Lack of respect

[dartmed]

Out of curiosity, how do most of you handle when other specialities don't "respect" you? For example, I had a snarky colleague who recently said, "well ED physicians don't do much apart from consulting others in the hospital." I have found this to be highly offensive. I am an incoming EM resident and I know EM physicians do so much more than that. How do we change this perception?

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[deleted859535]

Out of curiosity, how do most of you handle when other specialities don't "respect" you? For example, I had a snarky colleague who recently said, "well ED physicians don't do much apart from consulting others in the hospital." I have found this to be highly offensive. I am an incoming EM resident and I know EM physicians do so much more than that. How do we change this perception?

EM has been around for decades. Better now. Just do a good job and ignore the idiots. Life is too short.

 

[CliveStaples]

I find that the only consultants who say things like this are in fact just frustrated with their own roles. It also stems from their narrow perspective of what we do. The surgeon has no idea how to manage 1st trimester vaginal bleeding; the internist has no idea how to manage a trauma code; the neurologist has no idea how to manage septic shock on multiple pressers.

This is no fault to these specialties; they have a different role than we do. But we are resuscitationists first and foremost, and the end point of many successful resuscitations is a hospital admission. Now come see your patient.

 

[Fox800]

It's ok to stand up for yourself without coming off as an ass. Our surgery, OB, and medicine rotations were the worst about this - it's like they would forget we were sitting right next to them in the work room.

It helps to have strong EM leadership that doesn't put up with that. Snarky phone calls by residents here are met with phone calls by our faculty. All calls in and out of the ED are on recorded lines. Conflict between our residents and other attending are taken up by our attendings.

Our staff have had to remind consulting residents that we are consulting their staff, not them...and that consulting residents don't get to veto our push to admit a patient, especially if they haven't staffed or even seen the patient yet.

 

[nlax30]

As a specialist I agree with what’s been said above. Early in IM residency we certainly had our time of ragging on the ED though that tone tended to change the further along we got in training and closer to being out when we truly realized that we all have a different set of skills and role to play in managing these patients and that I have my own knowledge gaps in areas outside my speciality. I try and put myself in others shoes and if I find myself thinking of or about to say something snarky I just remind myself that I could just as easily be on the receiving end from the many consultants I’ve asked to see a patient I was managing.

In IM we had the same problem with inpatients and receiving some of the same attitudes from certain specialists. Thankfully it was the exception not the rule, and usually just the same few specialists who likely had an underlying personality disorders to begin with.

 

[dartmed]

The thing that bothers me the most though is when respected attendings actually rub off their bad attitudes on students/residents. You would think they would act in a much more mature manner than say, medical students, but alas it seems like expecting professional behaviour might be too much of an ask, at times. I will just ignore it, I suppose

 

[Hamhock]

Show them respect. Ask for their help more than give admissions or demand consults.
Be the best EM doc you can be.
Help out other services and show your skills in "their domain".
Be assertive but not aggressive.
Let the rest go.
HH

Addendum: my comments seem like fluff; but if you think so, read the many threads below in which we show contemptible attitude (e.g. the thread about never putting in a central line in shock patients/making "them do their job") and then re-read my comments.

 

[chillaxbro]

They can talk all the **** they want, they still getting an admission

 

[Groove]

All I can say is...Know thy value. Don't just say it... internalize it. Until you do, you'll always have uncertainty and lack confidence. Once you truly understand the value of your specialty, and your place among all the other specialists, you cease to stop caring what other people think. It's a wonderful feeling. The pt's notice it.. nurses notice it... other specialists notice it. If you're really good at what you do, you'll earn plenty of respect from your consultants and other physicians in the hospital, but that really should be a by-product of your work and not an end goal.

I see this question a lot among medical students and residents who just haven't quite "gotten it" yet. That's fine and honestly it's a bit more understandable within academic centers where disparagement and condescension is commonplace during "resident consults" but you'll notice much less of this sort of thing when you get out in community private practice.

