Ah, the ED ...

[ERMudPhud]

To ERMudPhud: you may not like me voicing an opinion regarding ED physicians (I assume that's why you want to call me a "******" so badly) but in my opinion my post was fairly non-inflammatory to begin with - like I said, I even gave people the option of calling me an idiot.

Actually, your collection of posts on this and other threads have been fairly inflammatory. Not quite to the level of some of the ED hating trolls that wandered through the EM forum in the past but close. If you and masonator want to add to your playa-hatin thread you could link to some of those old threads.

You're right - it is unfair to generalize. I've been told by others that I've been mischaracterizing the ED with blanket statements. But I interviewed at fourteen large medical centers - granted, on the East Coast, where you say the ED is not a good - and at 100% of them, the physicians said that their stories were the same as mine, so I'd have to accept that level of poor performance. I guess until I visit EVERY hospital in America, you can technically argue that I don't have a leg to stand on, but it's an OPINION based on my experiences.

You might first try looking at some of them with an open mind. If I interview at some of those same institutions and started out with, " Are the surgeons here as big a group of arrogant, compassionless, bastards as I've heard they are?" I might get just the response I'm looking for. Some of those surgical horror stories I quoted above came from my time at some big name east coast academic centers. You probably interviewed for surgical spots there. If you look for it you can find stupid and lazy people everywhere. You can usually find good ones in the same places. You better start learning how to recognize the good ones otherwise you'll be stuck working only with the bad ones once you are in practice and you'll be miserable. As I said before a good relationship with a good ED can make a huge difference in your life.

ED physicians are the LAST people who should be surprised that people are going off on them.

I don't call and yell at the PCP's when they send stupid stuff in at 5:00P.M. so they can close their office. In fact I generally don't yell at anybody and in return I expect not to be yelled at . I won't tolerate being yelled at by a derm resident at 6:00 pm. All I had to say was that if he didn't change his tone I would wait and reconsult him at 3:00 AM. We got along great after that.

Why? ED people are never called at home; once their shift is done, it's over. There are no pagers or interruptions.

Actually, a disturbing number of patients seem to be able to find my home phone number.

And even when they are calling people in the hospital, you're someone working 8-10 hours TOPS calling someone who (at least in the past) may have been there for over 30 hours straight ...and, at least in my case, calling them to do the ED's work.

Just as I chose my specialty knowing it had its problems, you also chose yours knowing it had its downsides. One of those downside is you will be on call and you will be paged. I'm not calling you to do my work so don't be angry when the pager you signed up for goes off.

Also right on this point, too. But realize that, while ED guys DO get patients thrown at them by private docs, it's not just you guys who are getting hit, it's us too. A lot of times, the patients end up with the people on non-ED services (rightfully so) - but don't act like you're getting the hit in isolation.

I wasn't trying to say I'm the only one getting dumped on. My point is that like us or hate us your going to need us once you are an attending.

And by the way, I've gotten MANY a call from the ED with "Dr. So-and-so's patient is in the ED. *click*"

Never done this. Not sure why I would since Dr. So and so knows his patients is the ED, having sent him there.

As for what is harder - the ICU or the ED - it's apples and oranges, but if you HAVE to compare them, it's ICU hands down.

Actually, I don't think I started the whole comparison thing and I know I concluded that I was equally exhausted after either.

Why? First of all, you're there longer - it's NOT an eight-hour shift. My personal opinion is that doing anything for over fifteen hours straight - even leaning against a wall - is torture.

That's why many of the intensivists I know and all the hospitalist I work with do 8-12 hour shifts.

Second of all, the patients are uniformly disasters - a large percentage of ED patients are either not sick at all or bread and butter. So what does that mean? I don't know - I can't see why you would feel angry or threatened that someone brings this up

.
Actually, I think the mix is remarkably similar. I've done plenty of time in MICU's and SICU's as well as covering any acute decompensations in the large ICU at my current hospital at night. You generally have a whole lot of really sick patient with lines and tubes in every possible place. Most are slowly getting worse or slowly getting better. You spend most of your time(since you really can't be in more than a few places at once) with the few who are really going to hell fast. Just a few of those can ruin your night. The ED is the same but the vent-vegetables ponderously spiralling the drain for days or weeks are replaced by ankle sprains, backpain, and headaches. The few going to hell fast can make or break your night.

ERMudPhud, you do seem like someone who, at the very least, is reasonable and not reactionary.

You on the other hand still seem to be a bit pissed off (reactionary?) Just what exactly was it that caused you to leave your residency? My experience with those same east coast institutions we've been talking about was that the ED's didn't have the power to get rid of a tranport tech much less drive away another service's resident. As angry as you are now I hope you can eventually learn to live with us because we aren't going to just disappear. To paraphrase something from the gay rights movement, "WE'RE HERE, WE MAY NEVER DO A GOOD ENOUGH JOB FOR YOU, GET USED TO IT"

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[Masonator]

Some of my best friends do really cool Derm/immuno research--sorry

That's ok, I used to do derm/immuno research too. Our little war has gone beyond dermatology. MrHide has left his peers far behind in arrogance, and ****ty attitude. Even the most pompous dermatologists would shake their head and say "What the ****!!" Now it's more of a narcissistic prick vs. the rest of medicine war.

 

[Masonator]

How do you link two threads together??

 

[DoctorDoom]

...comparing work loads across departments is a mistake since you are right there is a different pace for different jobs. However, responding to "ever worked in an ED" with "Yes, I have. Ever take q2 call in the SICU as the senior resident? Oh riiiight..."

That 's why I, for example, try like hell not to consult from 3:00 AM to 6:00 AM. I know that is the best chance for many of my consults to sleep. I fax notes to their offices, leave messages with their services, or sit on patients for a few hours if at all possible during that time.

