pristine21

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So- I am curious how much SCUT everyone else is doing now a days as a resident- I feel like if I didn't have to do any BS I could see 50% more patients per day- no lie.

Things that I always do:
-Set up and gather all the equipment for pelvic exams and any procedure- suture material etc- somehow all at different areas of the department. Clean up after myself
-fill out forms for x-rays, CT scans ultrasound exct... and fax them and/or speak to the people on the other end-
-sometimes find someone to send the patient- always takes a while occasionally take them myself
-fill out lab forms, which are triplicate forms with stickers
- perform all my own strep and rsv swabs- label samples get the ice
`PAPERWORK- there is a form for every little thing- something to fill out to request a bed, something to fill out to disposition the patient (both need to be done for admitted patients) Fill out their medical requisition form a job that is technically the nurses, but we are responsible if its not there, so you know what happens with that (no you cant staple a long med list you actually have to write out each one) fill another form for any additions or changes in their meds...
-Sift through stacks of transfer paperwork and nursing home stuff
make phone calls to the prior center (often waiting on hold)

Things that I have to do if asked by the patients (ie it's bad form to ask a nurse or tech to do it for you)- sounds like no big deal but being the ED almost every time you see a patient they ask for something- (not to mention if they have a male nurse or tech they will always ask the female doctor first anyway)
Get patients water
Get patients food
Get patients blankets and pillows

I feel my first job is to take good care of my patients and my next job is to learn as much as possible I feel everything else should be secondary-

Don't get me wrong- I have no problem with a team approach and I will do anything if I am not busy taking care of people, I have started IV's and drawn my own blood when the nurses are super busy and I am not, and I have no problem with that but sometimes it gets rediculous how much BS we as residents do...

Where I work it is expected that I do this stuff, it's not a "thank you Dr for helping us out" situation, it's a "well why couldn't you do it" situation It seems crazy that I am doing some of this BS while techs are not doing anything sometimes, but I am not allowed to ask them for help, as they are there to help the nurses, if/when I do ask I get pushback every time.

Perhaps I shouldn't be complaining and this is nothing and I am lucky compared to everyone else... What does everyone else do as far as BS stuff? What do you think is acceptable?
 

aggiedoc2010

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I am a tech and a incoming med student in the fall, so take this with a grain of salt. Do you not have unit clerks to put orders in, set bed assignments, and arrange for patient transport? Your clerks are paid to take phone calls and push paperwork that a doctor is not needed to fill out. Also you are a doctor not a nurse, those techs are there to help the nurses with nursing duties which include getting blankets, pillows, water, family, ect. By doing those things they are helping their nurses. Speaking as an ER tech I find it absurd that the techs wouldn't do these things especially during the times you are clearly busy. Your techs need to get off their lazy butts and earn their keep, and I wouldn't think twice about asking them to do something. I think it would be reasonable to tell them it is part of their duties, especially if you get pushback from them when you are even remotely busy.

You seem very proactive, but it seems the staff is really taking advantage of your willingness to do some of these things.
 
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pristine21

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I hardly ever do any of that as an attending.

Yeah I am pretty sure I won't as an attending either, but how about when you were a resident- is this worse or better than you had it and in what ways?
 

BADMD

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Some of the stuff I do, much of it I don't.

Sounds like you need electronic ordering. Basically, if it isn't materially furthering my medical evaluation and decision making or requires a physician level interaction (such as providing justification to bump several high priority cases for my emergent case), then it is up to nursing, clerks, bed coordinators, techs or someone else.
 

SoCuteMD

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So- I am curious how much SCUT everyone else is doing now a days as a resident- I feel like if I didn't have to do any BS I could see 50% more patients per day- no lie.

Things that I always do:
-Set up and gather all the equipment for pelvic exams and any procedure- suture material etc- somehow all at different areas of the department. Clean up after myself
-fill out forms for x-rays, CT scans ultrasound exct... and fax them and/or speak to the people on the other end-
-sometimes find someone to send the patient- always takes a while occasionally take them myself
-fill out lab forms, which are triplicate forms with stickers
- perform all my own strep and rsv swabs- label samples get the ice
`PAPERWORK- there is a form for every little thing- something to fill out to request a bed, something to fill out to disposition the patient (both need to be done for admitted patients) Fill out their medical requisition form a job that is technically the nurses, but we are responsible if its not there, so you know what happens with that (no you cant staple a long med list you actually have to write out each one) fill another form for any additions or changes in their meds...
-Sift through stacks of transfer paperwork and nursing home stuff
make phone calls to the prior center (often waiting on hold)

Things that I have to do if asked by the patients (ie it's bad form to ask a nurse or tech to do it for you)- sounds like no big deal but being the ED almost every time you see a patient they ask for something- (not to mention if they have a male nurse or tech they will always ask the female doctor first anyway)
Get patients water
Get patients food
Get patients blankets and pillows
Hmmm
- Set up pelvics - sometimes, but usually try to make a tech do it.
- Fill out forms - nope, have electronic ordering. I do put the orders in, though. For CT scans have to make one phone call, can't make someone else make it for me.
- Strep/RSV swabs - nope
- I do sign the med reconciliation form, but we have someone to fill it out for us.
- I do make phone calls to the prior care facility, but am resolving to make the unit secretaries make them for me starting next week.
- I ALWAYS get patients pillows/blankets/water if they ask. The ED is uncomfortable, busy, and who knows when their nurse/a tech will be able to get that stuff for them if I don't. It's just as quick for me to grab it as it is for me to make someone else get it for the patient.
 

Greenbbs

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the problem with some things that you view as 'scut' really could be viewed as 'customer service'.

In the non-academic ED world, you're under a microscope in terms of how patients, staff, etc perceive you.

