Y2KPSD

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Have you guys seen this in the IM forum.

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Yes, you all know what I'm talking about. Come shift change, the ER decides to admit ALL of their patients at once. Obvious admits sit in the ER for 12-14 hours with nothing being done (the "not sick" branch of the "sick-not sick" triage algorithm apparently doesn't extend to actual diagnoses or interventions) and then get urgently dumped at 6 pm with the ER screaming for admission orders stat. Or worse yet, that guy who came in at 9 am the day before and got 150 mL of NS running at KVO, MUST absolutely make it to the floor this very minute at 6:45 am.

I mean, how ignorant and disrespectful can you get to your IM colleagues...




http://forums.studentdoctor.net/showthread.php?t=298380
 

docB

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Duly noted.

That's life in the fish bowl.

If it's not on the EM board I don't care.
 

beyond all hope

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Everyone has their good days and bad days, and everyone has times that they need help.

For every ER dump medicine gets, we will get a clinic dump, and vice-versa. We all get overworked or just brainfried at different points in the day or night and start dumping. The best way to handle this is realize that we're all in it together, and we're all here for the patients.

I rely on the PMDs to do nonemergent outpatient workups for my patients that I shouldn't be doing in the ED. They rely on me as a safety net in case their patients get emergently sick.

I've done some crappy admissions, and I've seen some pretty bad clinic dumps. On the other hand, I've taken the extra time to people home who I could have admitted, and I'm sure a lot of PMDs have taken their time to work up their patients as outpatients.

We just have to remember that the real victims are the patients. E.g. having to drive to the ER when they didn't need to, having to stay in the hospital when they didn't need to.

And yes, sometimes we all have to vent...
 

NinerNiner999

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I can't speak for other hospitals, but where I work, this often means the patient has been posted for a bed for a while and no resident has come down to see them...
 

bulgethetwine

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NinerNiner999 said:
I can't speak for other hospitals, but where I work, this often means the patient has been posted for a bed for a while and no resident has come down to see them...

DFTT.
 

ERMudPhud

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Whatever...

If they want to troll here by all means let'em have it but if they're just venting on their own forum I could care less. I guess one cure would be to call in the admissions at 3,4,5 AM instead of trying to let the oncall team get some rest and call at 7. I know in my resident days I used to do that if there wasn't any urgent need to move the patient. Now I have hospitalists that are awake all night like me so it really doesn't matter when I call.

One defense I can make for the "dumping syndrome" I've noticed in myself. If its very early in the AM my thinking probably isn't at its peak. I may have a borderline patient who I've been holding on to for several hours trying to figure out if anything is really wrong and prove to myself that they are safe to go home. At sign out my fresher colleague may point out that there is no way said patient can go home. Or, I may realize that in my current foggy state I just can't figure out what is wrong with the patient but I'm uncomfortable with them going home and I punt to the fresh AM hospitalist. None of us are perfect, we all have our weak moments, and those moments are probably more common in the early AM when we are feeling a bit foggy.
 

willlynilly

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beyond all hope said:
Everyone has their good days and bad days, and everyone has times that they need help.

For every ER dump medicine gets, we will get a clinic dump, and vice-versa. We all get overworked or just brainfried at different points in the day or night and start dumping. The best way to handle this is realize that we're all in it together, and we're all here for the patients.

I rely on the PMDs to do nonemergent outpatient workups for my patients that I shouldn't be doing in the ED. They rely on me as a safety net in case their patients get emergently sick.

I've done some crappy admissions, and I've seen some pretty bad clinic dumps. On the other hand, I've taken the extra time to people home who I could have admitted, and I'm sure a lot of PMDs have taken their time to work up their patients as outpatients.

We just have to remember that the real victims are the patients. E.g. having to drive to the ER when they didn't need to, having to stay in the hospital when they didn't need to.

And yes, sometimes we all have to vent...
cant we all get along?
 

Jeff698

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willlynilly said:
cant we all get along?
Actually, after having read the posts in both fora, this is a pretty respectful discussion compared with others. There was a minimum of pissing for the sake of pissing and a fair amount of "yeah, the job sucks but let's try to do the right thing and move on".

I just started my second year. In my program, this means we're getting our butts kicked with 8-12 patients at a time, many of them seriously sick. This is a real change from intern year when we had more help from our third years. This is a high-yield part of my education but right now I'm frequently struggling to keep my head above water and not let badness happen to my patients. As I read the OP's rant, I knew I was guilty of doing this from time to time. I have a stable patient that I know needs to come in but I also have 9 other patients that I'm still working up. Should I have gotten the stable admit in earlier? Sure. It just didn't happen. It's July. It sucks but it'll get better.

Take care,
Jeff
 

ER-ER-Oh

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Just remember: We are seen and judged by every specialty in the hospital. They all come down to the ED to do consults and admit. We NEVER go and watch them work.

But this is what makes us solid. We're the only ones who get it. You have to be more confident as a human being in general to stand up to constant scrutiny and criticism. To do that you just need to be good, work harder, try to know more. If you do that nobody will have the ability to make you angry, or to make you flinch. You have nothing to prove to anyone other than yourself. Enjoy it.
 

signomi

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Just remember: We are seen and judged by every specialty in the hospital. They all come down to the ED to do consults and admit. We NEVER go and watch them work.
Come on up to my office...shift work gets lonely. ;)
Extra points if you bring coffee.