My response was basically a snarky way of smacking cg115 down by pointing out his status. I agree that's not the best way to frame my point generally. It's just a snarl, junkyard dog style, as a reaction to a perceived snideness, which I think was bourne out in cg1155 later posts. And he can't claim to have covered 40 patients as an ER attending either. My baring of the teeth may have been an overreaction, but I'll stand by it.

You need to write primer by the way, for ER management of relationships with consulting servies. Kudos. But your example is quite uncommon, and very few ER docs cover the ICU as part of their attending duites, so I don't think you can generalize your own experience either. And just as you try not to consult during certain hours, I always tried to do as much of the workup and procedures as I could. IF I think a patient needs an NGT or something, or lab/test results come back, I do the minor procedure and/or let the ER doc know what I know. I just keep in mind that everyone is busy, and the point is to communicate in order to give the patient the best care between both services. Because I have been on the side making the call to surgery or medicine at 4AM also.

You said:
Actually, I don't think I started the whole comparison thing and I know I concluded that I was equally exhausted after either.

But posted earlier:
In the end trying to compare who works harder is pointless since your are exhausted at the end of either shift but on a per minute basis my time in the ED is clearly more tiring(at least to me).

Not to be nitpicking, and I get your point, but I can see why kinetic might understand you otherwise.

The point is I agree that comparing buy-ness is pointless. Which probably is how I should have responded in the beginning rather than just go for the jugular. But what can I say, us surgical types are just ill-tempered snakes.

 

[ERMudPhud]

But your example is quite uncommon, and very few ER docs cover the ICU as part of their attending duites, so I don't think you can generalize your own experience either.

It is actually too common in the community setting where the intensivist, surgeons, cardiothoracic surgeon, pretty near everyone is taking home call.The only other doctor in house at my hospital overnight is the labor deck doc. There might be a CRNA or anesthesiologist but I haven't met them. Plenty of others might be in house but they don't have to be. So, if their response time is 15-30 minutes and I'm in the ED, who ya gonna call...? Actually ACEP is lobbying quite hard against this practice and I think it will gradually disappear even in community hospitals. The problem arises when you have simultaneous arrests both in the ED and upstairs somewhere. Then you try to get them both intubated, lined up etc... as fast as you can and then run one by phone while supevising the other. One of my coworkers once did three at once. Fortunately one of the arrests was a found dead on the floor so it was pretty much tube,epi,atropine, 5 minutes CPR, and pronounce but the other was a post-op cardiothoracic case who bled into his chest and tamponaded. She ended up reopening his chest in the unit while simultaneously managing an unstable, intubate AMI in the ED. Fortunately, you don't have to keep that up for long before the oncall cardiothoracics guy gets to the hospital and the cardiologists shows up to take the other one to the cath lab.

 

[kinetic]

I don't call and yell at the PCP's when they send stupid stuff in at 5:00P.M. so they can close their office ...All I had to say was that if he didn't change his tone I would wait and reconsult him at 3:00 AM. We got along great after that.

Nice job, acting as quasi-terrorist. First of all, if you read my post, you'll see that I stated that people shouldn't yell at each other - so I don't know why we're arguing about this. Second of all, threatening someone like that is just as poor form whether you want to admit it or not. I once was told by a nurse that if I didn't do exactly what she wanted, she'd page me every ten minutes from 10 PM until the morning. Professional? You tell me, because that sounds a lot like what you're doing. (And I reamed her ass out and got in trouble for it, but it was worth it.)

Actually, a disturbing number of patients seem to be able to find my home phone number.

Yep, as do they for all of us. But that's an "unofficial" page, one that is just crap that comes with being ANY kind of physician. (I mean, the psychiatrists probably get stalked, but that's not because of ED doctors or anyone else - it's because the patients are loony.) I'm talking about the fact that you will never be paged by any physician when you are not on shift (and probably not much while you're ON shift, either).

Just as I chose my specialty knowing it had its problems, you also chose yours knowing it had its downsides. One of those downside is you will be on call and you will be paged. I'm not calling you to do my work so don't be angry when the pager you signed up for goes off.

Actually, while YOU may not be, the ED doctors are my place DID. Like I said, they'd page people with minimal workups, falsified histories, incomplete physicals, no labwork ordered, and once I was paged before the patient - who was stable - was even checked in yet. I have also been paged numerous times to "discharge" a patient (i.e., write a note saying that it was OK for the patient to leave, so I get sued instead of the ED). Yep. A grand old time was to be had by all. That was why I went nuclear on them - which, as I've said before and will say again, was nevertheless immature but oh-so-satisfying at the time.

Also, if you want to say that we picked out specialties knowing what we would get, then you should be quiet: you picked the ED knowing that they would be looked down upon by other residents. In medical school, when I was on Surgery or Medicine or OB-GYN, all the residents ripped on the ED - you knew that coming into it, so deal with it (by your logic).

Not sure why I would since Dr. So and so knows his patients is the ED, having sent him there.

It's because they're telling you that some patient is in the hospital that was sent there by an attending, thereby washing their hands of the patient. You know the patient is there, so it's your patient now - if something goes wrong, they'll say, "well, I told him the patient was right here, but he didn't come and take care of him/her." Guess who's butt is in the boiler? Meanwhile, you go down there and the patient is still dressed in street clothes and has been told that "someone is coming to see you." Yay!

Just what exactly was it that caused you to leave your residency?

I didn't leave - I was fired. A combination of me being an a--hole, the ED having a lot of political clout despite people knowing its deficiencies, and my PD being a skeeve (he didn't mind letting our residents get abused, as long as we just shut up and covered for the ED - but once someone started "rocking the boat" it was boot time). I wrote about it in a post. It's here:

http://forums.studentdoctor.net/showthread.php?t=115806&page=2&pp=20

Have fun; I gave everyone a lot to rip on me with in it.

