EM Bashing

Discussion in 'Emergency Medicine' started by SilverScrubs, Dec 12, 2008.

  1. SilverScrubs

    SilverScrubs Energizer Bunny
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    So I'm pretty tired of EM bashing. I'm doing my IM rotations at the hospitals.... and responses to my answer of career choice is...

    "Emergency? Don't you like to think?"

    "Emergency? Aren't you too smart for that?"

    "Emergency? What the hell do you want to do that for?"

    "Emergency? Don't you like to take care of your patients?"


    This whole week I got crap from residents and attendings alike. I believe EM to be the most awesome job there could ever be! My response is who the hell doesn't?! Why would you want to follow Mrs. Soandso for SEVERAL days cause her H&H has dropped yet again...consult..bla bla write another boring ass progress note...how dreadful! ER docs are the only ones who are the most down to earth, cool, and can hold their own when the s%*t hits the fan. I'd like to see an IM doc or a specialist even handle a simple code, god bless their little "thinking hearts." :cool:
     
  2. WilcoWorld

    WilcoWorld Senior Member
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    I should just say, ignore them, but I can't resist:

    "Emergency? Don't you like to think?"

    - Yes, I like to think, but I also like to actually intervene occasionally as well.

    "Emergency? Aren't you too smart for that?"

    - Perhaps, but if so, then via the Transitive Property I'm also too smart for IM.

    "Emergency? What the hell do you want to do that for?"

    - I dunno, diagnosing undifferentiated patients, performing time-sensitive interventions, having a palpable effect on patients. Y'know - saving lives.

    "Emergency? Don't you like to take care of your patients?"

    -Oh, should I take care of patients the way we do on the floor? I guess I should block more admissions and get more subspecialty consults in the ED, but I've got this pesky desire to be efficient.

    On second thought, just ignore 'em.
     
  3. AmoryBlaine

    AmoryBlaine the last tycoon
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    EM bashing is not ok, you should in turn make sure that you never speak ill of other specialties like you just did in your post.

    EM needs to get over this inferiority complex that says, "we don't get no respect" while simultaneously belittling our colleagues in other specialties.

    Part of the way we do this is to perpetuate a myth than internal medicine residents and physicians suck at running codes. I have never seen any evidence that that is the case. The idea that an IM resident can't run a code is laughable and offensive.

    Part of the way we do this is to perpetuate the myth that internal medicine docs are nerds who sit around and pontificate while never actually helping patients. Well when my grandma is in undifferentiated renal failure and/or has an AMI I hope to god one of those tweedy, silly, internists is there to help her.

    Emergency med is a specialty just like any other, it is right for some people and not for others. We will never get respect until we give it, period.
     
  4. notdeadyet

    notdeadyet Still in California
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    Amen.
     
  5. Hernandez

    Hernandez Paranoid and Crotchety...
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    Can I get an amen?
     
  6. SilverScrubs

    SilverScrubs Energizer Bunny
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    That's very interesting and I'm very glad most of you have had great experiences with other docs. At the hospital where I'm at, the multiple codes that have been called on the floor...I find it interesting that the ER docs are the ones that come from the ER to run it. This has happened multiple times while we had 2 residents, 5 interns , and 6 med students in the room. These are they same residents who are giving me crap and telling me EM is a choice for those who aren't smart enough for IM. Please.

    Also...this was in reponse to all the attendings during the day that were giving me crap as well for choosing EM. I have the right to vent and am only doing it in reponse to their looking down on people who choose EM. How can they put EM down when they can't even handle a code?? I'm not gonna sit back and take it. That's why these forums are great!! I get to vent whereas I did not open my mouth at the hospital.
     
    #6 SilverScrubs, Dec 13, 2008
    Last edited: Dec 13, 2008
  7. AmoryBlaine

    AmoryBlaine the last tycoon
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    The EM physician probably comes to the code b/c he/she is the designated code team leader. That set-up is not at all uncommon in community hospitals. It usually is that way for 2 reasons -- a) there is always an attending in the ED and b) EM physicians are specialists at resuscitation.

