tubes. Anyone who has worked in a hospital, will tell you, that traumas are handled by in house trauma surgeons. Walk into any ED in the country, your ED doctor will be sitting at a desk, typing a note, with a phone in their hand calling a consult. Most of the time, their physical exams are lacking (if they do it at all).

This is all coming from someone who has worked in the ED as part of my training. I can confidently say that was the worse time of my life. I could not take pride in any of the work that I did. It was a dark time, and I had zero job satisfaction. I felt like I took no responsibility or ownership of any patients. I was simply a triage system designed to babysit patients until the real doctors showed up. Do not think the field is anything more than it is.

Also- there is something that should be said when most of the people that have posted in defense of ED physicians site "Good Money, with Good work hours". Id like to tell you this- ED physicians consistently rank lowest in terms of job satisfaction of all physicians, and have the highest burn out rate. So there is some truth to the fact that they really don't do much, and after a while I think they realize it.

A final thought, if a job can be done by an NP out in the middle of nowhere or an ED can hire on an internist, general surgeon, urologist to moonlight in their department- that probably means that the "speciality" is a sham. Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)

Nobody respects ED docs, most of all, other physicians.

lol and gtfo.

I should edit to note I read only the first 1.5 sentences.

 

[e30ftw]

troll-tastic.

If you actually are a surgical subspecialist then your entire post reads like a toddler's temper tantrum from being woken up in the middle of the night to take care of patients. I've spoken with many physicians like you, upset that your patient presented with a bowel obstruction post-operatively and wants to bitch and moan at the ER physician who is trying to take care of your patient. Guess what? You chose a specialty that takes overnight call and agreed to have privileges at your hospital. You knew what you were getting into and if you don't want to take call go do outpatient-only medicine. Otherwise call back and take care of your patient.

 

[littlejuan]

Only idiots think like this. They lack perspective, inability to see or comprehend the circumstances which others are in. It's pretty simple. Smart physicians who understand what a given field is about would never disparage that entire field. It's petty and immature to act this way.

 

[e30ftw]

Anyone considering Emergency Medicine as a career listen closely:

evillagedoc is most likely a troll, but you will encounter these people occasionally in practice. As an intern and junior resident it can cause you to dread consulting these physicians. Sometimes it makes you less likely to call a consult for a patient who needs specialty care.

Remember that at that moment you are the only person able to fight for your patient to get the care that they need. They trust in you through a fiduciary relationship to get them the emergent care that they need using the resources of the hospitals Emergency Department. The consulting physicians are paid well to take home/in-house call and their primary duty as such is responding to consults from the ED.

Call at will. Some people will come back when their partial bowel obstruction progresses but some will just go home and die. You're the only one in a position to use the hospitals resources to help your patients.

 

[deleted547339]

Give me a minute to explain. I am surgical subspecialist, and actually deal with the ED "physicians" a lot. To be clear, I do not consider them physicians, nor do I value any of their clinical judgement, or hold in any esteem any skill sets they claim to have. Lets just start by defining what a physician is. They are an individual that is involved in the diagnosis, prevention, and management of systemic manifestation of pathology.

Lets just take the first part in diagnosis: They do not really diagnose anything. They may be equipped to recognize certain diseases and manifestations of those diseases, but they are rarely involved at a point in patient care in which they are the diagnosing physician. They may have clinical suspicion of an underlying disorder based on a finite, limited differential diagnosis- however, they quite often enlist consultants in the final diagnoses and management of patients that present. The second part- prevention. I think we can safely say that these individuals do not play a role in any disease prevention. Finally, management- they are not involved in the continuous care of any patients. They may find a lump, mass, etc- but ultimately the care of the patient is relinquished to a real physician.

People go into ED medicine because they think their lives will be like that 90s TV show ER- a glorified depiction of physicians doing chest compression, aortic cut downs, and chest tubes. Anyone who has worked in a hospital, will tell you, that traumas are handled by in house trauma surgeons. Walk into any ED in the country, your ED doctor will be sitting at a desk, typing a note, with a phone in their hand calling a consult. Most of the time, their physical exams are lacking (if they do it at all).

