Emergency rooms find on-call specialists rare

[Castro Viejo]

Hmm, I think it's Castro Viejo who is being as offensive as possible about his ED colleagues, not SLUser.

I just want to know, from all you smart, brilliant, perfect surgeons, what your solution is to staffing the Emergency Department if you think that ED physicians are so worthless.

Fire them all and replace them with NPs, PAs, and an army of triage nurses.

That way, I don't have to deal with thoracostomy tubes that become -- Surprise! -- laparostomy tubes... Or enterostomy tubes... Or hepatostomy tubes...

Or have to be told about a "non-urgent consult" for a patient with abdominal pain who's "rock-solid stable, man" and when I get down there, the patient's got a pulsatile mass, hypotension, and abdominal/back pain. "This patient needs to go to the OR RIGHT NOW."

ED "doctor" says, in his usual confident tone, "OK, great! I'll order the CT scan!"

Seriously, if EDs were staffed by NPs, PAs, and every specialty committed a person to ED coverage, we'd probably get somewhere with all the healthcare dollars that are wasted by the ED. "Emergency General Surgery" is already evolving out of the Trauma guys and the UCSF people recently wrote up their experiences with a "surgical hospitalist" program where every ED consult is seen within 15 minutes. If we had that system in place in every hospital, it would truly eliminate the need for a dedicated EM "physician" triaging everyone to the appropriate services.

Have a triage nurse decide where the patient goes in the ED. Have the NP or PA do a quicky check to make sure the patient isn't about to die, and then consult it out. That's basiclly what happens now, but at double or triple the cost in some cases!

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[Castro Viejo]

- Sir, I got Crohn and just had a round of diarrhea. Sure wait a second.. lets call colorectal surgery?!

- Sir, I got Crohn and just got a fever. Sure wait a second.. lets call colorectal surgery?!

- Sir, I got Crohn and my belly hurts. Sure wait a second.. lets call colorectal surgery?!

Shoot, at least it they're trying.

Here's a page out of an ED at a major academic medical center in New York:

"Hi PV. We've got a patient down here who presented with productive cough for the last few days, fever, white count of about 16, general malaise, and the chest X-ray shows . . . " and it continues like this for about 20 minutes WITHOUT any obvious reason for a Vascular Surgery consult " . . . and he's here in the ED and we're admitting him to Medicine for presumed pneumonia."

Vascular Surgery: "Great story, but why the hell are you calling us?"

ED: "Well, we were looking in the EMR and we noticed that you guys had seen the patient when he was admitted six months ago."

Vascular Surgery: "So? That was for claudication. We're following him on an outpatient basis. He scheduled for an angio in a few weeks."

ED: "Oh, I forgot. He's complaining of lower extremity pain as well."

Vascular Surgery: "Claudication?"

ED: "Exactly."

Vascular Surgery: "So why the consult? We know him. We're following him. It's not an urgent issue."

ED: "Well, we feel that you should come see the patient anyway to make sure you don't think any of these other issues are related to his leg."

Vascular Surgery: "His leg? What's wrong with his leg? Is it threatened?"

ED: "No. It's warm. But there aren't any pulses!"

Vascular Surgery: "Any signals?"

ED: "Uh..."

Vascular Surgery: "Doppler? Any doppler signals?"

ED: "Oh... Yeah. So you gonna come see the patient?"

Vascular Surgery: "No. Goodbye."

(The alternate ending in private practice, unfortunately, would be the Vascular Surgeon saying, "Thank you for the opportunity to care for this patient.")

Sad... But everyone knows the drill ad nauseum.

 

[labst]

"Hi PV. We've got a patient down here who presented with productive cough for the last few days, fever, white count of about 16, general malaise, and the chest X-ray shows . . . " and it continues like this for about 20 minutes WITHOUT any obvious reason for a Vascular Surgery consult " . . . and he's here in the ED and we're admitting him to Medicine for presumed pneumonia."