 

[ERMudPhud]

On this note I'll stop taking up space in the surgeons forum

Nice job, acting as quasi-terrorist. Second of all, threatening someone like that is just as poor form whether you want to admit it or not. I once was told by a nurse that if I didn't do exactly what she wanted, she'd page me every ten minutes from 10 PM until the morning. Professional? You tell me, because that sounds a lot like what you're doing. (And I reamed her ass out and got in trouble for it, but it was worth it.)

You need to keep a few things in mind
1. I don't consult unnecessarily (I suspect I've only called derm 2 or 3 times in 6 years) and I checked what time it was before deciding to call him for what I knew was not an emergency but what was a truly impressive example of human suffering.
2. If 6:00 pm really is such a bad time for him, I think its appropriate to ask what might be a better time-perhaps 3:00 AM wasn't the most obvious choice but hey you never know, one of my favorite internists loves to go running at 3:00 AM and always answers his cell phone at that time in a great mood.
3. Based on your previous posts if you were in the middle of one of your 30 hour inpatient shifts and got a similar response from the derm resident(who left at 4:00) at 6:00 pm when all you wanted was some phone advice for a patient who was really suffering I suspect your response would be less than diplomatic.

Also, if you want to say that we picked out specialties knowing what we would get, then you should be quiet: you picked the ED knowing that they would be looked down upon by other residents. In medical school, when I was on Surgery or Medicine or OB-GYN, all the residents ripped on the ED - you knew that coming into it, so deal with it (by your logic).

You are exactly right. In fact when I decided to do EM and in the process turned my back on some very big IM opportunities I was told be several people that I would never amount to anything in research or academic medicine because I was going into"band-aid " medicine. One of those people is now a research collaborator of mine Unlike you my response to this downside of my chosen field wasn't to yell,scream, whine, and eventually get fired. Instead I do my best to do such a damn good job that whoever ultimately admits the patient has to admit I did fairly well. I also try to educate other fields about why we do what we do while learning from them what they would prefer we do. When possible I incorporate what they want into how I practice. Hopefully, I change a few minds in the process. You could try something similar. If and when you get paged again with a poorly worked up patient try, without sounding angry, accusatory, or like you just want someone else to do more work so you have less to do, pointing out how doing x,y, and z before paging would be of great benefit to patient care. Most of the time you, like me, will be wasting your time. In the end I will still be a triage monkey for the rest of my life and you will still be getting paged for the rest of yours but that doesn't mean we can't at least try to educate people

 

[kinetic]

Unlike you my response to this downside of my chosen field wasn't to yell,scream, whine, and eventually get fired.

Right, instead all you do is work WITHIN the system by threatening to call people at 3 AM. That makes you a lot better than me, right? No, it just makes you more devious. You never raised your voice, so no harm-no foul. At the same time, you leveled a tacit threat at a physician that you would basically harass him - but it would still be technically just you contacting him about a patient. It doesn't matter if you do it once a day or once every ten years; it's still wrong. And you're proud of that? That shows something about YOUR character, eh? Which is why I hate ED docs. They know what they are doing, but they want to rationalize that it's just business.

It's funny how people who have no leg to stand on feel the need to start using the old "well ...well ...uh, you're unemployed!" line. Hey, if I cared I wouldn't have posted it for everyone to see. They can all judge if I was inappropriate, the ED was inappropriate, or both. I'd like to see you on the receiving end of blank charts, consults for patients who haven't been seen or roomed yet, no vitals, no labs, histories that were lies, and patients who had not received any intervention (these were not all on the same patient, or I would have just kicked the guy in the nuts). You didn't want to be on the receiving end of that, so you cut and ran. Why is it my job to explain to an attending why he's not doing his job? (As if he doesn't already know it - what medical school teaches you that a blank chart is "A-OK"?)

P.S. Um, for the last time, I already said that what I did was wrong. So what's the point of throwing it back at me and saying, "yeah, so eat it!" At least I have the guts to admit that what I did was wrong, versus you who rationalize that you're such a great ol' guy and upstanding citizen. ("All I do is perform so spectacularly that people can do nothing but fall to their knees and grovel in respect." Yeah, great.)

 

[Apollyon]

11. Consultants - The consultant will never agree with you.

12. Emergency Doctors - An emergency doc is never smart and always has bad news.

13. No Admissions, Please - No admission is appropriate if you're on the receiving end.

All from A Little Book of Emergency Medicine Rules, by Corey Slovis, MD, Keith Wrenn, MD, and Clifton Meador, MD

I think kinetic would curse the Pope and the Dalai Lama for an insufficient blessing, or "boo Jesus for dropping the cross" (as was said of Philly fans). No matter what you say about anything, if you are EM-positive, he will denigrate what you say.

That is unfortunate.

 

[kinetic]

11. Consultants - The consultant will never agree with you.

12. Emergency Doctors - An emergency doc is never smart and always has bad news.

13. No Admissions, Please - No admission is appropriate if you're on the receiving end.

All from A Little Book of Emergency Medicine Rules, by Corey Slovis, MD, Keith Wrenn, MD, and Clifton Meador, MD

I think kinetic would curse the Pope and the Dalai Lama for an insufficient blessing, or "boo Jesus for dropping the cross" (as was said of Philly fans). No matter what you say about anything, if you are EM-positive, he will denigrate what you say.

That is unfortunate.

Versus you guys, who are totally objective and even-minded, right? Your little handbook paints this picture - which is apparently untrue because only I'm so stupid and ignorant that I hate the ED - that everyone dumps on the ED. So when we rip on the ED, that's knee-jerk and booing Jesus; when the ED rips on everyone else, that's just pointed hilarity ensuing.

