Are EM docs mean?

[Hard24Get]

I just got an earful from 2 people I know begging me not to be a mean doc like most of the rest.

It seems like every EP I meet is really nice and cares about people, but they say it's because I'm on the inside, whereas most EPs don't care about patients (presumably b/c they don't know them). They say residents are especially rude.

Could it be docs think they are nice but are being misinterpreted or are EPs in general honestly mean and don't care?

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[Sharn Penndroen]

Are Civil Engineers mean?...

I mean, I don't think you can say whether or not everyone in a particular profession have the same personality. That is just silly. That said, I'm sure that everyone in the medical profession can work on their bedside manner.

 

[OSUdoc08]

I just got an earful from 2 people I know begging me not to be a mean doc like most of the rest.

It seems like every EP I meet is really nice and cares about people, but they say it's because I'm on the inside, whereas most EPs don't care about patients (presumably b/c they don't know them). They say residents are especially rude.

Could it be docs think they are nice but are being misinterpreted or are EPs in general honestly mean and don't care?

Who is "they"?

 

[GeneralVeers]

On a relative basis we are mean. We kick out the drug addicts, drug seekers, and homeless people who want to abuse the system.

 

[DropkickMurphy]

Well.....only if you catch them on a day they forgot to take their medication. Then look out....especially residency PD's.

 

[bulgethetwine]

Well.....only if you catch them on a day they forgot to take their medication. Then look out....especially residency PD's.

We're cynical, sarcastic, and occasionally cranky, but I don't think we're mean.

Well, except when you poke us with a stick...

 

[Anuwolf]

I do not think EM docs are mean... They are ONLY interested in treating those who really need help. I almost agree to GeneralVeers's posts however I do not agree into throwing them out on the streets... especially the drug addicts. Drug Addicts are sick people and need help badly. Everybody from the ED should be aware of the drug withdraws… Some are mild but other times it can be severe such as high blood pressure, seizures, etc. I sure hope that each hospital has a detox unit to help people to get off of street drugs and to get them some therapy and treatment that they need to stay clean.

As far as the drug seekers the ones who aren’t sick and trying to make a living by hospital drugs should be thrown in prison. Don’t throw them out… let them be greeted by law enforcements and security instead.

And not but least the homeless people introduce them to county programs for the homeless.

 

[Anuwolf]

We're cynical, sarcastic, and occasionally cranky, but I don't think we're mean.

Well, except when you poke us with a stick...

Hey thats a good idea! Next time I go to the ER with something I'd grab myself a healthy stick and start poking you docs!

 

[DropkickMurphy]

Hey thats a good idea! Next time I go to the ER with something I'd grab myself a healthy stick and start poking you docs!

That'll earn you another dose of Haldol......

 

[BKN]

Well.....only if you catch them on a day they forgot to take their medication. Then look out....especially residency PD's.

*sings* I've got a little list, you never will be missed.

 

[DropkickMurphy]

 

[Anuwolf]

That'll earn you another dose of Haldol......

that sounds exciting but how are you guys going to dope me up with haldol when I'm running up and down (I run pretty good) the hall way poking the nurses and docs with my healthy stick?

Don't tell me you have those haldol dart guns, do ya?

 

[DropkickMurphy]

Don't tell me you have those haldol dart guns, do ya?

Yeah....it's called the "Saturday night special"

 

[Anuwolf]

Yeah....it's called the "Saturday night special"

No that's cheating!

 

[DropkickMurphy]

No that's cheating!

All's fair in love, war and the chemical restraint of psych patients.

 

[Febrifuge]

EM docs and PA's are very interested in giving patients what they need, and in the grand scheme of things, they care very little for what patients think they want. Which stands in contrast to a lot of other providers, in a lot of other settings.

Also, emergency people tend to concentrate on doing better next time, rather than on being perfect every single day. Finally, as a group, they tend not to stew for long periods about whether patients think they are mean.

If that makes 'em mean, oh well. They're people I like to be around, and will eventually be one of.

 

[GeneralVeers]

EM docs and PA's are very interested in giving patients what they need, and in the grand scheme of things, they care very little for what patients think they want. Which stands in contrast to a lot of other providers, in a lot of other settings.

Nicely put. Patients may WANT a dose of Demerol for a vague complaint, but if I have to wake them up to do an H&P, they definitely don't NEED it.

 

[EPA7X1]

I can't speak for everyone else, but I am especially mean. I have been known to give a frail, elderly patient a swift kick in the nuts.

 

[Hard24Get]

Who is "they"?

Co-workers at my lab. They are not drug seekers or anything (ie, have advanced degrees) but several of them have been yelled at or treated abruptly.

