I work too much.

[docB]

I work too much. I'm here 3 hours past the end of my shift now. I can tell I've been working too much when I start to say things out loud that I normally wouldn't. Such as:
-(to mother of 2 year old with fever) "Well, I'm sure it's nothing but we'll stick needles in him until I can prove it."
-"Well that's just silly. You really called an ambulance for that?"
-"Now Mr. X, you swore you'd kill yourself when I kicked you out of the ER yesterday. What happened?"
-(to EMS crew) "So what were you thinking when you drove past every other hospital in town to bring me a severe epistaxis when you know I don't have ENT on call?"
-Family-"My mother might have a broken hip and that's all you're going to do?" Me-"Morphine and an xray, yup, that's it. I could sing if you like."
-"So you decided to treat your chest pain with cocaine and alcohol. How's that working out for ya?"
-"Are you kidding me?"
-"Nurse. I need a gomertonin level on this pt stat!"
I've actually said all these in the last 2 weeks. I need a break.

---

Members don't see this ad.

 

[Seaglass]

Gomertonin level. Can I use that?

C

 

[MoosePilot]

I work too much.

That's hilarious!

Did you work the extra time because you wanted to or had to? In another post someone pointed to definite shift end times as a plus to EM. Would you agree?

 

[aliraja]

-(to mother of 2 year old with fever) "Well, I'm sure it's nothing but we'll stick needles in him until I can prove it."
-"Well that's just silly. You really called an ambulance for that?"
-"Now Mr. X, you swore you'd kill yourself when I kicked you out of the ER yesterday. What happened?"

Classic!

 

[spyderdoc]

You sound like you need to improve your efficiency. If you use paper charts, get in the habit of walking into the room with the chart to interview the patient. Fill it out as you go, this way your chart is complete be the end of your encounter...I find that this works very well. One of my colleagues does them at the end of her shift, and then stays 1-2 hrs after to complete the charts...Not very efficient. With my inherent EM ADD, I forget about my patients as soon as they are gone, so I couln't imagine having to remember details of my exam 8hrs later at the end of my shift....

Oh, I use these comments all the time! Very funny!
Mark

 

[SaltySqueegee]

-(to mother of 2 year old with fever) "Well, I'm sure it's nothing but we'll stick needles in him until I can prove it."

-"Nurse. I need a gomertonin level on this pt stat!"

Damn, and what the hell is gomertonin; respectively!

ROTFLMAO!

 

[Sessamoid]

You sound like you need to improve your efficiency. If you use paper charts, get in the habit of walking into the room with the chart to interview the patient. Fill it out as you go, this way your chart is complete be the end of your encounter...I find that this works very well. One of my colleagues does them at the end of her shift, and then stays 1-2 hrs after to complete the charts...Not very efficient. With my inherent EM ADD, I forget about my patients as soon as they are gone, so I couln't imagine having to remember details of my exam 8hrs later at the end of my shift....

Oh, I use these comments all the time! Very funny!
Mark

I don't really want to turn this into a documentation efficiency discussion, but I'm gonna second the opinion that you should do your charts immediately, or your dictations if that's what you do. Doing them all at the end of or after your shift is over is gonna burn you out unnecessarily. Even on my worst shift ever when I saw 34 patients in an 8 hour shift (yes, that's 4.25 pts per hour including two critical care patients in single coverage overnight) when my relief came I was ready to go home, and would have if I hadn't opted to stay to make sure one of the critical patients (whose family had kind of bonded with me) made it to the ICU in one piece. Of course, I was using T-Systems at the time, which I wish I still was.

Anyway, we've all said some rather impolitic things at times, I'm sure. One of my favorite lines for cocaine-induced chest pain is "It sounds like you need to find some new hobbies, buddy."

 

[DrQuinn]

Anyway, we've all said some rather impolitic things at times, I'm sure. One of my favorite lines for cocaine-induced chest pain is "It sounds like you need to find some new hobbies, buddy."

That's a good one!