Get over yourself. I may be biased, but at least you know where I'm coming from - I don't run around here pretending to be objective and just sitting on the sidelines, like you guys. Your words are just as skewed the other way as mine, but you can't even see it.

 

[DoctorDoom]

Whomever is the little beeyotch that keeps sending me snide comments by karma, read my edit. And if you think little anonymous notes are a good way to communicate, good luck with the rest of your life.

 

[kinetic]

Whomever is the little beeyotch that keeps sending me snide comments by karma, read my edit. And if you think little anonymous notes are a good way to communicate, good luck with the rest of your life.

Yeah, these people who use karma as a 'weapon' a) think that anyone cares about a colored square next to their name (give me all your negative karma if you want) and b) have such microscopic balls that they can't even link a comment to their screen name. That cracks me up. Good thing we have such gutsy, principled people in here.

Anyway, if it bothers you THAT much, DoctorDoom, just turn off your karma.

By the way, cursing in your karma ratings really shows a level of maturity that I am awed by - I'm glad such level-headed and clear-thinking individuals are ripping on me. What happened, your ability to formulate independent thoughts stopped in the fourth-grade and now your Tourette's is the only thing that guides you?

 

[DoctorDoom]

It doesn't bother me at all that some little beeyotch is giving me bad karma... if they had any integrity or courage they would sign their comments with their screen name... I mean come on...

My karma is on, bring it...

 

[kinetic]

In response to this post:

Yeah, these people who use karma as a 'weapon' a) think that anyone cares about a colored square next to their name (give me all your negative karma if you want) and b) have such microscopic balls that they can't even link a comment to their screen name. That cracks me up. Good thing we have such gutsy, principled people in here.

Anyway, if it bothers you THAT much, DoctorDoom, just turn off your karma.

By the way, cursing in your karma ratings really shows a level of maturity that I am awed by - I'm glad such level-headed and clear-thinking individuals are ripping on me. What happened, your ability to formulate independent thoughts stopped in the fourth-grade and now your Tourette's is the only thing that guides you?

Here is what someone sent me via karma:

Jesus christ is this poor bastard bitter. No wonder why he is failing in life (most recently evidenced by his unmatched, unemployed status). Grow up my friend and maybe you can achieve something before it's all over

Actually, it's MORE mature to admit one's mistakes, but I guess it's hard for someone who is immature to understand that. All you guys ripping on me run around acting like you're the picture of perfect sainthood - and in your mind, that's probably how you like it (defense mechanism, anyone?). Yes, I am the only person who has ever made mistakes around here; the rest of you are all right-thinking, clear-headed, non-hypocritical, principled, level-minded physicians who can rise abov -- ah, who am I kidding, everyone can read your posts, too. And like I said, I may have acted in an immature manner, but I at least did it because I was standing up for my principles ...something Mr. Anonymous might want to learn how to do sometime during this life.

P.S. By the way, I didn't have to post my recent history with it's failures, but I did. And guess what? All you cowards come out of the woodwork to snipe at it behind your anonymity. I hope that preserves your fragile egos and makes you feel like more of a man. Oh, I shouldn't have said that ...now people will make my karma box change colors and everyone knows THAT'S the most important thing in your life!

 

[aboo-ali-sina]

In response to this post:

P.S. By the way, I didn't have to post my recent history with it's failures, but I did. And guess what? All you cowards come out of the woodwork to snipe at it behind your anonymity. I hope that preserves your fragile egos and makes you feel like more of a man. Oh, I shouldn't have said that ...now people will make my karma box change colors and everyone knows THAT'S the most important thing in your life!

Although I hate to chime in on this thread (it has been entertaining to read it though); I have to agree with kinetic on one issue:

it is stupid and petty to rebutt his comments with "Ha Ha Ha you don't have a job" That's like what people used to do in the 5th grade "Ha Ha Ha my dad can beat up your dad" or it's like saying: "Ha Ha Ha you are poor and your family is starving to death"

You may not like kinetic, you may not like what he has to say, he may even be an inflammatory SOB but grow up and make educated comments.

 

[RADRULES]

"OB residents who misread their u/s from a few day before and insisted a patient had an IUP despite a belly full of blood on my u/s."

You should have asked the radiology resident what he/she thought. We are usually know what we are talking about....

 

[DoctorDoom]

Yeah, these people who use karma as a 'weapon' a) think that anyone cares about a colored square next to their name (give me all your negative karma if you want) and b) have such microscopic balls that they can't even link a comment to their screen name. That cracks me up. Good thing we have such gutsy, principled people in here.

I'm gonna post some of the ones that made me laugh the most... hopefully it will generate more bad karma reports... maybe with everyone else's support I can weather this... I'll just can't sit at home alone and hold myself, rocking slowly back and forth weeping, any longer ... oh dear God how do I deal with these little red anonymous squares...

"whah whah whah...i get bad karma, whah whah whah. Well grow up and maybe people would respect you."

*pout* NO!! I want to remain 3 forever!! WAAAAAAAHHH!!!
Oh wait, you're the one sending me anonymous messages... and was upset because I was so haughty (SAT word)... and apparently didn't get the point that it's not the karma at all, but your cowardice... got it... LOL.

By the way apologies for making this thread a personal rant of sorts by this point, but heck people can still vote in the poll and thread hijacking is always fun. And laugh at pissantes who like to stalk me virtually.

 

[neutropeniaboy]

[...]what he/she thought. We are usually know what we are talking about....

Do you guys usually know how to speak English properly?

 

[kinetic]

Do you guys usually know how to speak English properly?

You've obviously never heard me dictate a patient's chart late at night. Not much English and a whole lot of vague mumbling interspersed with random curses.

