How do you handle when other doctors insult EM?

Started by tsbqb
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tsbqb

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Has anyone else felt that docs in other specialties are pretty brazen to insult EM? Ive had people in social situations insult EM very soon after asking what kinda doc I am. Sometimes its some veiled insult like "oh man where I work the ER calls us for everything" or some such thing. Im honestly taken aback sometimes with how uncouth they are being.

I guess they genuinely dont realize how impolite they are being but I could never imagine meeting a GI doc or whatever and immediately saying "our GI docs where I work are so dumb"

Just curious as to how other people handle this.
 
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When I was on my ICU month the fellows would do this a lot. So I started presenting every patient on rounds with "the *****s in the ER admitted this person for septic shock, ICU day 3, on norepi, ceftriaxone, ...."

It made everyone deeply uncomfortable and stare at me awkwardly. Good times.
 
I find it far more collegial when you get away from an academic medical center. Those guys not only know who feeds them but also who takes care of their BS at 3 am.

As near as I can tell, most docs are a little jealous of emergency medicine- interesting cases, ability to keep a cool head no matter what comes through the door, no call, relatively few hours, some of the best hourly rates in medicine....what's not to like?
 
1. I step up and say "yeah I'm one of those stupid emergency medicine residents that [did whatever they're complaining about]". Calling them out and making them feel like a jerk has been particularly effective.
2. If reasonable, I explain why we do what we did in the context of the constraints and unique environment of the emergency department.
3. I walk out of the hospital after 9 hours while they're still on 24-hour call, and I do something fun and feel better about myself because my life is pretty sweet compared to theirs.
 
When you have the ability (depending on area and how hard you want to work) to make half a mill/yr, work as much or as little as you want and are never on call... you cease to care what other specialties think. Also, take it with a grain of salt because inevitably when the s*** hits the fan somewhere in the hospital, the panic reflex is to always call the ER doc. No matter what derogatories you may hear at some point, people are well aware of the value in your skill set when there is an actual emergency.
 
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witzelsucht said:
When I was on my ICU month the fellows would do this a lot. So I started presenting every patient on rounds with "the *****s in the ER admitted this person for septic shock, ICU day 3, on norepi, ceftriaxone, ...."

It made everyone deeply uncomfortable and stare at me awkwardly. Good times.
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I mean, if the pt is on levophed and CTX, shouldn't they be admitted....
 
Lexdiamondz said:
I mean, if the pt is on levophed and CTX, shouldn't they be admitted....
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ImageUploadedBySDN1492728368.243177.jpg



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tsbqb said:
Has anyone else felt that docs in other specialties are pretty brazen to insult EM? Ive had people in social situations insult EM very soon after asking what kinda doc I am. Sometimes its some veiled insult like "oh man where I work the ER calls us for everything" or some such thing. Im honestly taken aback sometimes with how uncouth they are being.

I guess they genuinely dont realize how impolite they are being but I could never imagine meeting a GI doc or whatever and immediately saying "our GI docs where I work are so dumb"

Just curious as to how other people handle this.
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As others have said, ignore them and remember that our jobs are pretty sweet. Everyone thinks EM is so dumb because we can't manage their own specialty's issues as well as they, the sub-specialist, can. What these guys forget is that we can manage their emergencies pretty well, plus emergencies for any other specialty - they can't do the same.

Also, the reality is that there are some EM docs that do call for everything. These EPs do make life worse for our specialty and our consultants, but there isn't a lot you can do about that.
 
tsbqb said:
Has anyone else felt that docs in other specialties are pretty brazen to insult EM? Ive had people in social situations insult EM very soon after asking what kinda doc I am. Sometimes its some veiled insult like "oh man where I work the ER calls us for everything" or some such thing. Im honestly taken aback sometimes with how uncouth they are being.

I guess they genuinely dont realize how impolite they are being but I could never imagine meeting a GI doc or whatever and immediately saying "our GI docs where I work are so dumb"

Just curious as to how other people handle this.
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Every doctor in that hospital moves the meat, we all just do it at different stages of the patient's health care experience. ER doctors move the meat for a lot less hours than pretty much anyone else. Who are the really dumb ones?