Before anyone jumps to any conclusions, just realize that the only reason the EM guy knew that much about the patient was because they're reading it off the H&P done by Medicine. I've seen that one in action, too. Once I did a consult on a patient and told them the patient could be discharged from my standpoint. The EM guy jumped up and said, "thanks!" and told the nurse to start the discharge process. And then I continued "...but since the vitals show that the patient has a systolic blood pressure of 180 (without a recheck), I'd probably have Medicine see him first." Yes, you can bust on me for not managing his HTN, I'm not planning on doing it. So then the EM guy called Medicine and picked up my consult sheet and read them the history and added, "...so there are no surgical issues, but we noted that the patient is hypertensive, so could you see the patient?" I ran into the Medicine resident before he saw the patient and mentioned that the patient was a known hypertensive who was non-compliant with his medications, which helped them.

 

[Castro Viejo]

Exactly. I used to think it was the idiots in my ED, and I thought, "Damn it. If I were training at a real academic medical center, I bet it wouldn't be this bad."

Yeah right...

 

[labst]

Heck they take it a step further... they will call the attending and tell them they are admitting this patient to his service cause the last time the patient was here, she/he was under "his" service. I get so mad at that... Pt "known" to us. #$#!@#!@ So whenever a crohn pt comes to the ER you automatically call Colorectal Surgery?!

Our ER does it one better. When the patient arrives, they ask him two questions: "what are you here for?" (chief complaint) and "who is your doctor?" They will then call that physician/service and tell them the chief complaint. Now, in patients who are chronically ill with the same problem, that's going to get you to the same endpoint as if you actually take a history and physical and think about what's going on. And that's their defense: hey, it would have come to you anyways, right? OK, but what did you do as a physician? Drew the same labs you draw on everyone, got a random chest x-ray that you didn't look at, an EKG that isn't interpreted? They're door greeters.

And, yes, they have no problem in saying that a person with a problem will always go to the same service. I got called for a patient with an ostomy who was having abdominal pain. The ostomy had been performed by our attending about fifteen years prior. There was no other history. I asked the EM attending why we were being consulted and he looked at me with irritation and said, "you guys did the ostomy, right?" And I said, "yeah." And he said, "this could be a post-op complication." And I realized what I was dealing with and just said, "OK, we'll see the patient."

 

[labst]

Fire them all and replace them with NPs, PAs, and an army of triage nurses.

Or a monkey in a clown suit with direct dial. That's actually cheaper and I'm sure he would make the children smile.

 

[droliver]

You make a lot of sense except for one glaring detail that you conviently ignore.
The patient was sent home by the ER doc.
The ER doc felt this wound was not serious enough to warrant even one more phone call to another specialist before discharge. That ought to tell you everything you need to know about this case.

I'm not going to extensively outline my thoughts on this, but this lady's wound was potentially much worse then it might have been by delaying treatment almost a week. I cannot fathom why a 60+ year old with an acute, open, & contaminated wound wasn't treated more aggresively by this ER. I believe she'd been better served by admission, IV antibiotics, wound care, & urgent surgical evaluation by whomever.

Also, can we please tone down the ER trash-talk. Please remember that at the end of they day they are your colleagues.

 

[Faebinder]

Or a monkey in a clown suit with direct dial. That's actually cheaper and I'm sure he would make the children smile.

mmm... a monkey that randomly dials the admitting service... I like it. Can the monkey hand out free bananas...if so, i'm for it.

 

[Castro Viejo]

Shoot... I'd rather see a blonde stripper in glass heels wearing nothing but a garter belt and tassels on her nips.

And as patients walk in through the ED, she'll make a "visual diagnosis" and direct them to the proper area. Only she won't even have to talk... Just do a booby dance and swing the tassels in a clockwise fashion to direct the patient to go right... Counter-clockwise to go left... And jump up and down for the ultimate booby alert for someone coding. And hospital closed circuit television would broadcast this nonsense so that the consultants upstairs can get the visual cues and know who to see downstairs.

 

[Castro Viejo]

Some ED guy is here reading this thread and thinking, "Boy, those surgeons are such jerks. Even if they don't appreciate me, I know Medicine, Peds, and Radiology all think I help them out a lot!"

So I challenge you ED guys to ask an internist or pediatrician or, dare I say it, a radiologist and ask them what they think of you.

Hell, the radiologists probably think EVERYONE in the hospital is a *****. Even us.

 

[labst]

Shoot... I'd rather see a blonde stripper in glass heels wearing nothing but a garter belt and tassels on her nips.