 

[GeneralVeers]

I find sometimes asking for help on a patient I intend to discharge goes a long way. "I have Ms. X here who has this history and is on X mg of this drug. I think she can go home, but I'd like your help to arrange safe discharge". Often they are ecstatic that they've been able to help arrange an outpatient plan over the phone that avoids an admission. It is especially useful for OB/GYN patients. I can often get the specialist at 2AM to agree to see the patient in the office rather than admit. Of course I document this in the chart prior to discharge.

 

[Angry Birds]

I no longer believe in this groveling attitude of asking “for your help, your highness.” If I’m calling you for a consult or admission, you’re not doing me a favor. You’re doing your damn job.

I agree with Groove who said knowing your own value and internalizing it. I’m good at what I do, and I don’t need the confirmation of someone outside my specialty. How can they judge what they know not?

 

[EM2be1957]

As a surgery prelim, I see this attitude with my co-residents (and attendings :/) all the time. I think it mostly extends from already being the busiest service in house, then being consulted by the ED and having to add even more work to their long list of things to do. They're just mad that they have more work.

My program doesn't have an EM program, so I think the culture here is a little different. Even from my inside view of both surgery 'and' EM, it seems that the ED relies on surgery a lot for things that I KNOW ED physicians can manage, ie somewhat complicated laceration repairs and I&Ds, chest tubes, dislodged g/j-tubes, etc. So I can understand how that can get frustrating. A lot of the department is run by midlevel providers and family medicine physicians, with limited EM trained physicians, so I think this may have something to do with it as well?

They know I reapplied/matched EM, and they still make negative comments around me, and then end it with "but no offense." As if that helps, lol. They always tell me, "I wish you would stay with us for surgery; I hate losing a good resident to EM." I hate the mentality. I've just tried my best to show them a different perspective and that EM physicians ARE smart and hard working. I've found that some of them have even begun asking the ED attendings clinical questions and for help, which before they wouldn't respect most things they said.

I guess my point is, everyone just needs to understand where the other is coming from. And OP, on rotations or as a resident, my plan is just try to bust their misguided perception of ED physicians by being the opposite. Work hard, be smart, know your information, be able to defend your stance with clinical evidence, take charge, take initiative, etc.

 

[Angry Birds]

My program doesn't have an EM program, so I think the culture here is a little different. Even from my inside view of both surgery 'and' EM, it seems that the ED relies on surgery a lot for things that I KNOW ED physicians can manage, ie somewhat complicated laceration repairs and I&Ds, chest tubes, dislodged g/j-tubes, etc. So I can understand how that can get frustrating.

Yeah, but is the rule that we should only consult them for things we absolutely can't do ourselves? If you have an extremely busy ER and a complex laceration comes in, this could tie up the entire ER if the ER doc is stuck repairing that for an hour.

See, the thing is, I'm willing to bet that if you ask the higher ups, they intend for the system to work this way, i.e. consult specialists for such long, complex procedures. I mean, if you ask the head of surgery, I'm willing to bet they would say, "Yes please, our service is willing to help out in any way possible." It's just the surgery minion-on-call that thinks to himself that he should only be consulted for things that only he can do, as if that includes anything in the ER. The surgery minion-on-call makes himself feel miserable by imagining that this is the standard and then he gets angry when he constantly gets paged for other than this imaginary standard that he himself created in the first place.

 

[EM2be1957]

I don't disagree with that. I think the program I was at is different than others in that we don't have a separate trauma team, consult team, floor team, etc. So the person taking consults also goes to all the traumas, operates for emergency cases, responds to emergent pages on the floor, all codes on the floor, so maybe for us it was a fault of how everything was set up for this specific program. But I still think it comes from a lack of understanding/perception of each other. If the ED is busy, it's likely the surgery consultant is also busy with consults. If surgery is busy, they can't come see your non-emergent laceration right away, which in turn just keeps the patient waiting in the ED, which creates the same problem? I'm still an underling so if you have a different insight, feel free.