 

[aboo-ali-sina]

to the person who sent me karma stating:
"Give it up kinetic, posting under another name to support yourself is stupid"

I am not kinetic

 

[kinetic]

It's probably some lame ED doc with his panties in a bunch.

 

[Whisker Barrel Cortex]

Do you guys usually know how to speak English properly?

Its pretty obvious he was writing something else and then edited it, but didn't proofread. Is that really causing you problems on an internet forum? Do you have a hard time understanding things if they are not perfectly written? Lighten up.

 

[MasterintuBater]

Sorry to admit I've just been trolling this thread for a while.
Seems to me a lot of the frustration against the ED would be more appropriately directed at the inherent flaws in the Healthcare system. Unfortunately, it is in the ED that these flaws are most greatly exploited and visible. As stated numerous times before, we ALL went to medical school and all come from the same piece of clay. Is it that those who go into EM immediately become stupid doctors? I think we are simply products of circumstance that become molded into what the flawed system forces us to be. So..."Don't hate the Playaz. Hate the Game" (yes, smacks of Masonator ) There are bad doctors in every field that make bad decisions. EM docs get the bad rep because they work with other specialties more than most other inter-specialty relationships. If every IM/Surg doc had to work mostly with, say, neuro, they would probably be ranting about all the neuro's stupid mistakes.
Incidently, many of the IM residents I've talked to say one of the most frustrating things about IM is the fact that they don't get the opportunity to diagnose much (not never), but only manage diagnoses. Their claim is that MOST of the diagnosing is already done for them in the ED.

 

[kinetic]

Is it that those who go into EM immediately become stupid doctors?

No, they're not stupid at all. One of the DUMBEST ED doctors (actually, dumbest PEOPLE) I have ever met was AOA in his class, apparently (via the grapevine). A girl I knew who went into ED from my class could kick me around the block with one leg. They're not STUPID, they're LAZY. That's why the ED doctors I had to interact with would put no thought into diagnosis, workup, or even H&Ps. That's why that girl from my class went into ED - she wanted to have "a life". But I bet if you gave them a test and said "if you fail this, you lose your M.D." they would destroy it. (And I'm sure all the ED doctors will post stuff like "I agree that we are super-intelligent people and you are dumb, but I disagree that we are lazy.")

This is the funny part. On the one hand, you know they do shift work and triage people to other services. They even admit that. But then they get all defensive about the fact that everyone looks down on them for that. So then they run around talking about how "rough" their day was or how many "trainwrecks" they took care of. It's totally contradictory! If you're going to brag that you're working an 8-hour shift, then don't get mad when people point out that you're only working an 8-hour shift. If you're going to talk about how "I don't diagnose - that's your job - I just triage" then don't get mad when people call you a triage nurse.

And another thing: I know we're all human. We all make mistakes and we all need to make judgement calls. I've said it before and I'll say it again (even though nobody can read this line - for some reason they all skip past it). I don't get mad when the ED makes mistakes, I get mad when said mistakes occur because people are not even making an attempt at being a physician. I was called to see a lady and this is the message I got from the ATTENDING:

Hi, the patient of Dr. So and So is down here. She's got a headache, but she's had those in the past. Anyway, she's here in room 9.

When I arrived, I talked with the patient for TWO minutes. In those two minutes, I discovered that she had been transferred from another hospital. She had received a CT scan and MRI. She had brought those films and those films had been interpreted by a Radiology ATTENDING and dictated. She had brought the dictations. The film and the dictation showed an intracranial mass with a midline shift. And she was having a deteriorating neurological status.

Now, I'm not mad that the attending didn't meet me at the door with a diagnosis. I'm mad that he didn't even bother TALKING to the patient. I'm mad that I didn't know how urgent this was. I'm mad that the patient could have suffered permanent injuries or died. I'm mad that after I left the room to start writing some stat orders, the attending came up and said "so what do you think ...are you guys going to do anything?" I'm mad that I wasn't allowed to punch him, give him an atomic wedgie, kick him in the balls, and pistol whip him. THAT, my friends, is why I'm mad.

 

[RADRULES]

This was a very entertaining thread to read. Actually, it helped me understand the misery of the ED a little better. When I was taking call as a rads resident in the ED, I would laugh at the utter stupidity of the ER docs.... the number of unindicated CTs was mind blowing. The consultants would have to deal with a lot of **** also down there, and did not care to much for the ER docs. I think the rads people are stuck in the middle, but it would lead to a lot of conflict because of absolute unnecessary examinations being ordered by incompetent ED docs. Sure, the place is a cluster f*ck, but that is what you signed up for when you applied for ER residency... suck it up and deal with it.

 

[Docxter]

I have had my share of fighting the ER too and calling them stupid in their own faces. But, in all fairness, I think considering the things that they have to deal with, they do a decent job for the most part. They are sometimes stuck between a rock and a hard place (i.e. the patient and the other Docs). We frequently complain about them (more often justifiably than not), but we may have done the same if we were in their shoes. We just have to be fair about it. Let us all give them a little slack.

 

[FliteSurgn]

I'm mad that I wasn't allowed to punch him, give him an atomic wedgie, kick him in the balls, and pistol whip him. THAT, my friends, is why I'm mad.

I love it! We have a few unbelievably stupid ED attendings at our local VA. More than one of our residents have dropped the F-bomb directed at these idiots. Then, WE get the talking to...the ED docs remain just as stupid as before.

I agree that there are good and bad docs in every specialty, but that your opinion gets jaded by those that you are most often annoyed by.

 

[kinetic]

I love it! We have a few unbelievably stupid ED attendings at our local VA. More than one of our residents have dropped the F-bomb directed at these idiots. Then, WE get the talking to...the ED docs remain just as stupid as before.