I'm going to have to remind everyone at this point that we're trying to participate in a serious conversation. A monkey is reasonable, a stripper is just being silly. Let's remember that these are our colleagues at the end of the day.

 

[labst]

Hell, the radiologists probably think EVERYONE in the hospital is a *****. Even us.

The Radiologists don't really care, I don't think. They just get irritated when people ask them for "stat reads" or if multiple people ask them to read the same film. Other than that, I don't think they can even see who is asking them questions most of the time.

The Radiology residents that I know hate the ER because of the volume of films they get from them -- all "stat" -- but that only affects them when they are on call, which isn't that often (I think they're on call like once a week). So most of the time they're rather ambivalent towards the ER.

Also, unlike everyone else, the ER can't hurt them that much because they can literally just not do the films and say they're too backed up. (In these instances, they actually are backed up, I'm not implying they're lying.) That's quite different from everyone else because we have to see all patients in a "timely manner" even if they give us seven at a time.

 

[Faebinder]

I'm going to have to remind everyone at this point that we're trying to participate in a serious conversation. A monkey is reasonable, a stripper is just being silly. Let's remember that these are our colleagues at the end of the day.

YES! Lets use the three headed monkey!!

 

[Castro Viejo]

I'm going to have to remind everyone at this point that we're trying to participate in a serious conversation. A monkey is reasonable, a stripper is just being silly. Let's remember that these are our colleagues at the end of the day.

OK, fine... But I still like my stripper idea.

 

[labst]

I do, too, but let's remember that we're all here for the good of the patients. I mean, if the stripper was around, I'd probably attempt to make people code just to see her jump up and down. So I think you can see that this would never work.

 

[labst]

YES! Lets use the three headed monkey!!

Ha ha, that's a pretty neat smiley. Just don't let it near Castro Viejo's dancing banana. (Maybe that's why he's so anti-monkey.)

 

[Winged Scapula]

Members are reminded to keep their comments civil, free from personal attacks and foul language.

We've all had our negative experiences with other services in the hospital. It is ok to vent about those experiences but please try and keep them on a professional level.

 

[Castro Viejo]

Also, unlike everyone else, the ER can't hurt them that much because they can literally just not do the films and say they're too backed up. (In these instances, they actually are backed up, I'm not implying they're lying.) That's quite different from everyone else because we have to see all patients in a "timely manner" even if they give us seven at a time.

I dunno about that. Some of the ones I talk to get pretty ticked off when someone orders an "inappropriate study."

Like "pan man scans" and somewhat excessive radiographic workups from trauma patients... They seem to get irritated by those.

 

[Castro Viejo]

I do, too, but let's remember that we're all here for the good of the patients. I mean, if the stripper was around, I'd probably attempt to make people code just to see her jump up and down. So I think you can see that this would never work.

You are wise. You must be a surgical attending.

 

[Castro Viejo]

Wait a minute... Why would the dancing banana be attracted to a three-headed monkey? Unless it was a three headed STRIPPER monkey with tassels!

 

[labst]

Members are reminded to keep their comments civil, free from personal attacks and foul language.

We've all had our negative experiences with other services in the hospital. It is ok to vent about those experiences but please try and keep them on a professional level.

Notice how as soon as a female enters the place she's all lecturing and nagging. I'm just saying.

 

[Celiac Plexus]

This thread has morphed into something less than useful. Just my 00.02 but, I think we can all agree that some ER physicians are good, and some are not (just like in any field). In the spirit of the Christmas holidays, let's just all take a moment to be grateful for the lives we have, and try not to be overly judgmental of others.

Merry Christmas/Hanukkah/Kwanza, and best wishes for a happy new year.

 

[ESU_MD]

Talking with colleagues in med and peds- they have as much of problem with the ER "consults" as we do.

Then again, the medicine guys probably hate the surgeons too for all the "babysitting" consults we give to them.

But at least they dont have delusions of grandeur

 

[Hernandez]

Medicine- they hate the ER. most of the medicine guys are ok though- they dont have the delusions of grandeur that the ER guys have. Thats what makes me hate the ER the most- they THINK they are good at what they do.

