Am I disillusioned to what ER really is?

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boolin_1

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Current 3rd year medical student. I am in between EM and IM. I really want to like EM. I like the shift work, and I really like the fact that you have no idea what could come through those doors and you have to think on your feet. You get to do some procedures as well.

I’ve been spending extra days in the ER and I’m not sure if this is what ER actually is and I’m just a naive student; or the people I’m working with are just burnt out and don’t care.

Granted it’s a small Lvl 3 ER in the south. There seems to be no physical exam, no diagnostic work up, no intellectual curiosity. We’ll go in to see someone, talk for a minute, and then all they tell me “she’s not sick so Zofran & go home”.

I don’t know if I’m just naive and I had my hopes high. Yeah the abd pain wasn’t anything serious, but they had no intellectual curiosity to at least try and find out why the patient is clearly in pain.

I was going to start fine tuning my application and sign up for aways but now I feel less sure that I wanted to do EM than before.
 
boolin_1 said:
Current 3rd year medical student. I am in between EM and IM. I really want to like EM. I like the shift work, and I really like the fact that you have no idea what could come through those doors and you have to think on your feet. You get to do some procedures as well.

I’ve been spending extra days in the ER and I’m not sure if this is what ER actually is and I’m just a naive student; or the people I’m working with are just burnt out and don’t care.

Granted it’s a small Lvl 3 ER in the south. There seems to be no physical exam, no diagnostic work up, no intellectual curiosity. We’ll go in to see someone, talk for a minute, and then all they tell me “she’s not sick so Zofran & go home”.

I don’t know if I’m just naive and I had my hopes high. Yeah the abd pain wasn’t anything serious, but they had no intellectual curiosity to at least try and find out why the patient is clearly in pain.

I was going to start fine tuning my application and sign up for aways but now I feel less sure that I wanted to do EM than before.
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What you thought was a patient who was clearly in pain was really a someone faking it to get dilaudid. 😉


OK, I kid...I kid.


First and foremost, EM is a disposition driven speciality. The most effective EPs are able to most efficiently achieve a disposition without sacrificing patient safety. Intellectual curiosity is among the first of several casualties that will be sacrificed if you are to do that well. If you like thinking on your feet with more intellectual curiosity, then I suggest a CCM fellowship after either IM or EM residency.
 
I think there is a balance. I still chase zebras at times, but I know when to cut bait and punt too. I love making the diagnosis and coming to an answer (when you reasonably can) but also realize that many times no answer is going to be found in the ED and further tests are going to be needed either as an inpatient or as an outpatient, and its my job to make the decision of if the patient needs to come in for those resources or if they can go home and followup for it.

Personally, the intellectual curiosity is still for me one of my favorite parts of EM.

So just goes to show you, everyone will have things they like/dislike and people all don't practice the same.
 
I strongly disagree about intellectual curiosity being sacrificed in the name of efficiency. ER docs tend to be more curious about **** that matters in the short term. Med students are used to learning about chronic diseases like lupus and sarcoid and granulomatosis with polyangitis and the various rare genetic disorders affecting the renal tubules which cause complicated biochemical cascades and physiologic dysfunctions that just don't really matter, for the most part, at the bedside in the ER. While it might appear that we are not intellectually curious, we just aren't intellectually curious about the same things as med students. You put an acutely abnormal ECG in front of me and I will talk your ear off about it if I have the time. You give me a good tox case and I perk up like a schoolboy during dodgeball day in gym class. You give me a complicated airway case and you'll be hearing me talk out loud about my airway plan including all of my backups. You talk to me about a study you just read regarding a specific disease in an ER population and we'll do a quick literature review on the subject if there is a lull in patients. Unfortunately, for the most part, people show up to the ER for non-emergent issues, and unfortunately we spend most of our time with these non-emergencies that require minimal thought process for us, nevertheless even the most mundane things you might be able to facilitate very intellectual conversations with EM attendings regarding things we take for granted. Abscess drainage (packing vs not), laceration repairs (sterile saline vs tap water), best way to drain a felon, chest pain eval, back pain red flag symptoms or exam findings, ECG findings to lookout for in young syncope patients, headache red flag symptoms, opioid sparing analgesia, etc.