It used to bother me a lot, too. But I feel a lot better being bothered by it at home while my surgical colleagues work 30 hours in a row every other day.
 
If the time is appropriate, I explain that we are very appreciative of their help and recognize their expertise in their specialty.

I then explain that it's very easy for everyone to second guess another but that it erodes collegiality which is needed for patient care.

To this end, I expect that they will understand that when something is a true emergency, we are the experts at hand and I offer that if they would like to debate that issue, I am happy to do so.

I also usually highlight that if they are truly so much better than us, we can certainly involve them on every case for their opinion at all hours of the day.

In my opinion, there is nothing wrong with factually defending yourself and your family. If someone insulted my kids, I wouldn't ignore it no matter how great my life is.


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One thing that helps is to work at a hospital where the consultants also get exposed to a separate ED that has non-boarded guys on their ED. Our consultants truly appreciate our skill set (and tell us about it) compared to our competitors. The hard part for many of us is that we don't work in towns where there is a non-boarded comparison to remind them how much better our specialty has made the ED.


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As someone from psych (which also tends to get bashed a lot by outsiders), I'd say just as a general observation:
Every specialty has its detractors and aspects that you can make fun of.
Sometimes when people are bashing you, it's not really about you but about how frustrated they are about their own life or job.

As someone who interacts with EM docs fairly often (accepting psych patients from the ED for admission or sending them back when something acute comes up on the psych unit), I respect and appreciate good EM docs.:highfive:
 
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I've seen us get blamed for things that aren't related to the individual EP, but how the hospital and department are run. "We got this patient from the ED, who is now extremely decompensated, had only 1 liter in the last 6 hours and now has an extremely low BP, etc." The context is the ED was slammed and is somewhat understaffed, 3+ pph, but the patient was already admitted and has been waiting for a bed to clear. The initial resuscitation and diagnosis was fine, but it's what happened after that EPs take the blame for, which you can argue about how responsible they are or not.
 
There is no specialty with better length of training and hours worked to compensation ratios.

The people who do this are usually those who went out and did some mega sub fellowship and spend 8 years training only to make half to as much as you.

It's amazing the jobs I hear my IM and Pedi colleagues taking post residency that they qualify as "the good jobs." I'd never take these in a million years.

Used to get uppity about this and try to defend the specialty, but usually I just chuckle and ignore now. They be jeally.
 
All doctors like to bash on others, but I think they do so most with specialties perceived to work fewer hours, or have a better life balance than themselves.

I'm in dermatology which obviously is very different than EM, and get similar insults occasionally (probably would be more frequent if I actually went to the hospital much). In residency more than a few (IM) docs said I was "wasting my career." Many subtle and not-subtle comments that dermatologists "don't treat anything important" and "don't know anything about medicine" (theres a radiologist in their forum that keeps repeating that dermatologists know the same amount of clinical medicine as a hairdresser - probably a troll but whatever).

Overall doesn't bother me much at all. I know I take good care of my patients and make a difference in their lives, which is all that matters. The money and ability to have a great life outside of work helps too 😉


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Restart13 said:
I've seen us get blamed for things that aren't related to the individual EP, but how the hospital and department are run. "We got this patient from the ED, who is now extremely decompensated, had only 1 liter in the last 6 hours and now has an extremely low BP, etc." The context is the ED was slammed and is somewhat understaffed, 3+ pph, but the patient was already admitted and has been waiting for a bed to clear. The initial resuscitation and diagnosis was fine, but it's what happened after that EPs take the blame for, which you can argue about how responsible they are or not.
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Did the ED nursing staff call the hospitalist to inform the hospitalist that the patient was decompensating?

Further more, getting the ED nursing staff at my hospital to implement admission orders while awaiting a bed is more painful than pulling teeth.

Is the ED medical director a part of the group contracting for physician coverage or not?
 
