Other Doctors

Ricky Slade · Jul 24, 2004

I would like some EM residents' opinion on this matter...

I love medicine, I love being a resident, and most of all I love being a doctor. But as I finish up my first month of my EM residency in NY, I have a growing concern that one aspect of my job is going to drive me insane.

It's not the drug-seekers, the borderlines, the chaos of the ED, the homeless, the malpractice situation, or the much maligned US heath care system that bothers me. No, what I hate most about my job is other doctors. When I entered medical school, I thought that I would be surrounded by humane, interesting, altruistic, compassionate people whose first concern would be for their patients. Now I have realized that I am surrounded by people who toggle between arrogance and insecurity, who are more concerned about pointing out how "dumb" family practitioners are, or how the "dumb" the orthopedic surgeon is. I loved rotating through medicine and surgey as a med student, and it was so uplifting to listen to them bash each other. It really solidified my faith in medicine.

And now with very poor foresight I have chosen a field where I have to deal with other docotrs daily. To make matters worse I feel the job I do is not respected. I know that after I consult the second year surgical resident, who was a whole one year more of experience than I do, will talk down to me like some naughty child who didn't do his homework. Then after his oh-so-thourough evaluation of the patient, he will retire to the surgical lounge, angry because had to see a surgical patient, because god forbid he's a surgeon. Then his conversation with his senior will begin "stupid ER docs...don't know a f@#$ing thing."

Maybe its because I have been in acedemic institutions thoughout med school and now residency, maybe things are different in the community, or maybe I have made a grave mistake in my specialty choice, instead of Em maybe I should have opted for fam med in Nobody Lives Here,Montana where the nearest doctor is a time zone away. Maybe I am overreacting. What do you guys think?

docB · Jul 24, 2004

Other docs can certainly be a pain. You'll learn the art of talking to consultants. You have to know what the main point each one cares about is to break down their resistance. For example when you talk to surgeons your first sentence has to state that they or their partner have recently operated on the pt or that they have an emergent surgical condition. Otherwise they couldn't care less. For internists you have to explain what needs to be done as an inpatient that can't be done as an outpatient. If all you need is follow up say that early because a consultant's main fear is getting out of bed. If they can jot down a note and see it in clinic they usually won't fight.
You also will learn to pick your battles. At academic centers you can force some things that you can't or shouldn't in private practice. You will also develop relationships with docs and they'll send their pts to your ER and they won't fight your admissions. You'll also run into times where the consultants are wrong.
Other docs can be a pain but they are not the worst part of the job.

DrQuinn · Jul 24, 2004

Agreed. It sounded in your post that you were an EM intern. You are three weeks into internship! Speaking to your consultants is truly an art and will only get better with practice. One of the purposes (IMHO) of the EM intern year (consisting of a lot of off-service rotations) is just to learn what each specialty wants to know when they work up a patient.

Ex: OB/GYN: Know the patient's dates, exam findings on pelvic, previous OB history, vital signs and Hb.

Optho: Visual acuity, slit lamp exam, and need for emergent intervention.

Ortho: Describe the fracture (especially open/closed), is it reduced, did you give Ancef/Gent.

I fumbled around a bit last year but this year as a whopping 3 week old PGY2 I feel much more comfortable speaking to my colleagues over the phone. It also helps that I rotated with them so its more of a colloquial conversation, especially with the IM guys.

Bashing other specialties is unfortunately part of medicine... actually, its part of life. My brother is a lawyer and its innate in his DNA to bash doctors. My uncle owns a restaurant, and its innate in his DNA to downplay all other competing restaurants in a 10 mile radius (even though they may have better food).

I used to have a smirk everytime I heard a comment about the "dumb guys in the ER." Then I watched an IM attending try to transfer a patient to the MICU (where I was the intern) because of "status epilepticus." I show up, order an accuchek, and it was 30.