This is all coming from someone who has worked in the ED as part of my training. I can confidently say that was the worse time of my life. I could not take pride in any of the work that I did. It was a dark time, and I had zero job satisfaction. I felt like I took no responsibility or ownership of any patients. I was simply a triage system designed to babysit patients until the real doctors showed up. Do not think the field is anything more than it is.

Also- there is something that should be said when most of the people that have posted in defense of ED physicians site "Good Money, with Good work hours". Id like to tell you this- ED physicians consistently rank lowest in terms of job satisfaction of all physicians, and have the highest burn out rate. So there is some truth to the fact that they really don't do much, and after a while I think they realize it.

A final thought, if a job can be done by an NP out in the middle of nowhere or an ED can hire on an internist, general surgeon, urologist to moonlight in their department- that probably means that the "speciality" is a sham. Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)

Nobody respects ED docs, most of all, other physicians.

The troll is strong in this one.

 

[5739]

Before I decided to apply to EM, I was interested in Thoracic Surgery. I'm ashamed to admit it now, but back then I honestly was looking forward to how impressive I thought I would sound when I said "I'm a thoracic surgeon." I then floated to ophthalmology, where I remember being told by my friend (a neurosurgeon) that it was a "classy" specialty.

Then I realized I was making a huge mistake. I didn't go to med school to do VATS or cataract surgery. I came to be the one ready to step up at moment's notice to treat someone in need, and then send them where they needed to go. I love medicine, pathophys, differentials, and procedures - but only for a short time (15-30 mins) per patient, and then I get bored. What did this all point to? EM.

But what about my ego? What about the prestige? Yes, EM's getting cooler and more competitive, but it still doesn't have the ring that "I'm going in to peds cardiac surgery" has.

At the end of the day, I realized I needed to make the best decision for MYSELF based on what kind of doctor *I* wanted to be. Any, I mean any other input simply needed to be ignored. Yes, I'd lose the right to claim to be the hardest working or smartest doctor around, but, NEWS FLASH -----> no one really cares anyway. People are usually just impressed with themselves.

I had a great experience on OB/GYN. We had just pulled a uterus out of this woman's pelvis, and the attending told the circulating nurse "time to call the scientists!" with the condescending tone I'd learned surgeons usually have for pathologists. He then suggested that I (then an MS3) go with them to see how they prep a specimen. The pathologists came, got the specimen, and I left with them. As soon as the OR door closed behind us, they started talking about what an idiot the surgeon was.

That was a huge moment for me. See, up to that point, I had naively assumed that, although they were obviously being jerks, the surgeons had somehow earned or deserved to look down on other specialties by virtue of their unparalleled hard work and unique clinical perspective gleaned from hours in the OR. This shattered that. I suddenly realized that everyone in medicine basically thinks the other doc is an idiot.

I found that very liberating, because I realized the folly in getting caught up in the silly game of trying to buttress the prestige and relevance of one's own field and put down others. It's a losing game, and I am grateful to have learned that early in my career.

 

[5739]

OK, I really should not even respond to this, but I just can't resist.

Most of the time, their physical exams are lacking (if they do it at all).

Coming from a surgeon?

Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, ...

OK, so he suffered a severe trauma injury with likely multiple long bone and facial fractures, I'm listening carefully...

...and I could have one physician with me to take care of me, what type of physician would that be?

Let me see, if I suffered a ___ injury, I would want a ___ doctor, right?

100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)

Yes! I'm glad I got it right! That was a tough one!

 

[Birdstrike]

Give me a minute to explain. I am surgical subspecialist, and actually deal with the ED "physicians" a lot. To be clear, I do not consider them physicians, nor do I value any of their clinical judgement, or hold in any esteem any skill sets they claim to have. Lets just start by defining what a physician is. They are an individual that is involved in the diagnosis, prevention, and management of systemic manifestation of pathology.

Lets just take the first part in diagnosis: They do not really diagnose anything. They may be equipped to recognize certain diseases and manifestations of those diseases, but they are rarely involved at a point in patient care in which they are the diagnosing physician. They may have clinical suspicion of an underlying disorder based on a finite, limited differential diagnosis- however, they quite often enlist consultants in the final diagnoses and management of patients that present. The second part- prevention. I think we can safely say that these individuals do not play a role in any disease prevention. Finally, management- they are not involved in the continuous care of any patients. They may find a lump, mass, etc- but ultimately the care of the patient is relinquished to a real physician.

