Is it common for surgeons to rip EM docs where you are?

[surfguy84]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

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[Rendar5]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

No disdain at all here. But I work in a community hospital.

 

[fahimaz7]

Our surgeons love us. We feed them business which = $$. We also don't call them to "figure it out."

 

[engineeredout]

Everyone bitches about everyone else

 

[Vandalia]

About as common as it is for EM physicians to rip surgeons and every other medical specialty. Take that as you will.

 

[Dr Mantis Toboggan]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

Residents or attendings? Every time the ED calls a resident they get more work without any extra compensation...

It is generally much different in the community, as was mentioned already. Also the culture in many academic institutions is biased towards no miss, consult heavily which may lead to some weaker consults.

 

[surfguy84]

Residents or attendings? Every time the ED calls a resident they get more work without any extra compensation...

It is generally much different in the community, as was mentioned already. Also the culture in many academic institutions is biased towards no miss, consult heavily which may lead to some weaker consults.

These are attendings in a community hospital

 

[swamprat]

Every specialty rips every other specialty. Heck even amongst my colleagues people rip on each other's management post sign out. Human nature IMO.

 

[Venko]

I'm sure every now and again there is some complaining but it is likely on both sides on the rare occasion.

In general our general / trauma surgery group and our ED group have the best relationship of any in the hospital IMO.

Some of the sub specialty services may think differently but it's generally quite good.


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[filhodeinferno]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

Yes. It happens everywhere. If you go into EM, you will get ripped on. The ones that say they don't are probably getting ripped on behind their backs, and they just don't realize it.

EM takes a lot of thick skin because we get ripped on more than average....however, everyone gets ripped on. EM docs rip on other specialties. It's part of life.

 

[Angry Birds]

About as common as it is for EM physicians to rip surgeons and every other medical specialty. Take that as you will.

I agree that all specialties rip each other. But there is a big difference. Surgeons are much more likely to be grumpy a-holes in person. They even treat their own horribly. I've seen how they treat their juniors.

In general, ER docs are friendly and surgeons are jerks. Many surgeons are arrogant, and far fewer ER docs are.

Of course exceptions abound.

 

[surfguy84]

I agree that all specialties rip each other. But there is a big difference. Surgeons are much more likely to be grumpy a-holes in person. They even treat their own horribly. I've seen how they treat their juniors.

In general, ER docs are friendly and surgeons are jerks. Many surgeons are arrogant, and far fewer ER docs are.

Of course exceptions abound.

I think its particularly surprising because these surgeons are actually really chill and down to earth..at least amongst each other. Even with the med students they're joking and very approachable. So when they start talking about the EM docs, I was taken aback.

 

[southerndoc]

You are not definitive management on a lot of admissions. Hence, specialists will always have an opportunity to critique what you do.

 

[CajunMedic]

The worst ripping I heard on rotations was from a pediatrician. The EM guys where I was at were pretty well-respected by everyone else.

 

[Angry Birds]

I think its particularly surprising because these surgeons are actually really chill and down to earth..at least amongst each other. Even with the med students they're joking and very approachable. So when they start talking about the EM docs, I was taken aback.

Surgeons down to earth? Lol good one.

They are not very chill except perhaps with their peers. I've seen them decimate their own interns.

 

[cbrons]

Seems pretty common in every department, at least in academia, to rip on the E.D.

 

[Fox800]

Seems pretty common in every department, at least in academia, to rip on the E.D.

It's a time-honored tradition. At my place general surg, OB, and neurosurg are the worst offenders. It's almost always shortsighted and shows that they don't understand what we do or our working conditions.

 

[anbuitachi]

here there is some ripping of EDs. Even anesthesiology occasionally rips ED because they keep getting emergency surgeries from the ED sent up to the OR area with a non functioning IV (50% of the time non functional), or 1-2 22G IVs in a bleeder etc. (Or a 20G + 22G in a AAA leaker about to go for open AAA repair). Ive heard surgery rip the ED for not putting in a NG tube for someone with very distended abdomen and likely obstruction on CT.

 

[Old_Mil]

Pretty common.