This thread really makes me sick. I could go on for hours the crap we physicians dish out to each other.

From the egotistical EM resident who is always on an IM rant while I'm down there admitting their pts. or the EM attending who can't seem to start any medictions without asking for advise or the many, many, MANY, admissions for pneumonia without any radiographical OR clinical findings consistent with that diagnosis.

The IM non-teaching attending who will reflexively consult every single service who is teaching and has residents so her pts get seen sooner. I can not tell you how many times I was the first doc in to this attendings room. The month I was on surgery it was abdominal pain which turned out to be DKA. When I was on cardio, it was chest pain. It's all crap from this attending.

Or how about the Surgery team who can't admit their own damn pts because they have a single medical problem? How many times do I have to admit a pt with cholecystitis because they're diabetic? Nevermind that they are diet controlled and not on any medications. And let's ignore the fact as consultants, you make more money for less of a time investment. Tell me, as an Internist, what the hell am I going to be doing for the cholecystitis?

Or how about the Radiologist who refuses to allow a VATS team in the hospital because that will take money away from him, yet they absolutely will not put in PICC lines on the weekend. Or can't read a single radiograph without hedging their reading OR just overlooking the interstitial process on the CT.

Or how about that urology consult I've been waiting on for 48 hours?

Or how about the jackass gas-passer who nearly ran me over with his gold plated H3,

and yes, I left ortho off of the list, because at my hospital, the ortho docs cover 5 hospitals and they aren't condescending butts to those of us who actually take care of their pts for them while they're working.

So instead sitting here and whining little the little bitches you're accusing the EM docs of being, why don't you realize that this is exactly how you're coming across? We're all down in the trenches getting dirty, but not all of us our up on our own personal cross.

 

[Castro Viejo]

Merry Christmas/Hanukkah/Kwanza, and best wishes for a happy new year.

I agree. Happy Holidays!

 

[Castro Viejo]

So instead sitting here and whining little the little bitches you're accusing the EM docs of being, why don't you realize that this is exactly how you're coming across? We're all down in the trenches getting dirty, but not all of us our up on our own personal cross.

I agree. Happy Holidays!

 

[Winged Scapula]

Thank you hernandez, for a reminder that all of us have parts of our job that we dislike and that most of us, at one time or another, have felt dumped on by another physician or specialty. We should try and understand each other rather than bashing each other's specialties. Venting is understandable, but this thread has gotten out of hand.

 

[labst]

This thread really makes me sick. I could go on for hours the crap we physicians dish out to each other.

So instead sitting here and whining little the little bitches you're accusing the EM docs of being, why don't you realize that this is exactly how you're coming across? We're all down in the trenches getting dirty, but not all of us our up on our own personal cross.

Most everything you cited occurs and most everything you cited occurs for one of two reasons: 1) money and 2) laziness. Or a combo of both. But while all of those specialties may do poorly due to one or the other at times, EM is special. You can bust on the IM who over-consults, but they're at least being the primary and managing the consultant's plans and discharge. You can bust on IR for not wanting to be there on Saturday, but the reason is because there's no real such thing as an "emergency PICC." You can bust on Surgery for not wanting to manage diabetes, but you're FOS because we admit lots of diabetics and slam out their gallbladders and other assorted body parts.

However, EM does none of that. They do Band-Aid medicine if they do it at all. Got the sniffles or a sore throat? OK, we can deal with that and then we'll complain that the ER is not for these cases (which is true). But if a person who SHOULD be in the ER arrives, what does EM do for them? Not a damn thing except call someone else. In other words, what is their point of existence? ZERO. So, yeah, we may all have our faults, but at least we do SOMETHING.

Merry Christmas! Because "happy holidays" is for pansies.

 

[GSresident]

SLUser writes:

"It sounds like the ER docs at your institution in New York suck. I've heard a lot of things about the way your hospital works, including the nursing, that is way less than ideal. This has led to frustration and crappy attitudes like yours, but this is not, however, something that you can then apply universally, and say that all ER docs are triage nurses. There are plenty I've interacted with that are excellent physicians. Maybe you should practice in the midwest.....of course, you'd have a lot less to cry about."