One of your colleagues at your previous employment had a line I have taken (which isn't really that exciting but...). When a drunk came in (or ESLD), he woudl ask "Whats' your poison, bro?" At first, I wasn't sure what he was asking, but it was amazing to see the patietn's say "BUdweiser," or "Scotch on the rocks," or "straight vodka." Crazy.

Q, DO

 

[St. James]

-Family-"My mother might have a broken hip and that's all you're going to do?" Me-"Morphine and an xray, yup, that's it. I could sing if you like."

fantastic. hope you get a break soon. did you get any good responses from your victims?

 

[beyond all hope]

Last night I saw a testicular pain and almost blurted out 'How's it hanging?'.

I saw an asthmatic who smokes, asked him to quit, he told me he would and I said. 'No you won't.'

Had a chest painer who wanted to go to the bathroom. I gave her a bedpan and said 'the next time, you'll remember that evil doctor who didn't let you go to the bathroom, and you'll take your BP meds instead of coming to the ER.'

Had a massive GI bleed who refused NG lavage, so I said. 'You want to die tonight, don't you?' He accepted lavage afterwards.

Had an attending who told me PPIs are not any more effective than H2 blockers for UGIB. Wanted to smack him. Didn't. Feel worse about that (not smacking him, that is) than anything I said to my patients.

 

[Sessamoid]

That's a good one!

One of your colleagues at your previous employment had a line I have taken (which isn't really that exciting but...). When a drunk came in (or ESLD), he woudl ask "Whats' your poison, bro?" At first, I wasn't sure what he was asking, but it was amazing to see the patietn's say "BUdweiser," or "Scotch on the rocks," or "straight vodka." Crazy.

Q, DO

Yeah, I loved that. Only a guy that looks like a big Irish bartender could get away with that though (I don't think he's Irish, as the name comes from Germany).

All my motorcycle accident patients who come in with their faces AFU (that's one of my favorite acronym/diagoses) secondary to lack of helmet usage, get my short speech on helmet use:

Me: "Riding your bike without a lid, huh?"
Patient (with sheepish look on what's left of his face): "Uh yeah."
Me: "Guess you won't be doing that again, will you?"
Pateint: "Uh, no."

 

[docB]

I actually don't do all my charting at the end. I've been getting held up lately because of some really weird, complex pts that have required 2 stage work ups and because we've been so busy I've had to stay late to help with volume. We also have a fee for service component in our compensation that makes you not want to sign out lots of patients but I don't care too much about that. I've also been working a lot because I have a week off at the end of the month and will be going on a trip with my wife. The problem is that I'm so tired I'd rather stay home than travel. Anyways, I got a nap in today so I'll probably be OK. I just hope it's an easy night (just by hoping that I've angered the fates and will get creamed).

 

[Sessamoid]

I actually don't do all my charting at the end. I've been getting held up lately because of some really weird, complex pts that have required 2 stage work ups and because we've been so busy I've had to stay late to help with volume..

Two stage workups are exactly the kind of patients I think should be checked out. I know some programs discouraged checking out any patients at all, and custom dictated that the residents had to clean up pretty much all their patients before leaving. I think that's just crazy. Set hours is one of the advantages of EM, and I specifically avoided those programs that had this macho mentality.

 

[DrQuinn]

Two stage workups are exactly the kind of patients I think should be checked out. I know some programs discouraged checking out any patients at all, and custom dictated that the residents had to clean up pretty much all their patients before leaving. I think that's just crazy. Set hours is one of the advantages of EM, and I specifically avoided those programs that had this macho mentality.

psssssssssssssstt..........
Docb's out of residency.



Q, DO

 

[docB]

psssssssssssssstt..........
Docb's out of residency.



Q, DO

But I hide it well. I act like a preschooler.

 

[beyond all hope]

I work at a program where we have almost no access to inpatient beds, so it can take days for an admitted patient to go up. Signout is part of the game. The trick is to do all of your dirty work (CTs, LPs, blood draws, etc) before the next resident to come on, so you sign out only pending results/consults/bed. Obviously, if the altered renal patient comes in 15 minutes before the end of your shift, you're basically going to sign out the entire patient, so we let the next resident do the entire workup.