You know, I guess that may be one of the most frustrating things. For some reason, that seems to be the case at all of the programs I went to. Those bastards complain and we get the hammer of God dropped down. Versus we complain and the next day you get more of the same from the ED the next day. Justice, eh?

 

[Apollyon]

For some reason, that seems to be the case at all of the programs I went to.

Just tell us what those programs were (where you interviewed, not where you matched, so you maintain your privacy).

 

[kinetic]

Hate to disappoint you (or here's my gift to you - whichever), but I got rejected from all 10 places I interviewed at:

http://forums.studentdoctor.net/showpost.php?p=1365501&postcount=26

It seems people in the medical field prefer me to "go with the flow" rather than speak up for patient care. Like I've said numerous times in the past, I was acting like an immature a**hole and I regret that, but I stand by my beliefs and principles that led me to become frustrated.

Feel free to throw my unemployed status in my face.

I will reiterate: when I told some of the above anecdotes to the PDs and chiefs at the places I interviewed at, the response was universally, "that happens here ...so what?" To me, that was unexpected. But maybe that's just me. And a lot of the chiefs I talked with said that they got LOTS of calls from the ED complaining about their residents, all of which were taken seriously (while their own complaints about the ED did not result in any changes).

 

[kinetic]

By the way, you know what's the most telling thing to me?

Here we have a collection of physicians and residents in a forum. I have given a number of anecdotes that are, in my opinion, quite horrific. And not just 'mistakes' - like I said, I understand mistakes occurring because we're all human and medicine is an art; for example, the attending who hadn't even talked with the patient with a deteriorating neurological status was not making a MISTAKE, he was grossly negligent.

My posts have spurred a lot of discussion. Many people have debated whether the ED is OK or not. Many people have debated whether I am a pile of feces or not.

Nobody has expressed any shock at any of my anecdotes. No "oh my gosh". No "you can't be serious". Not even a .

So you tell me: you think people know this goes on?

 

[Apollyon]

But that doesn't say where. If it was at Duke, I could tell you point-blank you're wrong. I don't know where these places are, but, if it's top-level places on the east coast, many probably have EM residencies, and, if they are all violating the law so much, I, for one, would like to know, even if only to avoid those places.

 

[kinetic]

But that doesn't say where. If it was at Duke, I could tell you point-blank you're wrong. I don't know where these places are, but, if it's top-level places on the east coast, many probably have EM residencies, and, if they are all violating the law so much, I, for one, would like to know, even if only to avoid those places.

It's not at Duke and I doubt these are top-level ED residencies (if by that you mean the top 1-10 programs in the nation). However, neither are they bottom of the barrel, middle of the swamp, podunk places. (By the way, considering they are all accredited, does it matter where they are? They are deemed worthy of accreditation, so even if they aren't Duke or Mass Gen or BID, they're still ED programs and, more importantly, they're still physicians.)

P.S. I'm too stupid to even think of applying to Duke. Especially after getting kicked out of a program. (I'm smart enough to figure that out. )

 

[Apollyon]

Are you talking about your original PGY-1, or your reapplying? I thought it was your PGY-1, and I would really, really like to know where these programs are that suck so illegally. I haven't intentionally been inflammatory, but you told me to get over myself. I have no parameters to guide what you say.

Why I say top-rated east coast, I thought that that is where you had said you'd interviewed before; you are correct in saying most EM programs are equal (however, I fear you will take that to be "equally bad"), unlike IM or Peds or General Surgery, where there are so many, that variability is introduced.

Hell, you can PM me the names of the places; there are more than enough people on SDN that can vouch for my discretion. I don't even know what your specialty was; I assume it was GS just because you posted in this forum.

 

[kinetic]

Yes, I did tell you get over yourself, but keep it in context. I actually had forgotten the post, so I went back and re-read it. You had posted an excerpt from 'A Little Book of EM Rules' ripping on the way that other docs viewed ED docs and then said that I would curse the Pope and the Dali Lama. I was merely pointing out that, while you were making fun of me for being anti-ED, your own example shows that the ED has just as many negative perceptions of non-ED docs (i.e., "they're always looking down on us"). Plus, at least I am giving examples of my claims, not just saying that someone "curses the Pope and the Dali Lama".

As to telling you where I interviewed, I'm not interested in doing that at this point in time. Perhaps in the future. I've been open enough about events in my life, which I certainly could have kept private. Telling you guys about it has resulted only in the predictable "well, at least I'm not unemployed!" catcalls from supposedly-mature individuals (and I'm not saying that you said that) - read post #64.

 

[Apollyon]

Fair enough.

 

[Annette]

Wow, what a thread!

I vote that for the most part the ED does a decent job. I just get to see a lot of their mistakes. Like the MI put on the floor (not even cardiac tele) with ST elevations that even the EKG machine was able to interpret as AMI and printed in large letters on the top of the paper. The orthostatic LOL getting a stat ICU consult when she hadn't even gotten a drop of fluid yet. Oh, and the massive fight and talking to I got when the the ED sent a patient to the CCU without the stop by CT for a chest angiogram to rule out a PE ("sorry, medicine can't order tests in the ED"). Sorry, just had to tell a few horror stories. There is a private doc that has a minimum 10 consult rule before he will discharge a patient home. CYA medicine.

However, the worst part is the drive of the ED to get patients OUT. It doesn't matter where, just as long as they are no longer in the ED. Doesn't matter that it is poor patient care at times. Patients get upset when they have to wait in the ED, I've been told. Administration is driving this to increase patient satisfaction (revenue), and I can understand that. What I hate is that I am no longer able to order tests on patients that will help me determine where a patient should go (unit vs stepdown vs floor, cardiac tele vs medical tele, etc.). I even have trouble getting antibiotics at times! It also doesn't help my disposition towards ED docs when I have the transporter/ER tech/and nurse breathing down my neck, demanding to take the patient to the floor when I have just gotten down to the bloody ED and the ED has already had the patient for 4 hours!