(which is why it is important to both train and work in an environment where a surgeon /surgery department is not your departmental overlord)

 

[DrYoda]

Most specialties rip on other specialties as has already been mentioned. I do find as other's have said above that there is a lot less of this in the community than in academic settings. Our general surgeons, and most of our subspeciality surgeons save a single individual are usually pleasant to work with. And I work straight nights so I'm usually waking them up at a ****ty time when I call.

 

[TheComebacKid]

When they rip on us in the ED, it's a testament more to their ridiculous work schedule and never being able to spend quality time with friends and family outside the hospital. Notice how dermatologists and psychiatrists rarely rip on the ED? Because they get to sleep. Every time I get ripped on by a surgeon, I just shrug it off and say, "Man, I'm glad I didn't sign up to do that job."

 

[Hercules]

When they rip on us in the ED, it's a testament more to their ridiculous work schedule and never being able to spend quality time with friends and family outside the hospital. Notice how dermatologists and psychiatrists rarely rip on the ED? Because they get to sleep. Every time I get ripped on by a surgeon, I just shrug it off and say, "Man, I'm glad I didn't sign up to do that job."

This. I really don't have to deal with this kind of behavior at my shop. Back when I did I just assumed they were unhappy people who had made poor life choices (personal, professional, financial) and were mad at the world as a result. You don't hear high functioning happy people continually ripping on their colleagues. There's a reason for that--constantly complaining says a lot more about the complainer than it does about their environment.


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[surfguy84]

When they rip on us in the ED, it's a testament more to their ridiculous work schedule and never being able to spend quality time with friends and family outside the hospital. Notice how dermatologists and psychiatrists rarely rip on the ED? Because they get to sleep. Every time I get ripped on by a surgeon, I just shrug it off and say, "Man, I'm glad I didn't sign up to do that job."

This is why, despite enjoying surgery, I will not consider it. I find the personalities in EM, Anesthesia, and psych to be so much more enjoyable. Coincidentally, the fields I'm seriously considering too.

 

[e30ftw]

I rarely have negative interactions with other physicians.

Our surgeons like to work; I bring them patients.

 

[emergentmd]

They don't rip the ED, but more of the whining/complaining b/c they were called at 2am when they finally got to sleep and have to wake up at 6a for surgery.

EM ripping has changed greatly since when I started 16 yrs ago. Now, all specialists see how much time the ER saves them.

I can't remember the last time when an orthopod came to the ER. Rarely ENT. Rarely Gas. Other than the hospitalists, most specialists rarely come to the ED b/c I do it all for them.

Chest tubes, reduction, peritonsillar abscess, etc.....

 

[DeadCactus]

It's common in the academic world because burn-out is common in the academic world especially among residents. Depersonalization is one of the major symptoms of burnout. When you start to resent the patients for the work they represent, you'll resent the perceived "deliverer of patients" as well. Throw in some of the ludicrous personalities of academic leadership and you just amplify the effect.

In the community, consultants have more control and a better lifestyle. Burnout is less and there is a financial incentive to see patients. The result is more collegial interactions with other physicians.

 

[HooliganSnail]

They don't rip the ED, but more of the whining/complaining b/c they were called at 2am when they finally got to sleep and have to wake up at 6a for surgery.

EM ripping has changed greatly since when I started 16 yrs ago. Now, all specialists see how much time the ER saves them.

I can't remember the last time when an orthopod came to the ER. Rarely ENT. Rarely Gas. Other than the hospitalists, most specialists rarely come to the ED b/c I do it all for them.

Chest tubes, reduction, peritonsillar abscess, etc.....

I would agree with this in my experience.

I generally work in smaller community ED's, where there is maybe one or two docs of each specialty type. I know them all on a first name basis.

They know I can handle a lot of things, so when I call they know that it is actually something that needs their expertise. They learn really quickly that 5 minutes on the phone explaining how they like there splints or what Ab'x they prefer is 5 minutes they don't have to spend ever again, because it gets done for them.

 

[HooliganSnail]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

Some physicians do not respect their own knowledge.

They assume that everyone should have an understanding of their specialty as well as they do, and that is just silly. They spend years in residency to learn their field.

They are discounting that they are the expert in their field. That is why I need their help.

By acting out, or degrading other physicians, or being rude, they are diminishing their expertise.

 

[iish]

What do they rip the ED for? I never call general surgery unless I have a diagnosis that requires management by a general surgeon. 95% of my gen surg consults result in admission to general surgery.