One great tip one of my attendings once told me back in the day. On the rare occasion that a consultant actually physically comes into the ED to see the patient, introduce yourself, shake their hand, and discuss the case with them in person. In the future, you will almost never have an issue with that person, because now you are an actual person / member of the med staff to them. Otherwise, you are just someone on the phone they've never met.
 
I think this was more from the past in EMs earlier days. Now EM residencies are everywhere and rarely do I ever get scoffed at.

I would say I get 50:1 appreciation that I keep them from coming in.
 
Restart13 said:
I've seen us get blamed for things that aren't related to the individual EP, but how the hospital and department are run. "We got this patient from the ED, who is now extremely decompensated, had only 1 liter in the last 6 hours and now has an extremely low BP, etc." The context is the ED was slammed and is somewhat understaffed, 3+ pph, but the patient was already admitted and has been waiting for a bed to clear. The initial resuscitation and diagnosis was fine, but it's what happened after that EPs take the blame for, which you can argue about how responsible they are or not.
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Isn't the physician culpable for their work environment, though? You guys are not easily replaceable, you can negotiate on behalf of your patients and your department. It seems like one of the most frequent complaints I hear from ED physicians is that they are hitting crazy patient throughput, like 3 pph, which is safe only in a clinic where you refer the high acuity stuff out to the ED and is crazily unsafe for the ED itself. I'm not talking about the rare catastrophe, keep in mind, I'm talking about normal, predictable surges in volume. However in the ED its always treated as unfixable. There never seems to be any insight that the ED group almost always has everyone working 10-12 shifts a month, or that they could just as easily have everyone working 20 shifts a month but seeing 1.5-2 pph for the same monthly salary.

I'm not saying the same thing doesn't ever happen in clinics. I have seen the 3 day/week high throughput clinic provider, usually working at 5 pph in an urgent care. However that model is rare, and that provider is usually looked down upon as unsafe and unethical by the more traditional 5 day/week 3 pph crowd. It seems like only Emergency Medicine has reached a profession wide consensus to prioritize time off from work over both the quality of life at work and also the quality of patient care provided.
 
Perrotfish said:
Isn't the physician culpable for their work environment, though? You guys are not easily replaceable, you can negotiate on behalf of your patients and your department. It seems like one of the most frequent complaints I hear from ED physicians is that they are hitting crazy patient throughput, like 3 pph, which is safe only in a clinic where you refer the high acuity stuff out to the ED and is crazily unsafe for the ED itself. I'm not talking about the rare catastrophe, keep in mind, I'm talking about normal, predictable surges in volume. However in the ED its always treated as unfixable. There never seems to be any insight that the ED group almost always has everyone working 10-12 shifts a month, or that they could just as easily have everyone working 20 shifts a month but seeing 1.5-2 pph for the same monthly salary.

I'm not saying the same thing doesn't ever happen in clinics. I have seen the 3 day/week high throughput clinic provider, usually working at 5 pph in an urgent care. However that model is rare, and that provider is usually looked down upon as unsafe and unethical by the more traditional 5 day/week 3 pph crowd. It seems like only Emergency Medicine has reached a profession wide consensus to prioritize time off from work over both the quality of life at work and also the quality of patient care provided.
Click to expand...

Speaking of douchebags insulting our profession....
 
Perrotfish said:
Isn't the physician culpable for their work environment, though? You guys are not easily replaceable, you can negotiate on behalf of your patients and your department. It seems like one of the most frequent complaints I hear from ED physicians is that they are hitting crazy patient throughput, like 3 pph, which is safe only in a clinic where you refer the high acuity stuff out to the ED and is crazily unsafe for the ED itself. I'm not talking about the rare catastrophe, keep in mind, I'm talking about normal, predictable surges in volume. However in the ED its always treated as unfixable. There never seems to be any insight that the ED group almost always has everyone working 10-12 shifts a month, or that they could just as easily have everyone working 20 shifts a month but seeing 1.5-2 pph for the same monthly salary.