If you are at the KU in Kansas City, Kansas then I know where the smell of crack smoke is coming from. I did 5 years of general surgery there and unless things have DRASTICALLY changed in the last 2 years then your ER is exactly as was described by others complaining about the ER in this thread.

In Kentucky it is no better. Here are 2 real face consults placed by real ER residents in Kentucky:
1) ER doc: "This guy has a hematoma to his ear requiring drainage."
- result: I examined the patient and did a history. It turns out that the lump had been there for years and wasn't even involving the ear itself, it was behind the ear. It would swell and get red sometimes and then resolve. Sebaceous cyst. Thanks for calling me to drive in for that.
2) ER doc: " I got a guy down here with a very complex ear lac."
- result: I examined the patient. I found a 0.5 cm superficial laceration that would require 1 stitch on the helix of his ear. Thinking I must be missing his real injury I called the ER resident into the room and asked - where is the complex ear lac? ER resident points to the 0.5cm superficial straight line lac on the ear. Then the ER resident says "I don't have anyone here to help me sew." I walked out to the ER 'fishbowl' and saw 3 medical students in there eating cheetos.

I am 6 months from setting up a plastic surgery practice and I am NOT going to be taking any ER call. Can you see why?

 

[SLUser11]

That way, I don't have to deal with thoracostomy tubes that become -- Surprise! -- laparostomy tubes... Or enterostomy tubes... Or hepatostomy tubes...

Or have to be told about a "non-urgent consult" for a patient with abdominal pain who's "rock-solid stable, man" and when I get down there, the patient's got a pulsatile mass, hypotension, and abdominal/back pain. "This patient needs to go to the OR RIGHT NOW."

ED "doctor" says, in his usual confident tone, "OK, great! I'll order the CT scan!"

Ironic that you condemn the ER docs for not doing enough to work up the patient, but then sharply criticize any work up or procedures that they do perform.....if I was an ER resident and received constant condescending remarks and criticisms about my workups, I may start to skip those things and go straight to the consult......

I hope it's as you described your Chicago ED when I show up in the Windy City in just a little over 6 months!

It won't be any different for you, I promise, because your attitude is still going to suck, and you won't be able to hide it from your new ER colleagues. I doubt they'll be bending over backwards to help you when they know how you view their role in medicine.

But, be sure that you continue to just blame them, and don't assume any of the responsibility in your bad relationships with the ER. Also, you should probably look into getting a vasectomy....something to think about....

I agree. Happy Holidays!

Don't talk constant s#@t for 10+ posts and then go "nevermind, let's all forget about it! Dancing banana time!" You have a horrible attitude, and you're almost done with training. I hope you go into academia, because if you act like this in private practice, you'll see your referrals dry up pretty fast.

If you are at the KU in Kansas City, Kansas then I know where the smell of crack smoke is coming from. I did 5 years of general surgery there and unless things have DRASTICALLY changed in the last 2 years then your ER is exactly as was described by others complaining about the ER in this thread.

Well, I'm in Wichita, but I'm sure SLU's ER had a similar reputation to KU-KC, and I still managed to train there without having a distorted blanket view of the ER.

 

[labst]

Ironic that you condemn the ER docs for not doing enough to work up the patient, but then sharply criticize any work up or procedures that they do perform.....if I was an ER resident and received constant condescending remarks and criticisms about my workups, I may start to skip those things and go straight to the consult......

Maybe they'd hear fewer criticisms about their workups if their workups made sense. Like, getting a CT when it is indicated or not getting one when it is not. Instead, it's usually "always get a CT scan because it's abdominal pain." When people practice like that, and then express incredulity when they are criticized, then you have to wonder what their credentials are to be a physician. And, yeah, you can just throw your hands up in the air and call a consult, but that's just going to open the door to more criticism. Oh, wait, that's exactly how things worked out for EM. What a surprise!

 

[Tired]

It won't be any different for you, I promise, because your attitude is still going to suck, and you won't be able to hide it from your new ER colleagues. I doubt they'll be bending over backwards to help you when they know how you view their role in medicine.

Yeah, that's why everyone on this board (except you, of course) has the exact same problems with ED docs. Inappropriate consults, pathetic workups, misdiagnosis, outright misrepresentations, using consultants because they're "too busy" to deal with their own patients.