Remember that your attendings are busy, and by the sounds of it are not academic attendings, and likely take for granted what they see as mundane or commonplace as being a fresh learning opportunity for the student shadowing them. Make sure to ask questions when they appear to have time to talk (not while they are placing orders), pick their brains. Tell them how you would work up a patient you just saw so that they can critique your workup.
 
I don't know which level 3 you were at, but as a resident at a level 1 in the south, we get a lot of referred patients from those level 3s . There is a lot of interesting pathology down here. At my level 1 the degree of medicine involved in treating our patients is crazy high. I've seen a lot of the weird things we learn about in medical school - cryptococcal meningitis, dengue fever, Maple syrup urine disease, henoch-schonlein purpura in an adult, etc. I'm sure the EM docs on here who've been in the ED longer have seen many of these things too.

IM docs too can get burned out (or appear burned out) depending on the patients they're seeing.

Shadow some other ED docs. Go to an academic ED where there are residents and the attendings really love to teach. Don't make a decision that affects the rest of your life based on one negative shadowing experience. I was a PA for years and still love the discovery portion of medicine. To me, there's nothing more fun than the undifferentiated patient, which is why I went into emergency medicine. Granted, that could change in the wrong job, but so far so good.
 
Wut.

Derm is taken over by VC.

Rarely an exclusive IR job out there except for academics. Most require DR time.

Academic Ortho joints can easily make more than community EM.
bronx43 said:
Ortho is saturated like crazy. Derm and IR would be best bet.
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Sent from my Pixel 3 using SDN mobile
 
TheSingularity said:
Wut.

Derm is taken over by VC.

Rarely an exclusive IR job out there except for academics. Most require DR time.

Academic Ortho joints can easily make more than community EM.


Sent from my Pixel 3 using SDN mobile
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What’s wrong with DR time? Even interventional cardiology does general part time.

Derm still killing it despite VC. Let’s not act like corporate encroachment unique to derm.
 
Zebra Hunter said:
I strongly disagree about intellectual curiosity being sacrificed in the name of efficiency. ER docs tend to be more curious about **** that matters in the short term. Med students are used to learning about chronic diseases like lupus and sarcoid and granulomatosis with polyangitis and the various rare genetic disorders affecting the renal tubules which cause complicated biochemical cascades and physiologic dysfunctions that just don't really matter, for the most part, at the bedside in the ER. While it might appear that we are not intellectually curious, we just aren't intellectually curious about the same things as med students. You put an acutely abnormal ECG in front of me and I will talk your ear off about it if I have the time. You give me a good tox case and I perk up like a schoolboy during dodgeball day in gym class. You give me a complicated airway case and you'll be hearing me talk out loud about my airway plan including all of my backups. You talk to me about a study you just read regarding a specific disease in an ER population and we'll do a quick literature review on the subject if there is a lull in patients. Unfortunately, for the most part, people show up to the ER for non-emergent issues, and unfortunately we spend most of our time with these non-emergencies that require minimal thought process for us, nevertheless even the most mundane things you might be able to facilitate very intellectual conversations with EM attendings regarding things we take for granted. Abscess drainage (packing vs not), laceration repairs (sterile saline vs tap water), best way to drain a felon, chest pain eval, back pain red flag symptoms or exam findings, ECG findings to lookout for in young syncope patients, headache red flag symptoms, opioid sparing analgesia, etc.

Remember that your attendings are busy, and by the sounds of it are not academic attendings, and likely take for granted what they see as mundane or commonplace as being a fresh learning opportunity for the student shadowing them. Make sure to ask questions when they appear to have time to talk (not while they are placing orders), pick their brains. Tell them how you would work up a patient you just saw so that they can critique your workup.
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great response. Thank you so much.
 
Ortho is probably most secure, but no-one who is considering IM or EM is going to want to do a 5+1 year residency at 80+ hours a week, every week.
 
boolin_1 said:
Current 3rd year medical student. I am in between EM and IM. I really want to like EM. I like the shift work, and I really like the fact that you have no idea what could come through those doors and you have to think on your feet. You get to do some procedures as well.