I'm not saying the same thing doesn't ever happen in clinics. I have seen the 3 day/week high throughput clinic provider, usually working at 5 pph in an urgent care. However that model is rare, and that provider is usually looked down upon as unsafe and unethical by the more traditional 5 day/week 3 pph crowd. It seems like only Emergency Medicine has reached a profession wide consensus to prioritize time off from work over both the quality of life at work and also the quality of patient care provided.
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Things take time to change. If the ED has been a ****show for a decade, then yes, the ED docs who have been there for a decade perhaps are practicing learned helplessness. But if the whole hospital system is undergoing ups & downs, then the ED may be just doing the best they can with a (temporarily) bad situation.
 
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WilcoWorld said:
Things take time to change. If the ED has been a ****show for a decade, then yes, the ED docs who have been there for a decade are practicing learned helplessness. But if the whole hospital system is undergoing ups & downs, then the ED may be just doing the best they can with a (temporarily) bad situation.
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Just going to answer his question and ignore the fact that he thinks we would uniformly rather give bad patient care for more time off and better pay?
 
Perrotfish said:
Isn't the physician culpable for their work environment, though? You guys are not easily replaceable, you can negotiate on behalf of your patients and your department. It seems like one of the most frequent complaints I hear from ED physicians is that they are hitting crazy patient throughput, like 3 pph, which is safe only in a clinic where you refer the high acuity stuff out to the ED and is crazily unsafe for the ED itself. I'm not talking about the rare catastrophe, keep in mind, I'm talking about normal, predictable surges in volume. However in the ED its always treated as unfixable. There never seems to be any insight that the ED group almost always has everyone working 10-12 shifts a month, or that they could just as easily have everyone working 20 shifts a month but seeing 1.5-2 pph for the same monthly salary.

I'm not saying the same thing doesn't ever happen in clinics. I have seen the 3 day/week high throughput clinic provider, usually working at 5 pph in an urgent care. However that model is rare, and that provider is usually looked down upon as unsafe and unethical by the more traditional 5 day/week 3 pph crowd. It seems like only Emergency Medicine has reached a profession wide consensus to prioritize time off from work over both the quality of life at work and also the quality of patient care provided.
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Its almost as though emergency medicine doesn't operate on a similar economic model to a 9-5 outpatient clinic.

I'm not going to pretend to understand the intricacies of patient throughout in the ED, but I can tell you it's not as simple as increasing physician staffing. The EM physician assessment is frequently not the rate limiting step. It's often things like number of beds, communication with specialists, limited number of imaging suites, the lab processing, collecting the mother ****ing urine, etc.

Beyond that, patient flow in the ed is not pre-scheduled: some shifts have very few patients, some have very many. The more physician staffing you have the higher your fixed costs: it doesn't make great economic sense if you can't show direct patient harm.

Even if it were as simple as increasing staffing, do you want to work a solid week of nights, weekdends and holidays every month? Probably not. The implication that EM physicians are lazy is not appreciated.

I have often enjoyed your posts, but the one I am replying to had an almost shameful lack of thought behind it.
 
TimesNewRoman said:
Just going to answer his question and ignore the fact that he thinks we would uniformly rather give bad patient care for more time off and better pay?
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I was answering the first sentence - are EM Physicians responsible for their work environments.

As to the rest of it - figured I'd come back to that later, or I'd pass over it in silence. Hadn't decided yet.
 
To follow up on my earlier post:
WilcoWorld said:
Things take time to change. If the ED has been a ****show for a decade, then yes, the ED docs who have been there for a decade perhaps are practicing learned helplessness. But if the whole hospital system is undergoing ups & downs, then the ED may be just doing the best they can with a (temporarily) bad situation.
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I think that if you work hard to see an ED (and thereby a hospital) through a rough 6 months (heck, maybe 24, things take time), then you are doing an honorable thing.

But if you worked in the same craptastic system for 10 years, and you spent 3650 out of 3652 nights bemoaning it, well...maybe you should've left by now.
 
doctalaughs said:
All doctors like to bash on others, but I think they do so most with specialties perceived to work fewer hours, or have a better life balance than themselves.