    When a code is called at this hospital are the IM residents standing around with their thumbs in their asses? Do they just stare at each other uncomfortably until the EM attending gets there? If they do it probably has more to do with them being bad residents than their specialty choice.

    Stop focusing on this ability to run a code as the all-important benchmark. How can you put down internal medicine when you can't even manage lupus? Can you run a code? It's a lot harder to do than you probably think.
     
  8. Hernandez

    Hernandez Paranoid and Crotchety...
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    and have you asked whether this is hospital policy? Every hospital is different, I've been in several where the ER docs are the ones who are by hospital by-laws the ones responsible for running the codes, I've been in some where no one is allowed to intubate other than Gas, and I'm personally in a hospital where IM runs everything unless it's in the ED.

    well aren't you special. I've stuck up for EM more than a few times in the surgery forums, but as stated above, get over your inferiority complex and come down off that cross you've put yourself on. Every field is different for a reason and focuses on different traits of medicine and it's implementation. My most recent annoyance with my ED is their seeming refusal to place a Central line in pt's who are in septic shock. I have no issues putting in a line myself, but one of the key components of the River's protocol is the early part of early goal directed therapy.

    all specialties can go back and forth about the weakness and flat out failings of the other specialties, but that does nothing but perpetuates self righteous feelings of superiority that are unfounded.
     
  9. AmoryBlaine

    AmoryBlaine the last tycoon
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    Those residents/attendings who get all huffy when they feel they are being slighted are usually those who are quickest to turn around and belittle other specialties.

    The mature attitude is to recognize that we all have our own areas of expertise and weakness.
     
  10. WilcoWorld

    WilcoWorld Senior Member
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    Now, I agree that one should take the high road in specialty-bashing situations. Usually, I will politely explain the limitations and the priorities of the ED, and if that doesn't work then I basically remove myself from the conversation. Hence my original post's advice to "Just ignore 'em." But this is an anonymous internet forum, and there's no better place to blow off some steam. So would you guys please cut the OP a little slack?

    Should you get into a verbal sparring match with non-EM docs when they complain about the ED or bash our specialty? No. Is it OK to come here to grumble about unfair criticisms? Absolutely.
     
  11. Hernandez

    Hernandez Paranoid and Crotchety...
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    But it's hypocritical to complain about unfair criticisms while throwing a bunch of your own around. Complain all you want, especially when it's warranted, but don't stoop to the same level of kindergarden shenanigan's, it only fuels the hostility on the forums and has lead to some pretty nasty threads which ended in locks and some post-holds.
     
  12. BADMD

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    At the risk of derailing the thread, this is one of those issues that gets to me.

    I fight with my ICU more frequently then I care to, regarding central lines. They always seem to want to one. It goes so far that an ICU fellow told me that all ICU patients need a central line.

    It isn't the line that is important, it is how you use it. If you aren't going to do continuous CVP monitoring and SVO2 monitoring, or worse, are going to ignore the results, don't bother with the line. You are just adding unnecessary risk. You can resuscitate a patient better with a few 18 gauge IVs then with a central line. Moreover, most patients with severe sepsis can probably be turned around with aggressive resuscitation and probably don't need "The Full Rivers." You just have to be cognizant that a few will need more.

    I've also run into a few EPs who want to leave the resuscitation to the ICU. I can't help them.

    Back to your regularly scheduled thread.
     
  13. Hernandez

    Hernandez Paranoid and Crotchety...
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    I fully agree with this. I don't put lines in just because they're in the ICU, and I'll put peripheral access with the u/s if the nurses can't get a line. But I've had a peripheral bite me in the ass more than a few times on patients that got transfered to the ICU on pressors without central venous access. I'm tired of having to use Rogitine on the levophed which infiltrated in a septic patient who needed more than volume.
     