Thanks to Press-Ganey, those little customer service things go a long way in keeping your scores high and keeping you employed.
 

pristine21

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the problem with some things that you view as 'scut' really could be viewed as 'customer service'.

In the non-academic ED world, you're under a microscope in terms of how patients, staff, etc perceive you.

Thanks to Press-Ganey, those little customer service things go a long way in keeping your scores high and keeping you employed.
So lets hire more nurses and technicians to do it... why is someone with 8 years of education behind them expected to do it in this world- That wouldn't be seen in the corporate world-
 

Jeff698

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I have so much education I frequently can't keep track of it all.

Guess what? I bring patients warm blankets and tuck in their feetsies, just like everyone else in my ED. We're in medicine and, like it or not, medicine is a service industry. Have you ever considered what being in a service industry means? We serve others. Their needs are more important than ours (taken in context, of course).

That's not to say that having the highest paid person in the department do clerical work makes any sense from an efficiency standpoint, just that we shouldn't think we're exempt from doing some things just because we're over-educated for them.

BTW, I almost never set up my own pelvics, sutures, etc. It just isn't efficient. Plus, doing that doesn't bump my PG scores like the warm blankets. :)

Take care,
Jeff
 

Greenbbs

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So lets hire more nurses and technicians to do it... why is someone with 8 years of education behind them expected to do it in this world- That wouldn't be seen in the corporate world-
Because that person with 8+ years of education is also the most respected, and most looked-up-to person in the department. Your job as an attending is to set an example to the rest of the department as to what's right and wrong. Being a lazy douchebag gets you nowhere, and will likely get people pissed at you (and I'm not calling you names....just using the word as an example).
 

Dr.McNinja

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Some people are classic "that work is below me".
However, when you get paid for patient volume, certain things should be left to the people paid to do that.
An example: If I make a mess while draining an abscess, I will put a towel down and at least make it not a safety hazard. I will not get a mop and clean the floor, as I have other things to do. I don't ignore the situation, but I don't completely take care of it.
We have a problem with how quickly urine samples are obtained in our department. Also, our lab frequently refuses to run specimens even though there are computer orders, simply because there isn't a paper copy (that they themselves can print out) sitting there with the sample. So I probably spend an aggretate of 20 minutes of my day dealing with this. It's frustrating. It is precisely the definition of scut. Any secretary could do that. Ours simply won't. (They also won't fax, or page consultants, or...)
Getting icewater for patients is not scut. I don't spend that much time that it interferes with patient care.
However, there are plenty of ways to make your job more efficient, and since we also train at a private hospital (that still has residents) that knows it earns money on the docs, things are set up for you. The kid with a fever? What size gloves are you doctor? The LP tray is set up already.
Often I have to document vital signs myself. Our nurses are zoned to 4 or 5 (depending on presumed acuity) patients. I have more patients that that. Why do I have to get the vitals? Because the nurses do feel it is below them, and instead make the nursing assistants (of which there are 2-3 for the whole place) do it for them.
I know of other residencies where the residents push the patients to x ray because it will otherwise take too long. At some point there is a line. I can push the occasional patient. I shouldn't have to do it every day.
 

Arcan57

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A lot of it depends on where your hospital has put its resources. We have 1-2 techs for a 48 bed ED, and they are used almost exclusively for patient transport. Our nurses tend to play dumb about what is required for a procedure (LP tray but no mask, suture tray but no sutures or lido) especially in regards to splinting supplies. It's often easier to get the stuff myself, especially since our nurses are busy doing a lot of tech-level jobs secondary to the above mentioned lack of techs. Asking for a pelvic set-up will usually generate a pelvic tray +/- the patient actually being undressed.

Our coordinators do order entry, place phone calls, hit or miss on getting old records. I don't have to do my own swabs, deal with lab specimens, or transport patients. Lack of ancillary staff + 40% admit rate means with heroic effort we max out at around 2.7-2.9 pts/hr and average 1.9-2.0.
 

southerndoc

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I guess I'm lucky to work in a place where each pod (which has 16 beds in 12 rooms) has 4 nurses, a tech, and a secretary. Techs splint fractures, set up pelvics (including having the patient ready for exam and the disposable kit already open, cultures waiting), irrigate lacerations, etc.

I really appreciate the hard work that our techs and nurses do. Definitely makes my work a lot easier!
 
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I work in the ED in the UK's National Health Service, who's tag line should be "County with scut!"

It never ceases to amaze me just how much nonsense there is to do - all bloods, IV access, orders, calling patients in, putting together trays etc. When putting a tray together, the ED is so hopelessly stocked that there is always something missing ... always.

What's more is the fact that this is all actually part of my job description. When I'm doing fast track, instead of working with a treatment nurse, I work with an Emergency Nurse Practitioner. I'm sure that with the ENP and me both calling in our patients, changing sheets, undressing patients, wheeling them to X-ray .... we actually see patients slower than if I was the only doc seeing patients with a good treatment nurse. I just tell myself if they want to pay me to sweep the floor fine - I'm making an hourly wage.

It really boggles the mind how the NHS can be run so mindlessly. After pondering this for years, the best explanation I can come up with is the following rule:
"The amount of accountability that both healthcare providers and receivers have for their health service is directly proportional to the standard of care"

Anyway, in response to the OP, when the opportunity to do mindless scut presents itself, I try to do a quick mental assessment of what is best value for time and act accordingly. I really think there are some things that doctors shouldn't be doing, but if it's going to take an hour to get someone else to do it then what are you gonna do?

I suppose the answer is to recognize the fact that if this stuff drives you up the wall, make sure you get a job in an ED where they allow you to do what you were trained to do and let someone else wheel patients to x-ray.