I’ve been spending extra days in the ER and I’m not sure if this is what ER actually is and I’m just a naive student; or the people I’m working with are just burnt out and don’t care.

Granted it’s a small Lvl 3 ER in the south. There seems to be no physical exam, no diagnostic work up, no intellectual curiosity. We’ll go in to see someone, talk for a minute, and then all they tell me “she’s not sick so Zofran & go home”.

I don’t know if I’m just naive and I had my hopes high. Yeah the abd pain wasn’t anything serious, but they had no intellectual curiosity to at least try and find out why the patient is clearly in pain.

I was going to start fine tuning my application and sign up for aways but now I feel less sure that I wanted to do EM than before.
Click to expand...
The time pressure in EM is tremendous. So is the stress level and exhaustion from the constant scrambling of circadian rhythms. Add to that tremendous pressure from administration on you to provide perfect spa-level customer service in a imperfect carnival-environment of chaos. What you're seeing is the truth of people doing what they've got to do to survive. You're not crazy. What you're seeing is real.

Don't forget that while running already near red-line with non-emergencies, it won't be unusual to be expected to save a dying baby or a homicidal meth addict screaming, "I'll sue you!" while full of gushing holes put in him over a drug debt.

Simply put, EM is not for wimps.
 
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Sounds like you might get more out of it with a more engaged preceptor.

I'm 8 years and around 30k patients out of med school and still look stuff up fairly regularly, usually to reinforce the management of an uncommon diagnosis. You have to have the differential down or you'll miss it entirely.

EM is a great career if you can handle it.
 
Is the IR thing regional? Our IR guys (there literally is not a female IR doc in this area that covers any hospital I cover) don't do diagnostic rads at all.
TheSingularity said:
Wut.

Derm is taken over by VC.

Rarely an exclusive IR job out there except for academics. Most require DR time.

Academic Ortho joints can easily make more than community EM.


Sent from my Pixel 3 using SDN mobile
Click to expand...
 
ace_inhibitor111 said:
Ortho is probably most secure
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I wouldn't be so sure, at least not at their current level of income. If the government ever overhauled the medicare pay tables and devalued procedures (which are crazy over-valued), procedure based fields would definitely have a decline in income. And if we ever migrated to a socialized single payer health care system, specially fields where many of their procedures lack strong evidence of benefit will get cracked down on. You think in a socialized healthcare system, the govt is going to want to be paying a fortune for knee scopes that haven't been proven to be largely beneficial? What about back surgery for non-radicular back pain? Or joint replacements in patient over a certain age?

I think the future of the US healthcare system could have HUGE implications on all specialties. The problem is its completely unpredictable how health care legislation will change, which means it's all speculation as to what will actually happen in medicine.

Which is why you should choose a field you actually enjoy doing and stop trying to gauge the market 20 years from now. If you choose a field based on money, you are only going to be setup to be unhappy. Because medicine, not just EM, but medicine in general, does not have a sunny future outlook from a political standpoint. So choose something that makes you happy.
 
Coming onto a forum and telling someone who is interested in IM vs EM and saying how Ortho / DR / IR is a better option is like telling a girl who is complaining about her Ex-boyfriend to just date girls.

It's not a choice some people can make, nor would they want to.

TheSingularity said:
Would avoid both IM (unless aiming for a sub specialty in cards or GI) and EM and aim for ortho
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KeikoTanaka said:
Coming onto a forum and telling someone who is interested in IM vs EM and saying how Ortho / DR / IR is a better option is like telling a girl who is complaining about her Ex-boyfriend to just date girls.

It's not a choice some people can make, nor would they want to.
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Don't be fooled by the smoldering pity party disguised as advice.
 
Are you really comparing sexual orientation to career choice? Lulz.
KeikoTanaka said:
Coming onto a forum and telling someone who is interested in IM vs EM and saying how Ortho / DR / IR is a better option is like telling a girl who is complaining about her Ex-boyfriend to just date girls.