 

[emergentmd]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

I glanced over this and There should be ZERO reason why a surgeon would complain about an EM doc's work up/consult. I can't remember the last time I consulted a surgeon unless they needed to actually do surgery.

Now a days with all of the imaging, when I call a surgeon its because they have a diagnosis on CT or the like.

Where is the room to complain? CT says appy/bowel obstruction/something surgical, I call them. CT neg, I send them home or admit to medicine for intractable pain/vomiting.

Surgeons doesn't have to think much given all of our imaging now adays.

 

[acadianvoyager]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

Where I did medical school, almost every other specialty would rip on the ED. I think when you're a medical student, some doctors will unload their frustrations with the department on you. I heard criticisms of the department while on OB, surgery, medicine and ICU especially.

Don't let it chase you away from emergency medicine. I almost switched fields because of all the negative things I heard about the ED, but when I finally rotated in the department I loved it. You'll develop a thick skin over time.

I'd encourage you to stay away from the trap of criticizing other physicians, even if you yourself will be the target of a lot of criticism as an ER doc. Take the high road and treat the other professionals with courtesy.

 

[LinearActuators]

I glanced over this and There should be ZERO reason why a surgeon would complain about an EM doc's work up/consult. I can't remember the last time I consulted a surgeon unless they needed to actually do surgery.

Now a days with all of the imaging, when I call a surgeon its because they have a diagnosis on CT or the like.

Where is the room to complain? CT says appy/bowel obstruction/something surgical, I call them. CT neg, I send them home or admit to medicine for intractable pain/vomiting.

Surgeons doesn't have to think much given all of our imaging now adays.

My surgery clerkship was at a known "malignant" program, and both attendings and residents ripped the ED every chance they could. One of the repeated peeves of theirs was basically what you said - that an ED doc would consult and basically say "pt with x here, found x on imaging, can you come see them." Surgeon uses that to then later say something like "wow, went to 4 years of medical school to be able to read someone else's work" or "done 3 years of residency and all they can do is order a test." Only 1 of the surgeons padded their trash talking when students were around (half of the group wanting to do EM) with "that's why we need you guys to be good EM docs."

 

[EMDOC17]

My surgery clerkship was at a known "malignant" program, and both attendings and residents ripped the ED every chance they could. One of the repeated peeves of theirs was basically what you said - that an ED doc would consult and basically say "pt with x here, found x on imaging, can you come see them." Surgeon uses that to then later say something like "wow, went to 4 years of medical school to be able to read someone else's work" or "done 3 years of residency and all they can do is order a test." Only 1 of the surgeons padded their trash talking when students were around (half of the group wanting to do EM) with "that's why we need you guys to be good EM docs."

What people don't realize is the people we don't order the test on whether it be CT or Ultrasound. It is also crazy that they would be mad about having being called for x on x imaging. This to me is the bitching that I simply blow off. I occasionally will have the absolute slam dunk appy. Classic story, WBC up, fever, everything that screams appy. On the several times I try and admit this to a surgeon they will want me to get a CT anyways so if I were to hear someone complain that I CT'd a classic story I would just blow it off. Overall have a decent relationship with the specialists now at the community hospital than I did in residency. I still agree with much of what is said. If you want to be looked at as the star of the hospital than don't do EM.

 

[Perfect Hair Day]

Friend who is a PGY1 in Surgery came to ED while I was on an elective and complained that "EM Docs are Glorified Triage Nurses." Rude.

 

[deleted859535]

Friend who is a PGY1 in Surgery came to ED while I was on an elective and complained that "EM Docs are Glorified Triage Nurses." Rude.

Surgical intern mouthing off like that. Comical. I'm a very hands-off guy, but that would be something I would make sure finds its way back to the program director right after a direct confrontation in the ED in front of anyone who is there.

 

[Fox800]

Surgical intern mouthing off like that. Comical. I'm a very hands-off guy, but that would be something I would make sure finds its way back to the program director right after a direct confrontation in the ED in front of anyone who is there.

I would think that would be grounds for an immediate call to their chief resident and attending and throwing this idiot out of the ED. Not like a PGY-1 GS resident is much use in the ED, anyways.