People go into ED medicine because they think their lives will be like that 90s TV show ER- a glorified depiction of physicians doing chest compression, aortic cut downs, and chest tubes. Anyone who has worked in a hospital, will tell you, that traumas are handled by in house trauma surgeons. Walk into any ED in the country, your ED doctor will be sitting at a desk, typing a note, with a phone in their hand calling a consult. Most of the time, their physical exams are lacking (if they do it at all).

This is all coming from someone who has worked in the ED as part of my training. I can confidently say that was the worse time of my life. I could not take pride in any of the work that I did. It was a dark time, and I had zero job satisfaction. I felt like I took no responsibility or ownership of any patients. I was simply a triage system designed to babysit patients until the real doctors showed up. Do not think the field is anything more than it is.

Also- there is something that should be said when most of the people that have posted in defense of ED physicians site "Good Money, with Good work hours". Id like to tell you this- ED physicians consistently rank lowest in terms of job satisfaction of all physicians, and have the highest burn out rate. So there is some truth to the fact that they really don't do much, and after a while I think they realize it.

A final thought, if a job can be done by an NP out in the middle of nowhere or an ED can hire on an internist, general surgeon, urologist to moonlight in their department- that probably means that the "speciality" is a sham. Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)

Nobody respects ED docs, most of all, other physicians.

"Internet Trolls Are Narcissists, Psychopaths, and Sadists"

https://www.psychologytoday.com/blo...rolls-are-narcissists-psychopaths-and-sadists

 

[Brigade4Radiant]

Except the trauma surgeons. At the trauma center I used to work at, the trauma guys there were essentially shift workers with really long shifts. When they were off, they were off. One of their partners handled all the inpatients and new traumas.

Well not entirely they still have clinic

 

[RustedFox]

Had a rather interesting exchange with a gen.surgeon recently about being a 'glorified triage nurse' and he being the end-all-be-all of .... all medicine. After he was done being a douchebag, I looked at him and said - 'Hey, I've got a pediatric rash in room 8, know ANYTHING about that ? Oh, and then there's the second trimester bleed in room 9. No idea, huh ?'

He shut up, sharpish.

 

[dotcb]

Haters are gonna hate.

 

[The White Coat Investor]

Get your loving at home. If having a thick skin is tough for you, the ED may not be the place for you. However, I can tell you this:

I've taken care of eye issues in an intensivist,
sepsis in an OB,
PTX in an anesthesiologist,
emergent pediatric issues in the children of an FP,
and psychiatric issues in a surgeon.

I don't need your respect. I don't even need your business. I get more than I need of both, plus 15 days off a month.

 

[Daiphon]

So, just to get this straight:

11 year necrobump from the bowels of SDN... meaning it was sought out specifically, likely with some effort.

Spends a lot of time deriding and insulting emergency medicine.

Spends no time talking about why he loves (or even tolerates) his specialty.

Defines physicians as those who:
1) diagnose - yep, I'm there. Hell, more than half my consults are based on my diagnosis and letting them know what they'll need to do
2) prevent - EM physicians are at the forefront of prevention. Screening, public health intervention, etc.
3) manage - more than they realize. I manage their freaking clinic, because all they do is "send it to the ED."

My only conclusion is there is some strong supratentorial pathology in this one, and that he/she resurrected a thread from beyond the white light simply to justify to themselves that their own specialty is a good fit for them. Standard prepubescent schoolyard bully tactics - if you can't improve your own self-worth, try to bring everyone down to your level.

Sorry you hate your life. I, and everyone else who has risen to this epic troll-baiting, love ours.

-d

 

[Xerxes1729]

Suppose you're going to have some sort of injury or illness. You don't know at all what it will be, if it will be traumatic or medical, etc. You don't know where you'll end up when it happens - could be a tiny rural hospital or the quaternary center. All you get to pick is who will be taking care of you when you present.

Do you want an emergency physician, or would you prefer a "smarter" doc? Maybe a neurologist for your hip dislocation? I'm sure they'll take a great history and do a very thorough exam. Perhaps an ophthalmologist to help with your massive pulmonary embolism causing obstructive shock? Those guys seem to know a lot and can always come up with diagnoses I've never even heard of. Neurosurgeon plus precipitous delivery equals wonderful time had by all, right?