It's not a choice some people can make, nor would they want to.
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Sent from my Pixel 3 using SDN mobile
 
TooMuchResearch said:
Like Birdstrike? (Not a great example as I know he hasn't done EM in some time but couldn't remember who else here is dual boarded...Hamhock? Dr. McNinja?).
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As a member of the EM trans-specialty community, I must say I'm quite triggered. Now let me go scream at the sky ...
 
No field is as glamorous as you think. Many fields envy EM docs when they are coming in for a consult at 11pm while I am finishing up my 8 hr shift.

All field eventually becomes boring. Ortho not too happy with an open fracture at 2am. Everything eventually becomes boring when you have done 100 of them.

I thought central lines, intubation, reductions, LP etc was exciting as a resident but I can go without the rest of my career and be very happy.

Surgeons is 80% bread and butter stuff. Gallbladder becomes tiresome eventually.
OB - You want another 2 am c section?
GI - I would be done after the 50th scope


You name it, it gets redundant. Pick the field you are happy with the redundancy. Or pick a field you can bear that allows you time to enjoy other stuff (like EM)
 
TooMuchResearch said:
I can't just make myself attracted to Ortho, I'm only attracted to EM.

See? It's not that difficult.
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Do EM. Trust me. You will come to enjoy the slow day with all layups where you go home happy and not tired. Give me that all day, every day and I will be a happy man.
 
Theres a reason EM leads in physician burnout and 50% of us want to get out.

In the academic sense, emergency medicine is one of the greatest specialties. In the day to day practice, though, it's essentially insufferable.

Every shift is having to come face to face with our dysfunctional society and the disaster that american medicine has become. Theres no escaping this. I find it unbelievable that some of you find this tolerable.

To the OP, your instincts are correct. The daily practice of emergency medicine becomes necessarily anti-intellectual and the metrics and unreasonable patients and administrators eat away at what's left of your brain.
 
Ask most specialists and they will have the same complaints. Eventually everything becomes boring and mindless.

Give me a shift where I can get out and interact with people/staff, grab a cup of coffee during my 4-6 breaks a day.

ER docs need to understand that no matter how busy the ER is, you can always take a 15 min break, go to doc lounge and grab a cup of coffee. Typical day has me going to the cafeteria/doc lounge 4 times in an 8 hr shift.
 
emergentmd said:
ER docs need to understand that no matter how busy the ER is, you can always take a 15 min break, go to doc lounge and grab a cup of coffee. Typical day has me going to the cafeteria/doc lounge 4 times in an 8 hr shift.
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Sadly, no. Single coverage places often aren't afforded the privilege of walking away from the ED. Many places run by administrative *****s have removed the doctor's lounge to level the playing field, as it were.
But these aren't EM specific complaints. Medicine as a whole is tough. I'm sick of being the captain of the ship, but not being given control of where it goes.
 
Dr.McNinja said:
Sadly, no. Single coverage places often aren't afforded the privilege of walking away from the ED. Many places run by administrative *****s have removed the doctor's lounge to level the playing field, as it were.
But these aren't EM specific complaints. Medicine as a whole is tough. I'm sick of being the captain of the ship, but not being given control of where it goes.
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Yeeeeeaaaaah-up.
 
Do the nurses still get break rooms at these hospitals? I know the answer, just putting the question down.
Dr.McNinja said:
Sadly, no. Single coverage places often aren't afforded the privilege of walking away from the ED. Many places run by administrative *****s have removed the doctor's lounge to level the playing field, as it were.
But these aren't EM specific complaints. Medicine as a whole is tough. I'm sick of being the captain of the ship, but not being given control of where it goes.
Click to expand...
 
DeadCactus said:
One thing to keep in mind is that what you perceive as a lack of engagement may really be an experienced physician using heuristic decision making.
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There is a really good podcast by the Curbsiders (an IM podcast) about IM vs EM by an EM doc about this issue. Really very interesting.

I work a bunch with my EM colleagues. Personally, I don't envy them at all. They deal with so much non-emergent garbage. Yes, they dump on to me, but they get so much more junk than me. I also get an appreciation for how hard it is to made decision on some patients really within the first few hours. It is much easier to make decisions after 8-20 hours.