Are Civil Engineers mean?...

I mean, I don't think you can say whether or not everyone in a particular profession have the same personality. That is just silly. That said, I'm sure that everyone in the medical profession can work on their bedside manner.

I just phrased the thread name that way to get attention.
That being said, though I asked "in general" we have patients out there that really do slap a label on the whole field/group of residents.

Also, emergency people tend to concentrate on doing better next time, rather than on being perfect every single day. Finally, as a group, they tend not to stew for long periods about whether patients think they are mean.

If that makes 'em mean, oh well. They're people I like to be around, and will eventually be one of.

As Anuwolf said EPs have the opportunity to do a lot of good socially for the community, and I think that how we are treating our patients plays into that. IMHO, once you become cavalier about your bedside manner, it's a slippier slope. What's so bad about me posting a thread for some reflection on how we are making others feel? It's a real issue that relates to obtaining a thorough history and insuring compliance, if nothing else.

 

[southerndoc]

I can't speak for everyone else, but I am especially mean. I have been known to give a frail, elderly patient a swift kick in the nuts.

Were you the one who gave my 95-year-old grandmother a Texas titty twister the other night?

 

[DropkickMurphy]

Were you the one who gave my 95-year-old grandmother a Texas titty twister the other night?

Please telling me you are joking about that happening.....

 

[Anuwolf]

All's fair in love, war and the chemical restraint of psych patients.

So you're telling me that each psych patients you see you use chemical restraints?

 

[DropkickMurphy]

So you're telling me that each psych patients you see you use chemical restraints?

Just the unruly ones.....

 

[Anuwolf]

Just the unruly ones.....

You guys just don't have the 4 pts anymore? Today it's all chemical restraints huh?!? that's the easy way

 

[DropkickMurphy]

I take it you've been on the receiving end of both before...... LOL

 

[Anuwolf]

I haven't been in 4 pts before but I was thrown into the "quite room" in the ER. I was there simply because I had a reaction torwards the medications that I was taking.... both penicillin (which makes me mean) and tylenol with codeine, I was taking them both because I was having a root canal treatment. I admit that I loved the feeling that the tylenol with codeine had on me.. I was taking twice as many as my dentist was giving me.. even asked him if he could give me more ;/

I became addicted and hated the withdraws that I was having at the hospital.

I did recieved Haldol in the hospital and it was an aweful feeling... I became a living Zombie and I had bizarre sleeping... Normally when you sleep you see black... but I was seeing RED! pretty werid.

 

[8744]

Nicely put. Patients may WANT a dose of Demerol for a vague complaint, but if I have to wake them up to do an H&P, they definitely don't NEED it.

Like the patient with 10/10 pain while eating a Quarter Pounder with cheese meal.

 

[Febrifuge]

As Anuwolf said EPs have the opportunity to do a lot of good socially for the community, and I think that how we are treating our patients plays into that. IMHO, once you become cavalier about your bedside manner, it's a slippier slope. What's so bad about me posting a thread for some reflection on how we are making others feel? It's a real issue that relates to obtaining a thorough history and insuring compliance, if nothing else.

Please don't misunderstand; I agree completely that bedside manner is vital. It's my belief that you get more and better info from a H&P if the patient knows that you are genuinely listening and are on their side -- and the best way to leave that impression is to actually listen, and be on their side. Not to mention, even the most cynical and burned-out EP should be good to people if for no other reason than that the majority of lawsuits stem from failure to communicate well, or failing to connect on a human level.

I was just trying to be concise, and I guess I wound up terse. It's a good question, and a good discussion. Why is it that EP's can come across as "mean?" What intention isn't coming across in those cases? How can they do it differently?

 

[Dimoak]

Could it perhaps be that when people arrive at an ED, they're generally already quite frightened, angry, irritable, agitated, etc., and that may contribute greatly to their opinion of the ED staff? Especially if they arrive at a busy time, where the staff is running back and forth, frantically trying to get meds acquired and administered, labs read, specialists contacted, etc. The mental state of both parties involved may already be pushed far enough to an extreme that less favorable opinions may be reached?

 

[SoCuteMD]

Were you the one who gave my 95-year-old grandmother a Texas titty twister the other night?

I am, unfortunately, acquianted with titty twisters, but have to ask what the difference is between a run of the mill titty twister and the Texas variety?

 

[st0rmin]

I am, unfortunately, acquianted with titty twisters, but have to ask what the difference is between a run of the mill titty twister and the Texas variety?