Just remember that its just how the world work, brother. All you can do is laugh it off, tell stories, and make a joke or two. Life is too short to worry about all that other crap. And be thankful you never have to be on call!

Q

beyond all hope · Jul 24, 2004

We all thought the same thing not too long ago.

Now that I'm a doctor, people will stop treating me like a medical student slug!

Starting intern year we learn different. You're just starting out, so you don't know the right way to call a consult or an admission. Insecure people, jerks and even nice people that are under stress will not be very symapthetic.

Several things will happen during your training which will make this easier:
1) you'll be a better, more confident doctor.
2) you'll learn to present better to your collegues.
3) You'll get a thick skin dealing with jerks (this includes nurses, patients, techs, other doctors, etc).
4) You'll get to know people. They'll learn to trust you and your judgement. Get to know them personally if you can: makes for a more fun and relaxed working environment.

Good advice from Quinn - know the important variables when calling a consult. Depends a bit based on location, but generally about the same.
You will also learn that some medicine people won't even talk to you about a patient unless you have labs, a chest x-ray (read by a radiologist) and EKG. Some surgeons won't see a patient without a belly CT.

Intern year is tough. You will probably have a lot of second thoughts (less in EM than in other specialities I imagine), but just keep plugging away. Things will get way easier and a lot more fun.

Sessamoid · Jul 24, 2004

The other thing to remember is that the world of academic medicine is not the same as practicing inthe real world. In academics, residents are overworked and paid relatively little, and they don't get paid more for doing more work. So naturally the instinct is to try to avoid work and they get angry and dump on those who they perceive as giving them more work.

In the real world, most of your patients will have some sort of insurance, a lots of them have primary doctors, and you'll find it's much easier to talk to your consultants or admitting doctors. In the real world, physicians rely on each other more to get work, so a specialist who dumps on internists or FPs a lot is going to find himself doing nothing a lot of the time (and paid accordingly). There will always be some a$$holes, but in general talking to other physicians is much easier in the private world.

Once you get known and trusted at a particular hospital, a lot of calls for admission go something like, "Mr. B is back again for CHF. He doesn't look like ICU material, but he'll need a tele bed for a few days." And that may be it for the admission. Not all phone calls will go like that, but a pretty significant percentage of them do.

Another thing they realize is that I have a choice in whom to send paying patients to for follow-up. I regularly send well-insured patients to the doctors who treat me politely. Non-incarcerated hernia? F/U with Dr. Goodby because he's a nice guy. The rude specialists get my Medicaid and uninsured followups when it's their turn on the call list.

USCDiver · Jul 24, 2004

Dude, if they're talking **** behind your back in the surgeon's lounge then who gives a flying **** in a whirlwind.

If they talk **** to your face then take that opportunity to ask them what you could have done differently.

Quit whining because people aren't treating you like you think you ought to be treated.

Plus all the good advice from the other people who know what they're talking about.

EMIMG · Jul 25, 2004

That surgery resident who as a second year is one whole year above you....once you are finished with your residency and become an attending, chances are they will still have more time as a resident (unless they actually finish their surgery residency in 5 years and you are at a 4 year program).

roja · Jul 25, 2004

I would definately follow the advice given. And realize some of this may be the institution you are at. It is rare that we have conversations like that in our hospital.

One of the MAJOR aspects of working in EM is dealing with consult services. And just like any other business, you have to learn how to deal with them, get them on your team. And this doesn't necessarily mean you have enough information stored in your brain to be a surgeon or optho or obgyn. It means that you are pleasant when youd eal with them, that you get them the work up that you know they need (especially in residency... does the BHCG really matter? no, but my ob consult can't present to thier senior with out it so I don't call them until its back unless the patient is unstable). They know this...

You have to work hard to build relationships with these people. I have made it a point to become friends with the vast majority of people I see on a regular basis.

I also will pull out the attending card. Have a soft consult? you don't necessarily agree with? tell the truth.. say, its a soft consult but my attending is worried about x. residents know what this is about.. they have all gone through it.