Emergency medicine is not a good field if you need to have other people fluff up your ego in order to get through the day. You have to learn to brush of the miserable people - patients and staff - who want to make you miserable like them, and take satisfaction in the people who actually can be helped.

 

[Brigade4Radiant]

Literally no one cares that someone is a surgeon. Use the free time to have to be apart of the hospital administration and feed your need to boss people around.

 

[emergentmd]

Gosh, what a silly thread. One surgeon makes a statement and OP gets hypersensitive. Every specialty dogs another now and then. Its life. But in the end everyone has worth in the eyes of all specialties.

It is funny how I get calls all of the time to thank me for

1. Putting in a chest tube at 2am for a CV surgeon.
2. Reducing a fracture and sending them home rather than an ortho coming in
3. Calls from OB on how to handle their prego pts with chest pain or headache

The list goes on........ I save these guys so much time b/c I can handle the pts immediate issues. I find what I do more important than the specialists. The difficult part is the stablization/diagnosis. Once I tell the internist that the pt has DKA, then geezzzz thats really hard to manage. When I tell an OB doc that the pt has an ectopic.... then geeeezzz that is really hard to manage. When I tell a CV guy that the pt has a dissection, then geeeezzzz that is really hard to manage.

Once I get the diagnosis, pt care is all cookbook. How hard is it to treat pneumonia?

Anyhow, I am going skiing next week. Taking a beach in June. Going to Las vegas in July. Going to New York in August. Opppsss, I guess it would be better waiting around for my pager to go off in the middle of the night from the ED doc who diagnosed my appendicitis just so I can take it out that any monkey could do.

 

[emd123]

Gosh, what a silly thread. One surgeon makes a statement and OP gets hypersensitive. Every specialty dogs another now and then. Its life. But in the end everyone has worth in the eyes of all specialties.

It is funny how I get calls all of the time to thank me for

1. Putting in a chest tube at 2am for a CV surgeon.
2. Reducing a fracture and sending them home rather than an ortho coming in
3. Calls from OB on how to handle their prego pts with chest pain or headache

The list goes on........ I save these guys so much time b/c I can handle the pts immediate issues. I find what I do more important than the specialists. The difficult part is the stablization/diagnosis. Once I tell the internist that the pt has DKA, then geezzzz thats really hard to manage. When I tell an OB doc that the pt has an ectopic.... then geeeezzz that is really hard to manage. When I tell a CV guy that the pt has a dissection, then geeeezzzz that is really hard to manage.

Once I get the diagnosis, pt care is all cookbook. How hard is it to treat pneumonia?

Anyhow, I am going skiing next week. Taking a beach in June. Going to Las vegas in July. Going to New York in August. Opppsss, I guess it would be better waiting around for my pager to go off in the middle of the night from the ED doc who diagnosed my appendicitis just so I can take it out that any monkey could do.

This post was very offensive to monkeys.

 

[deleted500612]

Give me a minute to explain. I am surgical subspecialist, and actually deal with the ED "physicians" a lot. To be clear, I do not consider them physicians, nor do I value any of their clinical judgement, or hold in any esteem any skill sets they claim to have. Lets just start by defining what a physician is. They are an individual that is involved in the diagnosis, prevention, and management of systemic manifestation of pathology.

Lets just take the first part in diagnosis: They do not really diagnose anything. They may be equipped to recognize certain diseases and manifestations of those diseases, but they are rarely involved at a point in patient care in which they are the diagnosing physician. They may have clinical suspicion of an underlying disorder based on a finite, limited differential diagnosis- however, they quite often enlist consultants in the final diagnoses and management of patients that present. The second part- prevention. I think we can safely say that these individuals do not play a role in any disease prevention. Finally, management- they are not involved in the continuous care of any patients. They may find a lump, mass, etc- but ultimately the care of the patient is relinquished to a real physician.

People go into ED medicine because they think their lives will be like that 90s TV show ER- a glorified depiction of physicians doing chest compression, aortic cut downs, and chest tubes. Anyone who has worked in a hospital, will tell you, that traumas are handled by in house trauma surgeons. Walk into any ED in the country, your ED doctor will be sitting at a desk, typing a note, with a phone in their hand calling a consult. Most of the time, their physical exams are lacking (if they do it at all).