 

[Perfect Hair Day]

I would think that would be grounds for an immediate call to their chief resident and attending and throwing this idiot out of the ED. Not like a PGY-1 GS resident is much use in the ED, anyways.

Burn team consultation...

 

[Got Em]

Who cares?

As you'll see in any academic setting, departments rip on each other all the time. Where I'm training now, trauma and ortho don't get along. At other places it was surgery vs medicine, medicine vs EM, etc. This is less prevalent in the community setting where most EM docs work.

Most consultants are very fair and don't complain. The <5% that complain and moan constantly mess it up for everyone else.

 

[Angry Birds]

What people don't realize is the people we don't order the test on whether it be CT or Ultrasound. It is also crazy that they would be mad about having being called for x on x imaging. This to me is the bitching that I simply blow off. I occasionally will have the absolute slam dunk appy. Classic story, WBC up, fever, everything that screams appy. On the several times I try and admit this to a surgeon they will want me to get a CT anyways so if I were to hear someone complain that I CT'd a classic story I would just blow it off. Overall have a decent relationship with the specialists now at the community hospital than I did in residency. I still agree with much of what is said. If you want to be looked at as the star of the hospital than don't do EM.

Yes exactly.

"You called me for an appy, what does the CT show!? What? You didn't get one and just called me? Please order it immediately."

Or:

"Stupid ER doctor just orders CT scan for a clinical diagnosis."

Can't win.

Surgical intern mouthing off like that. Comical. I'm a very hands-off guy, but that would be something I would make sure finds its way back to the program director right after a direct confrontation in the ED in front of anyone who is there.

I wouldn't tattle tell. Makes us look weak and inferiority complexed, which we are to an extent. Plus, his PD may officially reprimand him but deep down have the same belief. "Listen champ, I agree with you but it's unprofessional to say that publicly."

 

[EMDOC17]

Yes exactly.

"You called me for an appy, what does the CT show!? What? You didn't get one and just called me? Please order it immediately."

Or:

"Stupid ER doctor just orders CT scan for a clinical diagnosis."

Can't win.

My favorite was in residency. A patient got an outpatient CT that said they had an acute appendiciitis. Story was weird and really didn't think it was an appy. Still have an imaging study that shows acute appendicitis from an outpatient doc. Called surgery who told me how dumb I was (told them I had low suspicion but they needed to see the guy.) They proceeded to take the patient to the OR and take out their appendix. Few days later the same surgeon again was condescending about how I called them about the "appendicitis". The surgeon had just taken his appendix out a few days before! I was concerned enough to call he was apparently concerned enough to cut the guy. Crazy. Either way I am glad to have a much better relaxation shop with the surgeons outside of residency.

 

[alpinism]

Yes exactly.

"You called me for an appy, what does the CT show!? What? You didn't get one and just called me? Please order it immediately."

Or:

"Stupid ER doctor just orders CT scan for a clinical diagnosis."

Can't win.





I wouldn't tattle tell. Makes us look weak and inferiority complexed, which we are to an extent. Plus, his PD may officially reprimand him but deep down have the same belief. "Listen champ, I agree with you but it's unprofessional to say that publicly."

Exactly.

Where do you think he got that idea from?

If the intern thinks EM docs are triage nurses then chances are so does the chief resident, program director, etc...

 

[TooMuchResearch]

I'm on surgery rotation and the surgeons are constantly ripping the EM docs. They don't outright say they don't know what they are doing, but they're always complaining about them, their diagnoses (or lack thereof), and how often they are calling in consults.

Is this common where you are? Frankly, I was a bit surprised to see such disdain surgery has for EM physicians at my hospital.

So far our surgeons have been quite friendly by phone and to my face. Couldn't tell you what they say in private.

 

[dpmd]

I glanced over this and There should be ZERO reason why a surgeon would complain about an EM doc's work up/consult. I can't remember the last time I consulted a surgeon unless they needed to actually do surgery.

Now a days with all of the imaging, when I call a surgeon its because they have a diagnosis on CT or the like.

Where is the room to complain? CT says appy/bowel obstruction/something surgical, I call them. CT neg, I send them home or admit to medicine for intractable pain/vomiting.

Surgeons doesn't have to think much given all of our imaging now adays.