And for those of you interested, I've rotated in the ED (exhausting work), MICU, and the medical floors. I even did a cush surgery rotation as a student (cush=wasn't allowed near the patients!).

As a medical resident, I think the following would help the medicine/ED relationship:
Call me early. Let me know how many admissions you think might be pending and how sick you think they are. In return, I'll get there as fast as I possibly can, let you know if I'm held up by a patient crashing.

If you are slammed and need the beds, let me know, and I'll let you know which patients you can send to the floor immediately instead of waiting for me to evaluate in the ED. In return, if I need time with a patient in the ED, you let me have the time.

Call me if you need me. Just please ask the patient if he/she has a doctor that they see, even if it is only for an occasional problem. Even patients without insurance sometimes will have their own doctors (who might not be covered, so I can actually get 15 minutes of sleep before I get called with the 2 am blood sugars from throughout the hospital ).

 

[kinetic]

Amen. I hate the old "you can't order tests down here ...this is an ED!" line. And some attendings at my old institution would try to move drunks who just needed their alcohol level to fall onto a floor bed in order to maximize "throughput" (their favorite word, meaning movement of the incoming patient OUT of the ED - think of it as ED diarrhea).

As for consults: like I said, our docs consulted people to clear patients for discharge. Consultants were required to write "in my opinion, this patient is not at risk for further injury and I feel that he/she is able to return home safely". Talk about CYA (and, yes, I understand that the ED is a high-litigation zone). I don't get that, though. When I talk about the "good things" about the ED profession (shift work, relatively large time off, relatively high pay), all I get is "hey, we knew that was the case coming into the profession ...you can't change that and stop being so bitter!" When I talk about the "bad things" (lawsuits), all I get is "that's not fair, something should change". What happened to "you knew that was part of it coming into the profession"? Instead, you try to shift that litigation onto other physicians by making THEM tell your patients that they can leave.

 

[kinetic]

I will admit that, either due to my natural personality or bitterness over what happened, I am being very critical of the ED. I mean, it is clear that most other physicians have experienced at least SOME of what I am talking about; like I said, nobody thus far has expressed any real surprise about anything being discussed here. But not everyone hates the ED (although even the ones who don't hate it sure do complain about it a lot to me). Going by Annette's post, I would have guessed she picked one of the two bottom choices of the poll, but I guess she's more forgiving than me. Nevertheless, I stand by my outrage: the things I saw clearly affected patient care and were (I want to make this clear) NOT due to mistakes in diagnosis or treatment, but due to sheer and open laziness.

 

[kungfufishing]

In my experience, EM residents dont complain about other specialties in the way many residents/attendings complain about the ED. If you knew that as an IM resident you would be paged at all hours of the night and take call for the rest of your life, or at least through residency, and you still chose to do it, you must like it. If you dont like the job, why not do something else?
As an IM prelim who has matched into a 2,3,4 EM residency, I am surrounded by IM residents who complain constantly about their schedules, workload, admits, and lifestyle. They openly resent the EM doctors for 'creating' work for them and for having more free time than they do, yet they chose IM and its schedule/workload/call of their own volition. When I ask why they chose IM, they say something like "we are the most comprehensive doctors in the hospital/I like continuity of care and the relationships and outcomes it provides for/I like knowing the EXACT answer to my questions about each patient."
I think these are valid statements. However, if these things (or whatever you find rewarding) made it worth choosing IM despite the inherent difficulties, take the good with the bad and stop complaining, or do something else.

 

[kinetic]

In my experience, EM residents dont complain about other specialties in the way many residents/attendings complain about the ED. If you knew that as an IM resident you would be paged at all hours of the night and take call for the rest of your life, or at least through residency, and you still chose to do it, you must like it. If you dont like the job, why not do something else?

That makes little sense. First of all, it's not valid to say that, for example, IM residents chose IM because they love taking calls and getting paged; they chose it despite that fact. That's like saying EM residents shouldn't complain about getting crapped on by everyone else because "you knew that you would be crapped on and you still chose to do it, so you must like it."

Second of all, saying that IM, or any other specialty for that matter, is angry at the ED does not mean they are angry at the ED for giving them patients. That's an easy and lazy way for many EM residents and attendings to think of things. The reality is that they are pissed that they are getting patients who have (a) incomplete or poor workups (like I said, I've given some pretty horrendous anecdotes about patient management by the ED and nobody has batted an eye or sounded surprised) and (b) that the ED justifies this with a flippant, "hey, it's your job to do diagnosis, not mine -- we just triage here, buddy."

Thirdly, saying that "you should take the bad with the good" is the lazy way of saying "accept the status quo because it benefits me." People constantly say, "hey, IM or Surg or OB got into this game in order to see patients, so why do they fight it when the ED gives them patients?" OK, so why does the ED fight it when those specialties see a patient and REFUSE the patient? Shouldn't you accept the fact that you have no admitting privileges in many places? Or that while you are a jack-of-all-trades you are also a master-of-none and should listen to people who are more specialized?

P.S. Thanks for reactivating this thread; I was gonna do it sometime during the new training year, but what the heck.

 

[Apollyon]

(like I said, I've given some pretty horrendous anecdotes about patient management by the ED and nobody has batted an eye or sounded surprised)

But that's just it - anecdotes, without a framework (ie, where), from someone who admittedly got canned, and sounds to be bitter (I enjoy the hell out of what you write, for sure, but this is what I see), so we don't know from which side you're looking at it - like a BLANK chart, we don't know if that is legion, or one person (if it happens "all the time", either they're not billing, or they're a fraud arrest and conviction waiting to happen).