 

[GonnaBeADoc2222]

Out of curiosity, how do most of you handle when other specialities don't "respect" you? For example, I had a snarky colleague who recently said, "well ED physicians don't do much apart from consulting others in the hospital." I have found this to be highly offensive. I am an incoming EM resident and I know EM physicians do so much more than that. How do we change this perception?

I think about how I'm making probably 2x their hourly pay and working 1/3 the hours.

 

[alpinism]

You'll see as you go further along in training that there are a lot of poorly trained and/or lazy EM docs that make us all look bad.

Its far easier and better for business to consult out procedures and go see another 2 patients with URI symptoms instead.

 

[GonnaBeADoc2222]

In all seriousness though, this stuff is rampant in academic centers, but definitely less in the community.

I have great working relationships with my cardiologists (text them EKGs all the time), obgyn (frequently calling them to arrange outpt followup for 1st T bleeds, etc), ENT, Uro (honestly some of the nicest consultants I have, whereas in residency the uro residents were complete a**holes), etc.

Most often push back comes comes from a trainee, most of whom have no idea what they are talking about and haven't done the basic minimal task of seeing the patient.

Scenario: ICU PGY2 doesn't want to admit.

Solution: Me - "Come see the patient. If it's a problem, have your attending call me."

Result: Patient admitted to the ICU

 

[Birdstrike]

Out of curiosity, how do most of you handle when other specialities don't "respect" you? For example, I had a snarky colleague who recently said, "well ED physicians don't do much apart from consulting others in the hospital." I have found this to be highly offensive. I am an incoming EM resident and I know EM physicians do so much more than that. How do we change this perception?

What you want to say is, “Well, if it’s so easy why don’t you try to work the next 7pm to 7am shift here, jacka*ss? Oh? You never would? Why not?”

“Because I’m sure you’d know exactly what to do when EMS brings a blue baby in at 3am and there’s no PICU doc within 60 miles. And you’d know exactly what to do when a few minutes after that someone yells into the dying baby’s room that some punks dumped off their overdosed tat-painted buddy out of the back seat of their low rider with no explanation and drove off. And I’m sure you’re totally bada** when a non-English speaking woman comes in with belly pain and squirts a gasping-breathing fetus somewhere between 18-24 weeks old and you scream ‘NICU! NICU!’ do a few cartwheels until the charge nurse tells you the nearest NICU is 30 miles away. Because you’re awesome at intubating premies, and doing umbilical lines without having to change your depends.”

But you can’t say that. You just smile, walk away and do your job. Give your self credit, a LOT of credit even if others don’t.


Hardest job in Medicine. Hands down.

 

[Angry Birds]

You'll see as you go further along in training that there are a lot of poorly trained and/or lazy EM docs that make us all look bad.

Its far easier and better for business to consult out procedures and go see another 2 patients with URI symptoms instead.

I work in a place where I can’t consult anyone, except a few specialists I can just phone consult. But, even so, I can see how it would make all the sense in the world for an ER doc at a bigger hospital to consult out some long procedures in order to see a legion of other patients, not just two patients with URI symptoms.

 

[anbuitachi]

show them your pay checks! you get paid a lot more than most docs in the hospital. rub it in their face

 

[DoubleBogey]

In the community, anytime you guys call with an admission - we take it, no push back unless they need tertiary care/management required d/t lack of resources/specialists - but this practice environment is after completing residency. Certainly during residency there was always a battle between ED and admissions - likely from lack of added compensation for more work and/or the attendings pushing back and channeling it through the residents.

Like in most fields, life and work get better after residency training.

 

[Angry Birds]

In the community, anytime you guys call with an admission - we take it, no push back unless they need tertiary care/management required d/t lack of resources/specialists - but this practice environment is after completing residency. Certainly during residency there was always a battle between ED and admissions - likely from lack of added compensation for more work and/or the attendings pushing back and channeling it through the residents.