I don't do nights. I get a variety of medical stuff. I still have to look stuff up after being staff for 4.5 years (though not as much). The average IM will make less than the average EM, but they can have it. I feel my opportunities in medicine (and out of medicine) are more broad (though I accept that my knowledge of non-clinical EM opportunities is limited).
 
emergentmd said:
Ask most specialists and they will have the same complaints. Eventually everything becomes boring and mindless.

Give me a shift where I can get out and interact with people/staff, grab a cup of coffee during my 4-6 breaks a day.

ER docs need to understand that no matter how busy the ER is, you can always take a 15 min break, go to doc lounge and grab a cup of coffee. Typical day has me going to the cafeteria/doc lounge 4 times in an 8 hr shift.
Click to expand...

I did EM for over 15 years. I’ve seen EPs take bathroom, nourishment, pump breaks and the like when there was a natural lull in the ED patient flow. However, I’ve never, not once ever, seen an EP take a 15 min relax break when the ED was busy.

I saw a lot of faults in the practice of EM during that time. Fortunately, the resilience and work ethic of my colleagues was never a problem. Had it been, I would have popped smoke much earlier in my career.
 
Really? I take breaks all the time when it's busy. Obviously if there's a critical patient I need to be taking care of I'm not strolling out of the department for coffee. But I'm not gonna starve for 10 hrs hustling to move low acuity. If you're not sick you can wait.
ShockIndex said:
I did EM for over 15 years. I’ve seen EPs take bathroom, nourishment, pump breaks and the like when there was a natural lull in the ED patient flow. However, I’ve never, not once ever, seen an EP take a 15 min relax break when the ED was busy.

I saw a lot of faults in the practice of EM during that time. Fortunately, the resilience and work ethic of my colleagues was never a problem. Had it been, I would have popped smoke much earlier in my career.
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TheSingularity said:
Really? I take breaks all the time when it's busy. Obviously if there's a critical patient I need to be taking care of I'm not strolling out of the department for coffee. But I'm not gonna starve for 10 hrs hustling to move low acuity. If you're not sick you can wait.

Sent from my Pixel 3 using SDN mobile
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Me as well. Even when busy I sometimes just enjoy the 5 min walk to the doctor's lounge (always located geographically as far away from the ER as possible).
 
Even single coverage I take brakes call me with the phone. If they don’t like it then get rid of me. I’m also more productive and it helps my cognitive process far better.
 
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TheSingularity said:
Really? I take breaks all the time when it's busy. Obviously if there's a critical patient I need to be taking care of I'm not strolling out of the department for coffee. But I'm not gonna starve for 10 hrs hustling to move low acuity. If you're not sick you can wait.

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Yeah, really. I’ve never seen someone leave the ED for the lounge for 15 min to relax when the ED was busy. By busy, I mean beds full and at least one patient waiting to be seen.

Sure, I’ve taken 5 min to eat or drop the kids off at the pool, but never 15 minutes in the lounge to relax or get my chakra aligned when there are patients waiting to be seen.

Finally, that I said I’ve never seen it - I didn’t say that it never happens. I get the sense that my experience in EM was very different that yours; not necessarily better or worse - just different.
 
ShockIndex said:
Sure, I’ve taken 5 min to eat or drop the kids off at the pool, but never 15 minutes in the lounge to relax or get my chakra aligned when there are patients waiting to be seen.
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If patients are waiting, and I'm single coverage, I'll drop orders on them so stuff gets going then go take my break. Often I can come back and DC the simple workups like ankle sprains and CXRs. I've always found it a waste of time to do "2 visits" on these super simple stuff. Ankle injury? Order the X-ray then go see them when it's back so I can give them results and DC instructions all at once.
 