Everything is bigger in Texas...

http://www.urbandictionary.com/define.php?term=Texas+Titty+Twister

 

[Anuwolf]

Lay off the tities!!!!!!!!!

 

[totalbodypain]

I am only mean when the nurse managers make me throw out my coffee..

 

[Anuwolf]

They make you throw out your coffee?!?!?!? WHY?!??!?!

 

[totalbodypain]

They make you throw out your coffee?!?!?!? WHY?!??!?!

JHACO.....Making your life suck more one day at a time..... Not to mention you take away a Nurse manager's ability to write you up and/or take away your java and you drain her will to live...Seems to me patient mortality goes up after they throw out my coffee but I don't think the administration has caught on to this trend otherwise they'd force feed us starbucks double shots prior to every shift and likely keep bags of IV caffeine flowing (oh god I can't spell to save my life), just to improve productivity...

 

[bartleby]

I sure hope that each hospital has a detox unit to help people to get off of street drugs and to get them some therapy and treatment that they need to stay clean.

If you're actually serious, I hate to be the one to burst your bubble, but you are probably hard pressed to find such a common illness which has fewer resources directed against it than addiction. Most addicts get a pat on the back, a list of local rehab resources, and what little withdrawal symptom treatment we can offer before they get kicked to the curb.

 

[DropkickMurphy]

JHACO.....Making your life suck more one day at a time..... Not to mention you take away a Nurse manager's ability to write you up and/or take away your java and you drain her will to live...Seems to me patient mortality goes up after they throw out my coffee but I don't think the administration has caught on to this trend otherwise they'd force feed us starbucks double shots prior to every shift and likely keep bags of IV caffeine flowing (oh god I can't spell to save my life), just to improve productivity...

There's an interesting idea for a journal article: Is there any real correlation between EM physician caffeine consumption and productivity or patient outcomes?

 

[Hard24Get]

There's an interesting idea for a journal article: Is there any real correlation between EM physician caffeine consumption and productivity or patient outcomes?

The thread should have been called, "do EM docs have ADD?", 'cause boy has this thread gotten distracted!

There's no place to leave coffee in your fishbowls?

 

[SoCuteMD]

The thread should have been called, "do EM docs have ADD?", 'cause boy has this thread gotten distracted!

There's no place to leave coffee in your fishbowls?

Not only do I have a raging case of (unmedicated, but relatively well-controlled) ADD but I am a big big meanie too.

 

[Level_II_Trauma]

I haven't been in 4 pts before but I was thrown into the "quite room" in the ER. I was there simply because I had a reaction torwards the medications that I was taking.... both penicillin (which makes me mean) and tylenol with codeine

Last I checked, "mean-ness" isn't documented anywhere as side effect for penicillin. I suspect you're just innately mean, with your narcotic abuse exacerbating that wonderful quality. I woulda' thrown your butt in the padded room, too. Based on your story here, you probably deserved it.

I admit that I loved the feeling that the tylenol with codeine had on me.. I was taking twice as many as my dentist was giving me.. even asked him if he could give me more

Now, you wonder why ER docs can cop an attitude? They get sick of dealing with this kind of crap day in and day out. Really, what percentage of the patients that you see on a daily basis are drug seekers? Doc-shoppers? And I wonder how many of them ever really even pay their bill? Never mind answering that one.

I did recieved Haldol in the hospital and it was an aweful feeling... I became a living Zombie

Good. I'm glad it was awful. You brought it on yourself. The ER isn't your personal playground and you don't make the rules there. You got the Haldol because you were acting like an idiot.

No - I'm not cynical. Just sick of uneducated people who think they can walk into an ER and run the show. Once in the ER they all the sudden become actors and actresses, try to manipulate staff, and then if that doesn't work, they start threatening, become verbally and physically abusive, and end up having staff and security knock their asses to the floor or pin them down to the gurney. Yes, there is a very good reason for Haldol.

(Oh, and don't you just love the spitters?)

Yeah, ER docs are real nice. I think they should be given trophies for being able to remain "nice" with all the B.S. they put up with from these kinds of patients.

 

[ERMudPhud]

Last I checked, "mean-ness" isn't documented anywhere as side effect for penicillin. I suspect you're just innately mean, with your narcotic abuse exacerbating that wonderful quality...



...Good. I'm glad it was awful...

Dude, as near as I can tell anuwolf is a very young psych patient who some how wandered in here. So not only are you basically kicking a puppy, you're kicking a defenseless puppy who isn't all there. I have to admit he's often out of place here but every so often one of his first person observations on psychiatric care, like the haldol story, are enlightening.

To the original question: my wife and I both agree that after 8-12 years in this field we are a lot meaner than we used to be.