I am both proud and exasperated that the brunt of the current crisis in medicine is being dumped on the ER. We accept everything, deny nothing, take care of everyone, and do it as long as we have to. I do long for the time when inner-city hospitals have enough beds where we can practice only EM, not EM, Intensive Care, Ward Medicine, Family Practice and Social work.

 

[Sessamoid]

psssssssssssssstt..........
Docb's out of residency.



Q, DO

I know that, but habits learned in residency die hard.

 

[EMIMG]

I know that this is a great outlet for stress relief and joking about issues; however, the thing that is concerning which appears to be overlooked is that the original poster stated that he said the thoughts out loud. Now, I know that we all probalby have similar thoughts; however, we must do everything we can to bite our tongue.

The key is to remember that every single patients, no matter how much the abuse the system is still someone's brother, sister, son, daughter, mother, father, best friend, etc. We chose our residencies based in part of the patient population that we would see. The fact that these patients abuse the system, or don't take care of themselves adds to the pathologies that we can see and treat and our learning experience.

I know that I busted my butt off to get to the position that I find myself. Yes, I have similar thoughts at times; however, you need to keep them in check and realize that you are doing what you wanted to do. Whenever you find yourself starting to blurt something inappropriate out, just think of how you would feel if someone talked in a condescending way to one of your relatives, friends.

 

[Robz]

I know that this is a great outlet for stress relief and joking about issues; however, the thing that is concerning which appears to be overlooked is that the original poster stated that he said the thoughts out loud. Now, I know that we all probalby have similar thoughts; however, we must do everything we can to bite our tongue.

The key is to remember that every single patients, no matter how much the abuse the system is still someone's brother, sister, son, daughter, mother, father, best friend, etc. We chose our residencies based in part of the patient population that we would see. The fact that these patients abuse the system, or don't take care of themselves adds to the pathologies that we can see and treat and our learning experience.

I know that I busted my butt off to get to the position that I find myself. Yes, I have similar thoughts at times; however, you need to keep them in check and realize that you are doing what you wanted to do. Whenever you find yourself starting to blurt something inappropriate out, just think of how you would feel if someone talked in a condescending way to one of your relatives, friends.

I'm pretty sure the whole point is that if he didn't work so much or had a severe lack of sleep then your comments are assumed.

Sometimes when your have been pushed to the wall with no relief...you say things that you wouldn't normally say. I've done it too...you either laugh it off or you'll drive crazy.

 

[docB]

I know that this is a great outlet for stress relief and joking about issues; however, the thing that is concerning which appears to be overlooked is that the original poster stated that he said the thoughts out loud. Now, I know that we all probalby have similar thoughts; however, we must do everything we can to bite our tongue.

The key is to remember that every single patients, no matter how much the abuse the system is still someone's brother, sister, son, daughter, mother, father, best friend, etc. We chose our residencies based in part of the patient population that we would see. The fact that these patients abuse the system, or don't take care of themselves adds to the pathologies that we can see and treat and our learning experience.

I know that I busted my butt off to get to the position that I find myself. Yes, I have similar thoughts at times; however, you need to keep them in check and realize that you are doing what you wanted to do. Whenever you find yourself starting to blurt something inappropriate out, just think of how you would feel if someone talked in a condescending way to one of your relatives, friends.

Yeah, about that. When people use the ER as a primary care clinic, or rehab ward, for second opinions, etc. they get bad care. I'm not a PMD, or PM&R, or a social worker and I don't have the best weapon of a PMD, continuity. They arrive with unreasonable expectations, e.g. to have all of their various, chronic health problems solved in one ER visit or to be reassured that everything will be just fine without any work up (just like their clinic doctor does). And when these patients arrive with these unreasonable expectations pointing out to them that this is not what the ER is for is just fine. And as for everyone being somebody's something that doesn't mean they're not stupid or abusive. If anyone sees my mom showing up in the ER for a second opinion on a breast lump or something like that fire away.

 

[Robz]

Emergency Medicine - Saving the world from seeing its primary care doctor.

I love this quote!