  14. SilverScrubs

    SilverScrubs Energizer Bunny
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    I'm not sure why everyone is getting bent out of shape. I'm new obviously to all this. Let me make it clear:

    1. I totally agree with mutual respect.
    2. This is the 1st I'm hearing of an EM inferiority complex, crosses, and whatever else is being offered up.
    3. I am a measly little MS3 who got some good EM bashing from higher ups. This certain resident that put EM down was also the one who did not know how to run a code. I saw it.
    4. Can you see where I'm coming from?? I was venting people...sorry If I hurt anyone's feelings. Let's all have a nice holiday season. I will turn my ears away next time I hear nasty EM comments. Thanks Wilco.:)
     
    #14 SilverScrubs, Dec 13, 2008
    Last edited: Dec 13, 2008
  15. nymbarra

    nymbarra In flux
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    I agree that we shouldn't bash other specialties. Every field of medicine plays a role in patient care. We all went to medical school, all passed our boards, and are practicing our chosen field of medicine. Last time I checked EM was still a competitive specialty for the acuity and breadth of patient care, and not to mention the lifestyle.

    Other specialties often forget that we need to be efficient to run a busy ED, so that when we either have already made the diagnosis or have narrowed it down to those that require a consult and admit, our not having one lab back or not doing a test that will not change dispo is not because we're lazy or not as smart as you, but because it is in the patient's best interest to have the appropriate specialist come down and take over management. I feel bad for you surgery or medicine guy that this is the x consult for the night, but it's also been my x patient for this night and I have x more patients to see.

    Also, I think the way residents are trained play a role into how they view other specialties. EM is much more democratic. We are supported by our upper levels, but in the end we interact directly and learn from our attendings. In other specialties--especially those that are more resident-run--you might not have significant interaction with your attendings until you are well into your 2nd or 3rd year of training. I think this builds this hiearchy that is necessary in residency, but that may carry over in how you view the culture of medicine far after residency ends. As a result, as a resident of these specialties, you may be trained to view other specialties as subpar to your own. Which of course, is totally BS.

    With that said, most interactions are pleasant and collegial. It's rare to see an attending or resident from another specialty who will give you attitude or openly criticize management. Whenever that happens, I think of that scene in Top Gun when Goose says of the cocky Slider and Ice Man, "they were abused children..."
     
  16. Capgras

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    I think we have all been in situations where EM is bashed but it's usually done in reference to one specific EP or ED and then they generalize to the rest of the specialty. Third year is especially rough because every month you get a different team with their own opinions. I usually tried to avoid the topic because I'm not a EP yet and don't find the need to defend my decisions. Someone else can decide if thats the "high road" or not but in the end I was able to go home and avoid the need to vent.

    I think its fine to vent but you have to make sure its confined to their comments about EM instead of including their incompetencies. No one is better or smarter for picking one specialty over another and if you feel the need to defend yourself then you are probably the one who picked the wrong specialty.
     
  17. DrQuinn

    DrQuinn My name is Neo
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    Having just left an academic position that had every specialty and subspecialty known to man at my disposal, I can tell you that once you get out in the community, it is MUCH better.

    Most of the "bitching" comes from residents and is therefore heard from their attendings and it is just perpetuated. Trust me, when you get out where YOUR paycheck (be it the hospitalist, ICU attending, surgeon, ENT, etc) is related to the number of patients you admit to the hospital and/or consults, you treat the ED a lot better. In fact many of the cardiologists have really grown to love us for our fast STEMI recognition, cardioversion of AF and snet home, etc....

    Granted, I think I am at a sweet sweet community gig where the payor mix is GREAT so everyone gets paid well, but, far far different from when I was at an academic center.

    Q
     
  18. EM2BE

    EM2BE Elf
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    These comments probably happen everywhere. I hear them and ignore them and they know I want to do EM. What's nice is after they (whichever specialty) gripe about the ED, they follow up with, but we don't know how many patients they see in a night and discharge and why they give us they ones they do. Their job is difficult in that in a short interaction, they have to decide if the patient is well enough to go home. It's nice to hear the comments after venting, because then I assume the rest that vent are thinking it on the inside and forget to say it. Oh, and I tend to forget some things quite easily :)
     
  19. kungfufishing

    kungfufishing Senior Member
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    This is spot on and what I was thinking while not contributing to the thread. Very little specialty bashing in the community - i think this is both tied into money and, I expect, the humility that comes with experience. I'm only 6 months removed from residency, but even I notice that the further along I go, the less I care about interspecialty pissing contests and the more I respect people who just show up and do their job.
     