GeneralVeers said:
If patients are waiting, and I'm single coverage, I'll drop orders on them so stuff gets going then go take my break. Often I can come back and DC the simple workups like ankle sprains and CXRs. I've always found it a waste of time to do "2 visits" on these super simple stuff. Ankle injury? Order the X-ray then go see them when it's back so I can give them results and DC instructions all at once.
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What I’m pushing back against is this concept that EPs can take a 15 min breaks in the lounge NO MATTER HOW BUSY IT GETS. That is what was written and it doesn’t comport with the reality of EM as I’ve experienced. Part of that reality is framed by the fact that I never took a full-time job in a ****hole hospital or with a malignant SDG or cap CMG (I left EMP long before USACS). So, my experience is likely to be very different than others on the internet.

Finally, almost every shop tracks bed to doc times. While we all play chess with that clock and orders, clicking that a patient has been seen and then walking out of the ED for a 15 min break without at least sticking your head in the room is a quick way to land in a heap of trouble. I’m not suggesting that you do this, but I’ve seen well meaning docs pick-up three at a time as “being seen” but get side-tracked and not get to the last patient for a while. It can look bad under certain circumstances.
 
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Brigade4Radiant said:
Even single coverage I take brakes call me with the phone. If they don’t like it then get rid of me. I’m also more productive and it helps my cognitive process far better.
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Ditto, we've got vocera at my one shop and a handheld phone at the other, so they can easily reach me if there's something super emergent. Otherwise, peeps can wait...
 
ShockIndex said:
Yeah, really. I’ve never seen someone leave the ED for the lounge for 15 min to relax when the ED was busy. By busy, I mean beds full and at least one patient waiting to be seen.

Sure, I’ve taken 5 min to eat or drop the kids off at the pool, but never 15 minutes in the lounge to relax or get my chakra aligned when there are patients waiting to be seen.

Finally, that I said I’ve never seen it - I didn’t say that it never happens. I get the sense that my experience in EM was very different that yours; not necessarily better or worse - just different.
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Well then you either need to be more efficient or less controlling. No reason to freak out or get stressed about leaving the ED for 15 min when its busy. Rooms full and 1 pt in waiting room is NOT busy. I actually would consider this a lull.

I am highly efficient. I can avg 3+pph without any QC pts and done with my charting when the next guy comes in. Out of the 15 docs that runs the hospital, I am always top 3 in pph and the only one to typically leave right when the new doc comes.

This is not to Brag. But if I am a top 3 volume doc, can get my work done, and the board predominately has my name attached then heck yeah I will take my 15 min break whenever I feel like it unless there is crashing pt.

If I am carrying more than my expected load, I will take my 15 min tour to the cafeteria whenever I please if there is not a critical pt. Those 3 abdominal pain pts can wait.

Even when I am single coverage overnight, I have my phone. I put my name on any open charts and put some orders in. Down to the cafeteria I go for my 15 min coffee and food bread.

I do this minimum 4-6 times in an 8 hr shift. If you are not able, then either get efficient or stop being anal about that one pt waiting to be seen.
 
emergentmd said:
Well then you either need to be more efficient or less controlling. No reason to freak out or get stressed about leaving the ED for 15 min when its busy. Rooms full and 1 pt in waiting room is NOT busy. I actually would consider this a lull.

I am highly efficient. I can avg 3+pph without any QC pts and done with my charting when the next guy comes in. Out of the 15 docs that runs the hospital, I am always top 3 in pph and the only one to typically leave right when the new doc comes.

This is not to Brag. But if I am a top 3 volume doc, can get my work done, and the board predominately has my name attached then heck yeah I will take my 15 min break whenever I feel like it unless there is crashing pt.

If I am carrying more than my expected load, I will take my 15 min tour to the cafeteria whenever I please if there is not a critical pt. Those 3 abdominal pain pts can wait.

Even when I am single coverage overnight, I have my phone. I put my name on any open charts and put some orders in. Down to the cafeteria I go for my 15 min coffee and food bread.

I do this minimum 4-6 times in an 8 hr shift. If you are not able, then either get efficient or stop being anal about that one pt waiting to be seen.
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Good for you. I really appreciate the advice.
 
ShockIndex said:
What I’m pushing back against is this concept that EPs can take a 15 min breaks in the lounge NO MATTER HOW BUSY IT GETS.
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Push back all you want. My ER can be full, we can be 10 pts in the waiting room, I can be in single coverage, but if there is nothing requiring my Immediate attention, then off I go usually with my Scribe.