 

[beyond all hope]

EM is about making critical decisions. We have to make those decisions not just in the best interests of the individual patient but the entire emergency room population.

EM docs need to see lots of patients in a short period of time. We don't have time to talk to the anxious/depressed patient who just wants someone to listen to them, the seekers who want narcs, the frustrated patient who wants the cheif of surgery/cardiology/neurology to give them surgery/cath/MRI right now for nonemergent complaints. Many of these patients don't even realize they are abusing the priviledge of the emergency room (although in urban centers, many do)

If you're too nice to people who don't need it, then you're being cruel to the ones dying in the waiting room.

That sometimes means kicking out patients who just want a place to sleep/food/narcs/TLC even though it seems mean cause you need to see the MI/GSW/appy/CVA up next in the rack.

 

[docB]

EM is about making critical decisions. ....up next in the rack.

I'd been thinking of posting on this thread but that post almost sums up what I would have said.

I tend to use phrases like "What can I do for you in the Emergency Room tonight?", "Do you have a specific question?", "What made you come to the ER today?" and so on to limit the vague rambles. Some people feel that is curt and rude. People also don't like to be told that they came in inappropriately but that's what pateint education is.

 

[Hard24Get]

EM is about making critical decisions. We have to make those decisions not just in the best interests of the individual patient but the entire emergency room population.

EM docs need to see lots of patients in a short period of time. We don't have time to talk to the anxious/depressed patient who just wants someone to listen to them, the seekers who want narcs, the frustrated patient who wants the cheif of surgery/cardiology/neurology to give them surgery/cath/MRI right now for nonemergent complaints. Many of these patients don't even realize they are abusing the priviledge of the emergency room (although in urban centers, many do)

If you're too nice to people who don't need it, then you're being cruel to the ones dying in the waiting room.

That sometimes means kicking out patients who just want a place to sleep/food/narcs/TLC even though it seems mean cause you need to see the MI/GSW/appy/CVA up next in the rack.

Whoa, folks, no one is talking about being wimps, here - everyone is mentioning decisions the pt may see as mean, that doesn't count. EDs are not free clinics.

Just talking about the difference between, "lady, get to the point - I don't have time for your whole problem list" and, "I'm sorry, ma'am, but as you can see we are very busy tonight and I can really only address your most urgent problem". I think that's something we can work on.

Why, just yesterday there was a probable drug-seeker in FM and she just got a, "I know it must be hard, but we really to treat the disease, not the symptoms, and we have a policy that once a doc in our practice prescribes you narcotics, you have to discuss any additional prescriptions with them". She had just gotten a similar line from the ED recently....

 

[DropkickMurphy]

The thread should have been called, "do EM docs have ADD?", 'cause boy has this thread gotten distracted!

There's no place to leave coffee in your fishbowls?

Huh? I'm sorry....I saw a shiny object and I forgot what we were talking about.

 

[Anuwolf]

Huh? I'm sorry....I saw a shiny object and I forgot what we were talking about.

Was the shiny object a red ball? I cant find it anywhere!

 

[JaySin]

What i've learned in my year as an EMT is that the nicer i am the less i can get accomplished. Some patients like to ramble about things im not asking them about. If im short with them then i have a much better chance of getting the info i need so i can treat them better.

 

[Hard24Get]

What i've learned in my year as an EMT is that the nicer i am the less i can get accomplished. Some patients like to ramble about things im not asking them about. If im short with them then i have a much better chance of getting the info i need so i can treat them better.

Oh, nevermind about this thread, only a fraction of folks were feeling me . The bottomline is there is a good way and a bad way to be efficient. I am on a FM rotation now and often take half the time the primary does with the patient, yet they all gush about how nice I am.

That being said, there is a correlation between efficiency and impatience, and I think the occasional rudeness comes from the impatience. I now know what to look out for to keep ye old interpersonal skills sharp.

Getting off the phone with your rambling grandmother requires similar artistry....

 

[subi]

 

[bartleby]

There is a middle ground here. If you give them a little rope by asking them, "What seem to be bothering you tonight?" you will be able to tell within 5 seconds whether you're going to get anything useful out of them by letting them talk. Sometimes you will get more information by just letting them talk and really listening for a minute or two rather than asking questions which aren't really getting to the matter at hand. If they start rambling, I give them about 20 seconds before I interrupt and start asking them pointed questions to get things over with. The more people ramble, the more yes/no questions you should be askiing them. Letting them talk for a bit at least makes them think you were trying to listen.

Some patients like to ramble about things im not asking them about. If im short with them then i have a much better chance of getting the info i need so i can treat them better.