I'm in dermatology which obviously is very different than EM, and get similar insults occasionally (probably would be more frequent if I actually went to the hospital much). In residency more than a few (IM) docs said I was "wasting my career." Many subtle and not-subtle comments that dermatologists "don't treat anything important" and "don't know anything about medicine" (theres a radiologist in their forum that keeps repeating that dermatologists know the same amount of clinical medicine as a hairdresser - probably a troll but whatever).

Overall doesn't bother me much at all. I know I take good care of my patients and make a difference in their lives, which is all that matters. The money and ability to have a great life outside of work helps too 😉


Sent from my iPhone using SDN mobile
Click to expand...
Haven't even started medical school yet, but one of my main interests is derm...and I already get the "you're selling out before you even start" and the "why don't you want to be a real doctor" insults.
 
doctalaughs said:
All doctors like to bash on others, but I think they do so most with specialties perceived to work fewer hours, or have a better life balance than themselves.

I'm in dermatology which obviously is very different than EM, and get similar insults occasionally (probably would be more frequent if I actually went to the hospital much). In residency more than a few (IM) docs said I was "wasting my career." Many subtle and not-subtle comments that dermatologists "don't treat anything important" and "don't know anything about medicine" (theres a radiologist in their forum that keeps repeating that dermatologists know the same amount of clinical medicine as a hairdresser - probably a troll but whatever).

Overall doesn't bother me much at all. I know I take good care of my patients and make a difference in their lives, which is all that matters. The money and ability to have a great life outside of work helps too 😉


Sent from my iPhone using SDN mobile
Click to expand...

I'd give a limb to do Derm, if that makes you feel any better.
 
Perrotfish said:
Isn't the physician culpable for their work environment, though? You guys are not easily replaceable, you can negotiate on behalf of your patients and your department. It seems like one of the most frequent complaints I hear from ED physicians is that they are hitting crazy patient throughput, like 3 pph, which is safe only in a clinic where you refer the high acuity stuff out to the ED and is crazily unsafe for the ED itself. I'm not talking about the rare catastrophe, keep in mind, I'm talking about normal, predictable surges in volume. However in the ED its always treated as unfixable. There never seems to be any insight that the ED group almost always has everyone working 10-12 shifts a month, or that they could just as easily have everyone working 20 shifts a month but seeing 1.5-2 pph for the same monthly salary.

I'm not saying the same thing doesn't ever happen in clinics. I have seen the 3 day/week high throughput clinic provider, usually working at 5 pph in an urgent care. However that model is rare, and that provider is usually looked down upon as unsafe and unethical by the more traditional 5 day/week 3 pph crowd. It seems like only Emergency Medicine has reached a profession wide consensus to prioritize time off from work over both the quality of life at work and also the quality of patient care provided.
Click to expand...

I was thinking about this a little more, and I realized I probably missed what your thought process was. I assumed you were talking about clearing the waiting room/ed. If you instead meant "why don't ed physicians just divide the department into 1/2 instead of 1/1," then I'm even more confused.

Where do you think our pay comes from? Your proposal seems to be "why are you complaining so much when you could be paid 50% less to do your job?" I think that question answers itself

It's similar to asking why an outpatient family practice or pediatrician doesn't just give every patient 1 hr and work from 4am to 12am.
 
dadaddadaBATMAN said:
I was thinking about this a little more, and I realized I probably missed what your thought process was. I assumed you were talking about clearing the waiting room/ed. If you instead meant "why don't ed physicians just divide the department into 1/2 instead of 1/1," then I'm even more confused.

Where do you think our pay comes from? Your proposal seems to be "why are you complaining so much when you could be paid 50% less to do your job?" I think that question answers itself

It's similar to asking why an outpatient family practice or pediatrician doesn't just give every patient 1 hr and work from 4am to 12am.
Click to expand...