This is all coming from someone who has worked in the ED as part of my training. I can confidently say that was the worse time of my life. I could not take pride in any of the work that I did. It was a dark time, and I had zero job satisfaction. I felt like I took no responsibility or ownership of any patients. I was simply a triage system designed to babysit patients until the real doctors showed up. Do not think the field is anything more than it is.

Also- there is something that should be said when most of the people that have posted in defense of ED physicians site "Good Money, with Good work hours". Id like to tell you this- ED physicians consistently rank lowest in terms of job satisfaction of all physicians, and have the highest burn out rate. So there is some truth to the fact that they really don't do much, and after a while I think they realize it.

A final thought, if a job can be done by an NP out in the middle of nowhere or an ED can hire on an internist, general surgeon, urologist to moonlight in their department- that probably means that the "speciality" is a sham. Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)

Nobody respects ED docs, most of all, other physicians.

Ok the guy made a new account, dug up a decade old thread, then proceeded to roll his face across the keyboard until the screen was filled with 6 paragraphs of laughable horsesh|t. In summary, stop feeding the troll. Guarantee he is sitting back with a bag of popcorn having a chuckle while he reads the responses of people who are baited into taking this seriously.

 

[Mad Jack]

and psychiatric issues in a surgeon.

I thought that was required during every surgical consult.





Totally kidding, to any surgeons out there.

 

[engineeredout]

I don't need your respect. I don't even need your business. I get more than I need of both, plus 15 days off a month.

Love this quote

 

[odoreater]

You get to a point in your career where you are so content with what you do, know so deeply that what you do has true societal worth, and are so content with the path you have chosen that insults and threads like this are pure entertainment......

 

[RustedFox]

Jaaane says..... have you seen my wiiig around ? I feel naaa-ked with-OUUUUT iiiit !

 

[Doctor Bob]

For the medstudents out there reading this thread with some eye toward their future... troll-baiting aside...

There is a difference between how EM docs are viewed in an academic center and in a non-academic center. The lack of respect for EM docs at academic centers flows primarily from the residents/fellows in the various subspecialties. I've found the attendings to be very cognizant of our skills and utility. The residents however are still in the "I'm hot-s***" mode and tend to denigrate everyone around them. And EM people are an easy target.
In the community, it's very different. Sure, there are still docs who throw shade on everyone else, but that's just how they are and it's not just coming our way. Most private practice docs and community attendings know what we do and what we can do for them... and they're grateful for it.

 

[Birdstrike]

Now that I think of it, the troll on here is the Kanye West of SDN: "Gimme that Grammy! Only Beyoncé can ever win!" Only surgeons can have respect. No one else.

Lol

 

[met19]

For the medstudents out there reading this thread with some eye toward their future... troll-baiting aside...

There is a difference between how EM docs are viewed in an academic center and in a non-academic center. The lack of respect for EM docs at academic centers flows primarily from the residents/fellows in the various subspecialties. I've found the attendings to be very cognizant of our skills and utility. The residents however are still in the "I'm hot-s***" mode and tend to denigrate everyone around them. And EM people are an easy target.
In the community, it's very different. Sure, there are still docs who throw shade on everyone else, but that's just how they are and it's not just coming our way. Most private practice docs and community attendings know what we do and what we can do for them... and they're grateful for it.

Med Studs: This post is really important to note. But even in academic centers: having a bad attitude once/twice not a biggie deal (everyone has a bad day). If a consulting residents consistently comes down to the ED with that attitude issue it gets a discussion with their PD about professionalism. Not every academic place does that, but mine does as GME leadership stresses professionalism is an important trait to have as does the ACGME which mandates that professionalism is one of the 6 core competencies

 

[takeurmeds02]

It's not like specialists are fixing too much nowadays anyway; what with all of these chronic issues that pts are inflicting on themselves (i.e. COPD'er "but I quit smoking this morning"). Might as well let the ED doc see it and send them on their way to continue to die slowly or rapidly depending on how you look at it. Morbid but true.

 

[BruceWilly]

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