And the number one complaint that I hear from some consults is that ER residents will also try and get indignent when they have a soft admission. Just say, this is a soft admit. I'm sorry but this guy can't go home even though I think this 35 yo with chest pain is reflux, he has non specific twave changes and needs to be ruled out and stressed. I hope this helps you cap early. Or admit you don't know what the hell is goign on whith your patient but they are to sick to go home.

If you are constantly being called an ass or people are being rude to you all the time, check yourself and how you are interacting.

And then just realize, some people are just dicks and you aren't going to fix it. ITs the way of the world.

Don't worry, the learning curve is high but internship year goes fast. And you will elarn a ton. It gets better.

Annette · Jul 25, 2004

As an interloper, I'd like to add to some of the great advice. If I trust the person in the ED, I'm unlikely to bash them when something goes wrong. We all miss stuff. Don't tell me that you have done a full exam on a patient, can't discover why they have a fever, when I can smell the diabetic foot across the room. If you are crammed to the gills, and the patient "just looks sick," and you haven't had time to do a proper initial workup, OK, just be up front. And, one request, PLEASE look through the chart when you pick up a patient. I'll be very upset when I send a patient from clinic to r/o a PE, and all they get is a wound check for all their cat scratches, despite my phone call to alert you to my worry and the patient's base line lack of common sense.

The bashing will really slow down from the other interns as they eventually rotate through the ED. And, as you rotate through the other specialties, you'll learn more of what they need to know in your presentation.

maxheadroom · Jul 25, 2004

As a frequent consult resident to the ED, I've learned a couple of things . . .

First, certain EM docs are great. They don't call us unless they really need us. When Dr. X from the ED calls, I know that I really do need to see the patient because he's only called me for the real thing. When Dr. Y from the ED calls, I don't even listen to what he says because it's probably wrong. The same can be said for most of the services in the hospital. Certain people will call you with the correct info for an important consult. Others will call you to do their scut for them.

Second, you really, really, really need to know the specialist's concerns. When you call PRS or Ortho for a hand laceration, you'd better know about distal neurovascular function and their tendon exam. Don't call GenSurg and tell them every time you talk to them that, "This guy's got an acute abdomen" when he's got some bad GERD or gas pains.

Third, remember that you get to go home in 8-12 hours. Your consultant might have a huge service full of sick patients and another 24 hours before they get to leave. So if we're pissy about some crap consult/admission, you'll help yourself if you're polite in return. And we'll probably apologize when we see you later on for being cranky.

Ricky Slade · Jul 29, 2004

Thanks to all for taking the time to respond and give me some great, useful advice.

And whoever it was in Tampa say hi to all the South Tampa/Hyde Park/Davis Island/Channelside hotties for me. (I went to med school there and I miss it so.)

DrQuinn · Jul 29, 2004

Ricky Slade said:
Thanks to all for taking the time to respond and give me some great, useful advice.

And whoever it was in Tampa say hi to all the South Tampa/Hyde Park/Davis Island/Channelside hotties for me. (I went to med school there and I miss it so.)

Since you left, it appears our ED has hired all of them. I'm not kidding. In the past two months they've hired like 5-6 new nurses who are just hotttttttttttttttttt.

All I need now is Roja to come down and teach me some U/S.

roja · Jul 29, 2004

I am considering Miami for a trauma rotation.. 😀

But Puerto Rico is calling me.....................

DrQuinn · Jul 29, 2004

roja said:
I am considering Miami for a trauma rotation.. 😀

But Puerto Rico is calling me.....................

Damn those Latin men with the accents.

Febrifuge · Jul 29, 2004

QuinnNSU said:
Since you left, it appears our ED has hired all of them. I'm not kidding. In the past two months they've hired like 5-6 new nurses who are just hotttttttttttttttttt.

Ah, yes. NILFs. We have those in Minnesota, too.

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