Funny, now I'm wondering if I misunderstood Perrotfish's earlier post. I thought it was asking why EP's don't leave understaffed ED's for better work environments. On second read, I think I may have read my own meaning into it.
 
WilcoWorld said:
Funny, now I'm wondering if I misunderstood Perrotfish's earlier post. I thought it was asking why EP's don't leave understaffed ED's for better work environments. On second read, I think I may have read my own meaning into it.
Click to expand...

Actually the throughput limitation for physicians is charting. If we are busy, and all the nurses/techs/imaging are working at maximum efficiency, I can only move so fast even with a scribe. That limitation means even with a scribe I'm maxed out at 3 pts/hour.

I don't stay after my shift and chart. I've seen other docs stay 1-2 hours after their shifts just to finish charting and it frustrates the hell out of me watching it. In my opinion if we are expected to see so many patients that we have to stay late, then we should be reimbursed for those extra hours. I finish the chart on nearly every patient as I'm discharging/admitting them, then move on. I'm typically out the door within 10 minutes of the end of my shift.
 
GeneralVeers said:
Actually the throughput limitation for physicians is charting. If we are busy, and all the nurses/techs/imaging are working at maximum efficiency, I can only move so fast even with a scribe. That limitation means even with a scribe I'm maxed out at 3 pts/hour.

I don't stay after my shift and chart. I've seen other docs stay 1-2 hours after their shifts just to finish charting and it frustrates the hell out of me watching it. In my opinion if we are expected to see so many patients that we have to stay late, then we should be reimbursed for those extra hours. I finish the chart on nearly every patient as I'm discharging/admitting them, then move on. I'm typically out the door within 10 minutes of the end of my shift.
Click to expand...

It depends on your working environment. If your ED boards patients and you have to follow up on inpatient medicine stuff for boarding patients in the ED, then charting may not be the limiting factor. But in an ED that functions as an ED should, I would agree with your point.
 
meister said:
Well from the radiology department's perspective.....at least they consider you all doctors.
Click to expand...

Thats somewhat funny because the radiologist is my favorite Physician to call. Maybe its because they are just happy to talk to someone haha. But really we all get the weird radiology result or maybe something that needs clarification and calling the radiologist has been really helpful. I feel they have a lot of skill I don't have but can get my input because I'm seeing the patient. When something is odd I feel like I can call the radiologist and by then end of the conversation it is much more apparent. I also like just running to the radiologists room when I have a really sick patient that I am imaging. They have taught me countless times on images while I sit over their shoulder look at imaging with them. It would be great when healthcare realizes we are a team instead of advisaries.
 
EMDOC17 said:
Thats somewhat funny because the radiologist is my favorite Physician to call. Maybe its because they are just happy to talk to someone haha. But really we all get the weird radiology result or maybe something that needs clarification and calling the radiologist has been really helpful. I feel they have a lot of skill I don't have but can get my input because I'm seeing the patient. When something is odd I feel like I can call the radiologist and by then end of the conversation it is much more apparent. I also like just running to the radiologists room when I have a really sick patient that I am imaging. They have taught me countless times on images while I sit over their shoulder look at imaging with them. It would be great when healthcare realizes we are a team instead of advisaries.
Click to expand...

Agreed. vast majority of radiologists I speak to on the phone are very nice and happy to explain their interpretation and teach.
 
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See this all the time in peds. Primarily for patients we discharge as soon as they hit the floor (or kids admitted to PICU with crazy/odd/unnecessary work ups - especially from outside adult EDs) . Then I do a ED month and realize based on how they looked, I would have admitted them too. Or the kid with a seizure disorders who was in the ED for six hours and never got his home seizure meds and started seizing. And then I do ED, and admit the kid 30 mins in, and realize the bed just took forever to get assigned and I missed the dose. The further away you get from that, the less empathy you have towards it. It also doesn't help that you're never gonna be as good as the sub specialists at the job. To that I think, Well if the ED could do all of your jobs, we wouldn't need any of you in the first place. That's why you exist.
 
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