There is a range of experience on this board going from medical students up to fellows to attendings, and each of them tells the exact same types of stories about dangerous levels of incompetence that frustrate consultants and put patients at risk. The problems are real, they are inherrent in the field, but you want to pretend this is an attitude problem? Get real.

I've done a lot of time in the ER. I was an ER Tech for four years in three different facilities. I did two MSIV months in different ERs. I did a month as an intern. That's seven ERs I have worked in, in different capacities, in three different states. The situation is the same everywhere, and as a med student and intern I was embarassed and ashamed at the incomplete workups I was forced to do and the stupid consults I was forced to call. I have no sympathy for ER physicians; I have sympathy for their patients.

You fuzzy "let's all be colleagues" speech in nice. But no matter how good of an attitude you have towards the ER, it doesn't matter, they will still continue to use and abuse you, then sit around scratching their heads about why the specialty call schedule has more holes in it with every passing year.

 

[gasnewby]

Ironic that you condemn the ER docs for not doing enough to work up the patient, but then sharply criticize any work up or procedures that they do perform.....if I was an ER resident and received constant condescending remarks and criticisms about my workups, I may start to skip those things and go straight to the consult......

and that's why you're not a surgery resident. if you were, you'd be quite used to receiving constant condescending remarks and criticism. in our world, that motivates us; it doesn't make us work LESS. you sound like a lazy ER resident.

 

[Winged Scapula]

Since several users have ignored my comment above to play nicely, I'm debating closing this thread, if only because I'm getting tired of the complaints from others about the comments here.

One more warning (this is it) and the thread gets closed. No personal comments, no name calling tolerated.

 

[labst]

No, he's a surgery resident. He just happens to be one of those people who is touchy-feely, "let's all get along." I know people like that and they take great pride in the fact that they get along with people and that they are liked wherever they go, supposedly. Which is fine, if that's your goal in life. I personally care more about people doing their job. And, let's face it, if an EM physician is going to treat a PATIENT differently based on how he feels about ME, that says more about him than me. I hate the ER, but I try to do my best for the patients I see. I don't do some lame, passive-aggressive crap where I'm like, "the EM resident didn't do a history, so I'M not going to do a history, either!" Meanwhile, the patient dies. Whatever, dude.

 

[labst]

Since several users have ignored my comment above to play nicely, I'm debating closing this thread, if only because I'm getting tired of the complaints from others about the comments here.

One more warning (this is it) and the thread gets closed. No personal comments, no name calling tolerated.

I posted while you were posting, so my post doesn't count.

(hee hee hee)

 

[gasnewby]

anyone else kind of enjoy it when dr cox gives the beatdown??

 

[labst]

Yes, we ALL enjoy it when Dr. Cox gives the beat ...oh, did you say "down"?

 

[Winged Scapula]

anyone else kind of enjoy it when dr cox gives the beatdown??

Stop trying to make me laugh.

You are not supposed to enjoy your beatings but hey, if that's your bag, feel free to stop by. New Year's Eve would be good for me, I"ll have a lot of pent up anger that night and could use a punching bag.

 

[labst]

I thought you didn't take any general call any more. What, are you thinking a lot of women with breast masses are going to suddenly show up at your doorstep?

 

[gasnewby]

Stop trying to make me laugh.

You are not supposed to enjoy your beatings but hey, if that's your bag, feel free to stop by. New Year's Eve would be good for me, I"ll have a lot of pent up anger that night and could use a punching bag.

i happen to be on call the 24th, 27th, 29th, and 31st (awwww) but i have a SWEET call room that is calling your name! i'll bring the posey. 4 point?

 

[labst]

First of all, noob, know your restraints. A posey is just a vest. Second of all, if you need four point to restrain a female this late into residency, you don't know what you're doing.

 

[SLUser11]

Yeah, that's why everyone on this board (except you, of course) has the exact same problems with ED docs.

This board suffers from severe sample bias. As for you being ashamed at incomplete doctoring, wait until you get a little farther along in Ortho....

and that's why you're not a surgery resident. if you were, you'd be quite used to receiving constant condescending remarks and criticism. in our world, that motivates us; it doesn't make us work LESS. you sound like a lazy ER resident.