  20. ccfccp

    ccfccp Stays crunchy in milk!
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    Except Derm... They're better AND smarter than everyone else:rolleyes:
     
  21. southerndoc

    southerndoc life is good
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    Consultants seem pleased to admit borderline cases (i.e., "early cholecystitis" without all the classic findings, urology admitting patients with large stones in severe pain, etc.). I remember needing to argue with fellows and residents during residency for some of these cases. In the community, it's just a simple call and they want to admit.
     
  22. DrQuinn

    DrQuinn My name is Neo
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    Yeah, where I'm at, the urology attendings and ENT attendings are SO SO SO nice. Very differerent from residency, where these two specialties were sometimes the hardest to deal with as everything was a "medicine problem" and "we can consult."

    Like the time a 20 year old severe MR kid came in 48 hours after a torsed testicle (at outside ED), in pain. Urology came down and said "well, the testicle is necrotic, there is nothing we're going to do, you can send him home." Um, excuse me, he has a DEAD NUT and is in pain, please admit.

    Q
     
  23. Jarabacoa

    Jarabacoa non carborundum ilegitemi
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    I think that IM and FP attendings get a little disgruntled when fewer and fewer people go into primary care. Maybe they imagine a future of foreign medical colleagues, reliance on nurse practitioners, shrinking reimbursement, and a worsening shortage of quality primary care. Every smart student that bipasses primary care and picks ER is one less solid resident for primary care residencies to chose from.

    Last year, I was talking to the director of an FP program. They got 18 applicants for 8 spots. At that point, they are just praying that a good portion of their residents next year have a solid grasp of the English language.

    Some people take it personally when you see their life and their job and chose to do something different. If the greatest form of worship is emulation, these people might feel that the greatest form of distain is to chose a path different than their own.
     
  24. Dr Roboto

    Dr Roboto Indentured Servant
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    Wow that just blew my mind...nicely said. :thumbup:
     
  25. SilverScrubs

    SilverScrubs Energizer Bunny
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    I second that, very nice :)
     
  26. SilverScrubs

    SilverScrubs Energizer Bunny
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    :laugh::love:
     
  27. Dr.McNinja

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    This holds true in the community for consultations on floor medicine as well. The problem is that residents are trained to "be a wall", because you get paid the same to block work as you do to accept work. And inherently, everyone becomes lazy and bitter. Once out in the real world though, acting that way will get your privileges revoked, or at the very least, very few consults.
     
  28. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Another aspect is that the majority of us train in tertiary centers, and even if the subspecialists don't have residents, they still get an onslaught of consults, so maybe they're just burned out as well. The worst is when you actually need to transfer something for a specialty not in house, say peds cardiothoracic or peds neurosurgery, those guys generally don't want anything to do with you or your helicopter.
     
  29. AmoryBlaine

    AmoryBlaine the last tycoon
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    Very well put. Part of the reason EM is gaining ground is that the residency is a little bit more humane than IM. This is completely the fault of the IM powers-that-be. There is NO reason why hospitals can't hire PAs/NPs to do all the BS that takes up 60% of your day on the IM wards (scheduling studies, working on discharge, filling out paperwork).

    Something has got to give because now every hospital wants an EM program and what we don't need is to have more ER docs that primary care people. I hope the RRC has an idea of how many more programs they are going to allow and that they will put the cap on before it gets out of control.

    One thing that will be interesting is if the pay structure for EM changes significantly in the future. There is no inherent reason why an emergency physician should make more than an FP, an internist, or a pediatrician.
     
  30. southerndoc

    southerndoc life is good
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    There is still a predicted shortage of ER physicians in the future. This is why the RRC has been approving new programs.

    The more spots available, the less competitive residencies will become. This will allow those with a great commitment to emergency medicine, but without having top scores, a chance at landing a career in the specialty they desire.
     
  31. howelljolly

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    I think AmoryBlaine gets the award for Most Insightful Posts of the Thread. Strong work.
     

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