EM residents getting crap from other departments

Do you know who the smartest doctor is? The last one who sees the patient.

It's very easy for someone to second guess a previous physician after a diagnosis has been established or a majority of things excluded. Don't fret over it. Many "higher ups" feel immune to this, but trust me, it happens to them too. I've seen many medicine attendings criticized by specialists, many specialists criticized when they transfer patients to higher level facilities, etc.

We have this major problem in medicine that some people call "backbiting." It's here to stay, and that's sad.

So just do your job the best you can and enjoy it. Don't worry what other people say unless it's something you can learn from. If they are just running their gator as usual, then ignore it.

Why do people insist on criticizing others? Lack of confidence in their own abilities. Many have major ego complexes and wish to portray themselves as smarter than they really are. So they criticize other peoples' mistakes so it makes them look better. Ever notice how the really intelligent physicians with incredible clinical accumen never criticize others? Maybe it's because they know they're good and don't need reassurance, because they realize we're all human, because they don't care, or because they have better use of their words than griping about someone.

We in turn bitch at surgeons for being pricks; medicine for saying a patient should go to the ICU, and when that is shot down they say the patient is OK to go home; ortho for not managing stable DM; radiology for the hedge; EM being replacable by the CT scanner (hey!), etc. Whatever specialty you go into you will give it and you will take it.

In EM we are always the bearers of bad tidings - when IM's pager goes off at 3:15am with the ED # on the display, they already don't like you before they even hear your voice. We know the patient for 45 minutes, often with no knowledge of their medical history. When the patient retells their story for the 4th time and remembers "Well, maybe I haven't been taking my Lasix", EM is going to look stoopid.

P.S. Take anything you hear from a PGY-1 with a grain of salt. We are just as FOS as everyone else.

Originally posted by Chris_Topher
P.S. Take anything you hear from a PGY-1 with a grain of salt. We are just as FOS as everyone else.

Click to expand...

Take it with a salt mine. A PGY-1 bitching about other services' clinical acumen is just funny.

As mentioned above, every specialty seems to critisize other specialties, its a fact of life. I try to keep it to a minimum.

ED seems to get critisized by more people than other specialties just because they interact with everyone in the hospital, most of whom have in depth specialty knowledge in a topic that the ED doc does not. Also, as mentioned above, when the medicine intern has to come down to the ED at 3am to admit a nursing home patient that needs placement, they have to bitch about somebody. Since bitching about the patient is considered poor form, they take it out on the ED docs.

Radiology gets the same number of critics from every specialty because we are expected to know the radiologic diagnoses of every specialty and and also because we don't see most patients and are responsible for the care of no patients.

I think its pretty stupid (although I'll admit to some complaining about the ED and ortho as an intern). Specialists should realize that the knowledge base of different specialties is different than theirs and feel good that they are needed.

Being a good EM doc is all you can do. We can't always know what the definitive diagnosis is for every patient that shows up -- but it's cool that we can get the first crack at it. Believe me, if you're a good EM doc and build a rapport with the other specialties where you practice -- especially out there in the community -- you'll be respected. Consider it from their standpoint -- picture yourself as an primary care doc, and it's the middle of the night, and you practice out in the community, and one of your longtime patients calls you to say that he's got chest pain, and you tell him to go the the ER, and you call the ER to find out that Dr. Tum is working, and you talk to Dr. Tum, and you say "thank goodness you're working tonight, one of my patients is coming in with crushing chest pain", and you go back to sleep, and you get a phone call later from Dr. Tum who says "the pt is chest pain free now, he got aspirin, nitros, lopressor, his EKG is unremarkable, his first set of enzymes is negative, he's being admitted to telemetry, and a stress test is scheduled for morning" As a primary care physician, you're glad that Dr. Tum was in the ER that night, and you can rest easy whenever you send a patient to the ER especiall when Dr. Tum is working.

A lot of the crap ER residents get is because it is perceived that you create work for the services when in fact you have often times made their work easier by handing them a patient who's already been worked up. But it's the messenger effect -- don't shoot the messenger. My experience is that I get the crap from residents that I don't know -- it's very different when I'm talking to a resident that I rotated with while I was on MICU or cardiology -- or a resident who I've interacted with a lot over the years. What's funny is I think I now get more crap from some of brand spanking new interns who think they know so much as the consulting service. Anyway, just wanted to add my 2 cents.

-James
PGY3 Emergency Medicine
U of Chicago

Yes, we get crap from almost every other department. However, most honest people will admit they "have respect for most of the EPs, except for ----- and ------. they're idiots." More often than not, ----- and ------ trained as internists but decided EM was more fun.

As one of my colleagues says regularly, "Get yer lovin' at home." Expect other physicians to doubt your abilities until you've proven them. Remember, they will almost always know more than you about their field. Of course, they're going to be better at making the diagnoses in their field (especially if its obscure.) But EDs aren't staffed with one GI doc, one cardiologist, one traumatologist, one orthopod etc. They're staffed by one (or two or three) EPs.

Always expect residents to give you crap, they get paid the same whether they see another patient or not.

If you can't take the heat, stay out of the kitchen. Then you can hang out upstairs in the dining room and criticize the cooks.

Have you all seen this
It shows Favre criticizing everyone in a normal job who does something wrong. It is a visa commercial and at the end it says monday morning quarterback: Priceless. Though that was funny. Everyone is quick to judge

to tum, it sounds like you're starting out so just so you know... everyone complains about everyone else in medicine. unfortunately there is something about medicine, patients, and residency that makes everyone somewhat bitter.

personally, i've decided the people who make the most disparaging remarks are those who are the most unhappy with their own specialty. i'm grateful that others are doing medicine, neuro, surgery, etc, so that i don't have to do inpatient medicine. i enjoy my days off and not having to ever carry a pager around. i'm either at work or i'm off.

i've worked with great consultants (ortho, cardiology, neuro, etc) who are nice, respectful on the phone, often teach me something, and are more than willing to come see the patient in the er. in truth, it's a compliment for them, i mean, you specialize in something so that you can help out. i don't hate other specialties, i do dislike certain individual specialists but mainly b/c they are rude and disparaging.

as for messing up the differential... we may miss the diagnosis but it was probably on the differential and if we had the time to order more tests and studies or even wait a few more days, we would have the diagnosis. as geek medic puts it best ... the smartest doctor is the last one to see the patient. unfotunately, we do live in a fishbowl...

I agree with the vast majority of the points made here. I think one of the more important points not yet adressed is the issue of professionalism. Not only do I think that the vast majority of points made are valid, I think it is also very unprofessional to call other services idiotic (or any other similar term).

One intern here was told that all EM physicians were *****s. I would personally have difficulty respecting anything this person told me, primarily because I would wonder about their judgement skills.

One of the most refreshing and surprising experiences I saw first hand was my ICU month. The director happened to be attending and during rounds, the inevitable question 'why was this patient intubated' was launched once or twice. In each instance, the director was quick to state that intubations in the ER are something you should never really judge. That you weren't there at the time and thus don't really know what the patient looked like.

I also had several discussions with her about how crucial it was to treat each department respectfully and basically adopt a 'until you've walked in thier shoes' philosophy.

I empathize with IM. It really probably sucks to be called in at 3am.

But residents who complain, well, this is medicine and residency isn't supposed to be fun. (unless it's ER.... *g*)