If every consult from the ER was perfectly on point then complaining would be silly, however you are fooling yourself if you think that is the case. In residency there is a lot of complaining that is in reality just because of having to do more work for no extra money even though that work is legitimate. However, there is also stuff like a middle of the night consult for choledocholithiasis (that patient requires GI evaluation and likely ERCP prior to surgery but guess which specialist the EM doc hasn't called yet because they think the patient has acute cholecystitis despite telling me about the elevated bili and large CBD) or chronically incarcerated hernia in a medical train wreck of a patient (who needs elective repair if they ever are medically well enough to tolerate risk of surgery). Still not a good reason to be a dick to anyone or badmouth the specialty but is a legitimate complaint.

 

[Angry Birds]

If every consult from the ER was perfectly on point then complaining would be silly, however you are fooling yourself if you think that is the case. In residency there is a lot of complaining that is in reality just because of having to do more work for no extra money even though that work is legitimate. However, there is also stuff like a middle of the night consult for choledocholithiasis (that patient requires GI evaluation and likely ERCP prior to surgery but guess which specialist the EM doc hasn't called yet because they think the patient has acute cholecystitis despite telling me about the elevated bili and large CBD) or chronically incarcerated hernia in a medical train wreck of a patient (who needs elective repair if they ever are medically well enough to tolerate risk of surgery). Still not a good reason to be a dick to anyone or badmouth the specialty but is a legitimate complaint.

There should be a thread about stuff like this. Not to bash us. But to educate in a polite manner like you are doing.

Question however. I usually consult GI and then give surgery a call to see the patient in the morning. And then admit to medicine. I'm talking about choledo.

Would this upset you? I feel that the hospitalist wants all this.

By the way, if you guys talked to us nicer, well, you catch more flies with honey. Like, "Hey bro, just want to give you a heads up for the future..."

 

[dpmd]

There should be a thread about stuff like this. Not to bash us. But to educate in a polite manner like you are doing.

Question however. I usually consult GI and then give surgery a call to see the patient in the morning. And then admit to medicine. I'm talking about choledo.

Would this upset you? I feel that the hospitalist wants all this.

By the way, if you guys talked to us nicer, well, you catch more flies with honey. Like, "Hey bro, just want to give you a heads up for the future..."

My preference would be that hospitalist admits, contacts GI first thing in the morning unless there is cholangitis and emergent ERCP is warranted, then hospitalist can call me after the ERCP is done since I can't operate until the next day anyway. Since GI here likes to dick around with MRCP and stuff even when ERCP is clearly warranted, sometimes ERCP isn't done until the next day (or later). Which means that call I got at 3 am leads to a patient I can't even operate on until the day after. So my wednesday call instead of just making thursday busy now ruins my weekend. I would much rather the friday call person take that patient. But I recognize that the hospitalist presses for stuff sometimes. In that case I much appreciate the guys that pool those calls till the end of their shift (if a phone call is required per protocol) or just text me the consult (sound is off at night so I don't get those until the morning and the added benefit of having the info handy so I can't forget who I need to see). Just like in residency when sometimes any specialty resident was forced to call on something they didn't really felt needed a consult and if they mention that to you when they call it helps you not get so frustrated about it (or like I hope it helps when I call the ED to let them know why I sent someone over from my office for something that might be bad or might be dumb) I like it when they me know the hospitalist is making them call and wake me up. Then I know to focus my educating efforts on the hospitalists requesting consults prematurely (part of which is my colleagues' fault for being difficult about taking floor consults while on call since they felt they were just on emergency room call).

 

[emergentmd]

If every consult from the ER was perfectly on point then complaining would be silly, however you are fooling yourself if you think that is the case. In residency there is a lot of complaining that is in reality just because of having to do more work for no extra money even though that work is legitimate. However, there is also stuff like a middle of the night consult for choledocholithiasis (that patient requires GI evaluation and likely ERCP prior to surgery but guess which specialist the EM doc hasn't called yet because they think the patient has acute cholecystitis despite telling me about the elevated bili and large CBD) or chronically incarcerated hernia in a medical train wreck of a patient (who needs elective repair if they ever are medically well enough to tolerate risk of surgery). Still not a good reason to be a dick to anyone or badmouth the specialty but is a legitimate complaint.

I get it. I would love to do the right thing. I would love to do what is right for the pt. But this is what I get when I admit a Choledoco, and yes, I know they don't need surgery tomorrow.