I agree with KFF, though - you can't have it both ways: wanting to be the "total physician", but bitching about getting patients. At my hospital, before there was an EM residency, the medicine residents did the WHOLE workup (apparently even writing the admit note and orders), THEN called the team that would be getting the patient. The team would literally do nothing, except add the pt to the list. And I talk with the people I'm admitting to - not just, "Here it is - take it and EAT IT!".

 

[kinetic]

Apollyon,

You're right; I am still bitter (although it's diminished as the months have gone by). The way I see it (from my admittedly biased standpoint) is that I was canned for raising a ruckus (inappropriately, I'll repeat for everyone) about deficient care in the ED. Now, as I've said, you may question whether I'm a complete nutjob who saw one inappropiate chart and ripped off my clothes and ran screaming around the ED firing bullets at people as I let my bowels go on the floor, but that's not how it went down. (I have excellent bowel control.)

The residency program I left has acknowledged the problems with the ED, although they paid that lip service. Before I got the boot, there were the bi-monthly residency meetings that consisted of ten minutes of "other talk" and then would transition thusly: "OK ......now let's go to the ED ..." and for the remainder of the hour people would complain. The difference? They complained in the meeting but (and I hate this phrase) "sucked it up" outside, unlike me, who did the opposite (because I saw the same meeting over and over again and realized the administration wasn't going to do a damn thing). As I stated, we had hundreds of blank charts (and the charts were only part of the problem -- there were also tests that were lied about, incomplete H&Ps, and other B.S.). After I got the boot, I attended one last meeting and they said that they were "now" aware that things needed to be fixed (which was also bull, since I kept in touch with some residents there and nothing happened, predictably).

I was still able to garner support from a number of attendings, which would not be the case had I just acted like a lunatic imbecile with no basis for my anger. And, something that I note, when I go on interviews nobody blinks when I tell them my stories. They just shrug and say, "that happens here, too ...so what?"

Maybe I'm not being fair to the profession, but I only know what I have experienced. I guess my anger arose from the fact that I felt that ED docs would have the same drive to provide patient care as everyone else. Not to say that all other docs are excellent and perfect, but it's the rule, not the exception; with the ED, I get the sense that it's backwards. A lot of attendings, both at my home institution and at places I interview at, tell me that I have to drop this level of expectation down a few notches, but that rubs me raw -- why SHOULDN'T I expect that attitude from all doctors? Isn't that why we went through medical school and training in the first place?

P.S. After I moved back home, I was unpacking and I found one of the blank charts that I had copied months ago. I plan to frame it someday (sans patient info, of course). It'll look good next to my medical degree and my 'Employee of the Month' plaque from Burger King (just kidding ...I hope). [EDIT: Meaning, there's no way I'd be Employee of the Month, not with ol' Jose working fries.]

P.P.S. I know you (and others) keep pressing me for the name of the program and which specialty it was, but I can't do that quite yet. Since I was rejected last cycle, I am applying next cycle. Some institutions I have interviewed with know about Scutwork and so I can only assume that some know about SDN and I'd rather keep my identity close to the vest -- a few people I know say that I'm probably going to be blackballed from residency, which looks to be the case right about now. (Actually, if someone from the administration read this, they'd probably be able to ID me rather easily based on my anecdotes.) When I get in (if I do), I'll be happy to reveal full details. Until then, you can choose to believe me or not as you wish -- there's no reason for me to tell you such a humbling story if it weren't real (why would I reveal that I was canned and subsequently rejected on the interview trail?).

P.P.P.S. For anyone worried about Step III, don't. I passed it after being canned and sitting on my ass without being within 10 miles of a hospital for seven months. My residency didn't prepare me jack crap for it, but I did study a few review books fairly regularly -- didn't get me a great score, but I passed, damnit. Unfortunately, my craptastic state won't let me get independently licensed without a PGY-2 year under my belt, so I'm still unlicensed. *shakes fist at everyone and prepares to rip clothes off and let bowels loose*

 

[Apollyon]

[EDIT: Meaning, there's no way I'd be Employee of the Month, not with ol' Jose working fries.]

Suave! You're one suave ****er! - Frank Booth

Dude, I don't give a damn if you're an unemployed slacker - you're funny as hell.

As for your specialty, I can only figure that you were in surgery - that's just what repetitively pops into my head.

 

[EMDrMoe]

Any new news kinetic?

 

[Pir8DeacDoc]

I don't think he's allowed to post on this site any more. Somewhat of a shame since I found some of his stuff pretty darn funny. I know he took it a little too far but I found myself chuckling at him often.

 

[mshheaddoc]

RIP kn - you and your conservative outspoken brash nature are missed.

 

[Celiac Plexus]

I hate it when the surgeons come down angry because we've called them immediately for a suspected appy/chole/sbo/whatever, and we don't have labs, x-rays or a CT, and they say 'work up the patient!' Of course, if a really sick patient comes in and I didn't call surgery in the first 15 minutes, I get blamed and screamed at.

In our hospital, where consults regularly take 4 hours, we often have a diagnosis and treatment plan before the consultant arrives. We've already gotten a CT, done US, got lab results, started Abx, gotten (unnecessary) preop x-rays and EKGs. That's not the way it's supposed to be. The consultant is supposed to come down, look at the patient, and take over the workup so I can see my next train-wreck.

It's not my job to work up the patient. It's yours.[/QUOTE]

Wow. Where I went to med school, the ER docs worked up the patients before calling another service. In fact, that was one of the things that they took pride in. I guess that there is a big difference in quality of ER residency programs...

 

[kinetic redux]

Any new news kinetic?

Just bad news, but I'll live.

P.S. ER still suxs.

 

[fedor]

Bump