You are a PGY-4 surgery resident with the name Gas Newby, splitting your time between here and anesthesia's forum, and you are going to tell me that condescending remarks and criticism makes for good surgeons? It sounds like it's driving you away from the field.

Luckily, I am training in a healthy learning environment where daily verbal assaults are not the norm, and different specialties are cordial and supportive of eachother. Of course, thanks to the aforementioned sample bias, most of you don't believe these places exist. I hope some of the med students are taking note of the tone of this thread and realizing that there are other places to train where there isn't a mandatory surgical attitude of martyrdom and condescension.

As for questioning my status as a surgical resident, and alluding to a lack of work ethic, I promise you that they're both intact.

Merry Christmas.

 

[labst]

This board suffers from severe sample bias.

Based on what evidence?

You are a PGY-4 surgery resident with the name Gas Newby, splitting your time between here and anesthesia's forum, and you are going to tell me that condescending remarks and criticism makes for good surgeons? It sounds like it's driving you away from the field.

Not to speak for him, but maybe it's actually people like you who are irritating him. In other words, you leapt to a conclusion based on your own opinion. That's not very smart.

 

[gasnewby]

and the intern forum. don't forget that. must be an intern, too!

 

[labst]

That's a good point. For example, even though I spend a lot of time in the women's locker room of my local high school, it doesn't mean I'm a female or in high school.

 

[GSresident]

SLUser writes:

"Luckily, I am training in a healthy learning environment where daily verbal assaults are not the norm, and different specialties are cordial and supportive of eachother. Of course, thanks to the aforementioned sample bias, most of you don't believe these places exist."

I dream of a surgery residency where I wasn't beat to death every day and crapped on day and night by the ER. That being said the different specialties are generally cordial to each other both at KU and here in Kentucky.

As an aside I work on average an extra 60 hours a month moonlighting as an ER physician in a rural Kentucky town. I don't even have access to an ultrasound machine, let alone 24 hour consultants in ANY specialty. The result - I actually have to do a real workup with a real history and a real physical. I actually have to figure out what is wrong with the patient. If it can be handled by an IM physician I generally call the on call guy and admit the patient for him/her to see in the morning. If I am certain that the patient needs to be seen by a specialist I have to call one in some other place and arrange transfer. I have never once had the luxury of calling someone to the ER to do my work for me and I would never even DREAM of waking someone up in the middle of the night unless I was absolutely certain that they needed to be called. That is what an ER physician should do and in the 'real world' if you don't do that your ass is out the door. It is from that framework that I judge the care given by trained ER physicians.

I think the sample bias you mention is because we are mostly in large academic trauma centers where the ER residents have gotten spoiled by the 24 hour availability of consultants to dump work on. I shudder to think of what will happen when ER residents who train in those environments go out into the real world. Hopefully they will have the sense to find jobs where they have 24 hour consultants to call because if not they are in for some real trouble.

Edit: Merry Christmas to all and to all a good night!

 

[gasnewby]

I think the sample bias you mention is because we are mostly in large academic trauma centers where the ER residents have gotten spoiled by the 24 hour availability of consultants to dump work on. I shudder to think of what will happen when ER residents who train in those environments go out into the real world. Hopefully they will have the sense to find jobs where they have 24 hour consultants to call because if not they are in for some real trouble.

when i first started i couldn't figure out why the ER was so in-bred (almost all the attendings trained here). now i know why. they aren't qualified to work in the real world.

 

[labst]

when i first started i couldn't figure out why the ER was so in-bred (almost all the attendings trained here). now i know why. they aren't qualified to work in the real world.

Yeah, is it any wonder that EM is still heavily concentrated in large, academic institutions where they have a cushy job? Meanwhile, the ER in the sticks is still staffed by non-EM-trained physicians, like it used to be. Gee, this is curious.

 

[Tired]

This board suffers from severe sample bias. As for you being ashamed at incomplete doctoring, wait until you get a little farther along in Ortho....

So now that attendings, residents, interns and med students, with combined decades of experience (or maybe centuries if Dr. Cox is as old as she claims to be) dealing with the ER have all told you that you're FOS, you'll just dismiss everything with a "Well, it's sample bias."

You should have just said "n=1" so really sound like the nurses.