Internist - "Can you call GI and have GS on board. Thanks".
Me (early on) - Its 1am, can you consult GS in the Am if you need it
Internist - "Yeah but I had a bad case and needed GS, so please call GS before I see them"
Me (now) - Screw it, Im calling what IM wants

 

[dpmd]

I get it. I would love to do the right thing. I would love to do what is right for the pt. But this is what I get when I admit a Choledoco, and yes, I know they don't need surgery tomorrow.

Internist - "Can you call GI and have GS on board. Thanks".
Me (early on) - Its 1am, can you consult GS in the Am if you need it
Internist - "Yeah but I had a bad case and needed GS, so please call GS before I see them"
Me (now) - Screw it, Im calling what IM wants

See my last post. Letting me know you know it is choledocho and that GI has been called too because the hospitalist is being a punk makes me feel much better about it. The call I get annoyed by is the one where the EM doc seems to not recognize choledocho (which likely means hospitalist was told acute chole and that means no one is calling GI until hospital day 2 when I look in the computer for the GI consult and see none is there and contact the hospitalist to find out why not. Why hospital day 2? Because I don't see them hospital day 1 because I won't be doing anything to them until after the ERCP so it saves me a little time to skip them until I see the report in the computer).

 

[TheComebacKid]

I'm married to a surgical consultant, so I have a keen sense of how derailing it is to get a call in the middle of the night from the ED, for sometimes what appears to be a really stupid reason. Only to have to show up early the next morning to round and have a full OR schedule. It's a thankless job, and it ruins family time, sleep, and overall morale. You feel like you are at the mercy of someone else.

But I've also noticed how there is this expectation from some consultants that every consult they get is neatly packaged with a bow on it before they will even entertain talking to you. "Get the UA first and then I'll come see the patient." "Call me back after you touch base with GI". "Can you make sure you make OB aware before you send the patient up?"

I know that consultants have gotten some really bad consults as well, and I know their time is limited and they aren't sitting around on their butts waiting for more work to do. I recognize that. I recognize they have gotten the consult for "I'm concerned for acute abdomen" and then the ED person didn't even press on the patient's abdomen (inexcusable). I recognize that when they come in to see the patient in the middle of the night, they are still showing up to work for a full day at 5AM, while I am going home and going to bed.

But I think most of our consultants have a very convoluted idea of what the role of the EM physician is, especially at the bigger academic centers. We are here to complete the workup insofar as it tells us if there is an emergency or non emergency. Once we know whether the patient needs to be admitted or discharged, we are pretty much obligated to see the next patient in the waiting room, who may potentially have a life threatening emergency. I'm happy to provide basic management of non emergent things in the ED like pain control, and throw in basic labs/imaging for our consultants. But if I'm going to have to choose between seeing another patient in the waiting room and keeping the department moving or calling "GI to get them board" non emergently you can bet your ass the patient is getting admitted and the hospitalist is calling GI in the morning.

Calling GI non-emergently versus seeing a new patient in the waiting room with chest pain... Please consultants, please try to see why sometimes we don't have all the ducks in a row before calling you.

 

[dpmd]

I can't win. Patient admitted for choledocho from the ED with a hospitalist and a GI consult. No surgeon called which is great. GI for some reason gets a hida which shows no tracer reaching the intestines and for some reason decides no ercp so the hospitalist calls me on my Wednesday call for a lap chole because she still hurts (obviously she does because she has an obstructed cbd). So I let them know she needs ercp. GI decided to order mrcp which didn't get done till today so that is going to delay things more. It isn't like I wanted to do something fun this weekend that was supposed to be off.

 

[southerndoc]

Our hospital enacted a policy that choledocho gets admitted to surgery upfront (unless they have some other medical issue that takes precedence). Rationale being that (a) it's ultimately a surgical problem and needs operation prior to discharge and (b) if the surgeons are running the show there is usually less d**king around with unnecessary studies like HIDAs and MRs.

There is a study out there somewhere that they based this on - that study was able to show decreased LOS and decreased costs if the patients are admitted to surgery.

Can you please cite a reference to this? My institution has started admitting them to medicine. They get an MRCP +/- ERCP and sometimes are discharged without surgery. Would be curious what the difference in LOS is.