2 min walk to the cafeteria, 5-10 to grab some food, 2 min walk back to the ER. Amazingly, noone has ever decompensated or died in the 18 yrs. 18x15 shiftsx12 monthsx 4 breaks; so about 1300 trips and noone has ever had a bad outcome or complained.

To each his own. If you feel anxiety from leaving the ER when its full, then so be it. I have no issue walking away for 15 min and coming back more clear headed, relaxed, with a cappuccino in my hand.
 
If ours tracks door to doc times, they don't tell us about it. Let's hope it stays that way.
ShockIndex said:
What I’m pushing back against is this concept that EPs can take a 15 min breaks in the lounge NO MATTER HOW BUSY IT GETS. That is what was written and it doesn’t comport with the reality of EM as I’ve experienced. Part of that reality is framed by the fact that I never took a full-time job in a ****hole hospital or with a malignant SDG or cap CMG (I left EMP long before USACS). So, my experience is likely to be very different than others on the internet.

Finally, almost every shop tracks bed to doc times. While we all play chess with that clock and orders, clicking that a patient has been seen and then walking out of the ED for a 15 min break without at least sticking your head in the room is a quick way to land in a heap of trouble. I’m not suggesting that you do this, but I’ve seen well meaning docs pick-up three at a time as “being seen” but get side-tracked and not get to the last patient for a while. It can look bad under certain circumstances.
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LulZ. Let them fire me.
ShockIndex said:
What I’m pushing back against is this concept that EPs can take a 15 min breaks in the lounge NO MATTER HOW BUSY IT GETS. That is what was written and it doesn’t comport with the reality of EM as I’ve experienced. Part of that reality is framed by the fact that I never took a full-time job in a ****hole hospital or with a malignant SDG or cap CMG (I left EMP long before USACS). So, my experience is likely to be very different than others on the internet.

Finally, almost every shop tracks bed to doc times. While we all play chess with that clock and orders, clicking that a patient has been seen and then walking out of the ED for a 15 min break without at least sticking your head in the room is a quick way to land in a heap of trouble. I’m not suggesting that you do this, but I’ve seen well meaning docs pick-up three at a time as “being seen” but get side-tracked and not get to the last patient for a while. It can look bad under certain circumstances.
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
emergentmd said:
Push back all you want. My ER can be full, we can be 10 pts in the waiting room, I can be in single coverage, but if there is nothing requiring my Immediate attention, then off I go usually with my Scribe.

2 min walk to the cafeteria, 5-10 to grab some food, 2 min walk back to the ER. Amazingly, noone has ever decompensated or died in the 18 yrs. 18x15 shiftsx12 monthsx 4 breaks; so about 1300 trips and noone has ever had a bad outcome or complained.

To each his own. If you feel anxiety from leaving the ER when its full, then so be it. I have no issue walking away for 15 min and coming back more clear headed, relaxed, with a cappuccino in my hand.
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Who said anything about anxiety? I think that we just have very different concepts of what “no matter how busy it gets” means. Busy means that there are things that require my attention. Extremely busy means patients are trying to die. Under those circumstances, I don’t go to the lounge for a 15 min break, and therefor there are parameters of busy that define when I do. However, if you’ve mastered running an ED from the break room when it’s what I’d call busy, then I feel disappointed that we never crossed paths so that I could learn from a Jedi Master.
 
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TooMuchResearch said:
If ours tracks door to doc times, they don't tell us about it. Let's hope it stays that way.
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If you used Epic, Cerner, or MedHost the data is there. Epic time stamps “seen” when you sign on to a patient; MedHost has a patient seen icon.

Those times become issues when groups have ****ty metrics like LWOTs, LOS, door to needle, door to balloon, etc. If your group is knocking it out of the ballpark on metrics, it’s unlikely that your CEO or CMO will pull your director or Chair into a meeting with spreadsheets and graphs. They also become issues when a CMG is going after a contact as part of their pitch to the hospital leadership.
 
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