Like in most fields, life and work get better after residency training.

The hospitalists at my hospital right now are fantastic. One of them will even admit a corpse if I ask him to.

 

[emergentmd]

Not this again.

If we are so worthless and useless, why do the new ones always come in begging for referrals from me?

 

[Redrox]

It's something that bothered me more when I was in training, and also something I stopped seeing once I was out.

Working with the same docs over the years, when I pick up the phone for a consultant it's a different vibe when it's both of us on a first name basis with the knowledge that we're gonna be talking to each other for years.

For the specialists who come into the ER rarely, they understand they come in rarely and it's my house and my place and are generally extremely respectful.

 

[emergentmd]

Ortho loves me when I reduce all their fractures
Optho loves me b/c I do all eye exams
Cardiothoracic loves me when I put in their chest tubes
IM loves me when I intubate their patients and put in their central lines upstairs (if they are really nice to me)
Plastics loves me b/c I suture anything anywhere
Cards loves me b/c I cancel all the bogus Stemi alerts from EMS
OMFS loves me when I reduce their TMJ dislocation

I feel I am the favorite specialty in the hospital. IM may hate when I call them but everyone else, I save them from coming to the ER.

In residency they complain b/c the ER creates work for them. IN the community, they love us b/c we decrease their work load.

 

[siliso]

They don’t see all comers and dispo 3/4 of them without further bother to others like you do. They are whining whiners. But most of them would acknowledge this and how much you do for them and the patients if you caught them at a non-pissed/overstressed moment. Don’t take it personally.

 

[Angry Birds]

I honestly think we should have all conversations to specialists and hospitalits recorded for “quality control.” We did this briefly at one of the hospitals I worked for (in the academic setting).

“Hi this is Dr angry birds, just wanted to let you know that you’re on a recorded line. Is this Dr so and so?”

You can’t imagine how much nicer people became, and also how they finally just did their job without all the whining.

 

[The White Coat Investor]

Out of curiosity, how do most of you handle when other specialities don't "respect" you? For example, I had a snarky colleague who recently said, "well ED physicians don't do much apart from consulting others in the hospital." I have found this to be highly offensive. I am an incoming EM resident and I know EM physicians do so much more than that. How do we change this perception?

Get your loving at home.

 

[Gastrapathy]

There's only one thing an EM MD has to (not) do to keep me happy. Don't call to give me a "heads up" between 2300-0600. Call if you need my help anytime but I don't need to know what I need to do in the am at 0200.

Once the new attendings learn that, we are good. The residents...well, their "heads up" calls are really consults cause they're nervous about something. So that's ok too (unless the attending said not to call, which actually happened last week. She was pissed, I was amused).

Most consultants take call for several days in a row and work many more hours than EM. We don't work nearly as many nights. If you can help protect our sleep, we really do appreciate it.

 

[Doctor Christmas]

There's only one thing an EM MD has to (not) do to keep me happy. Don't call to give me a "heads up" between 2300-0600. Call if you need my help anytime but I don't need to know what I need to do in the am at 0200.

Once the new attendings learn that, we are good. The residents...well, their "heads up" calls are really consults cause they're nervous about something. So that's ok too (unless the attending said not to call, which actually happened last week. She was pissed, I was amused).

Most consultants take call for several days in a row and work many more hours than EM. We don't work nearly as many nights. If you can help protect our sleep, we really do appreciate it.

Agreed!! I would despise when attendings say oh call NSG or xyz team to "give them a heads up" or "let them know" about this or that. I'm always like - if
i was that team or attending I would not want to be called! If you are admitting the patient, just like you say or if you have a specific question, happy to help - but calling to give a head's up is annoying and useless

 

[Angry Birds]

There's only one thing an EM MD has to (not) do to keep me happy. Don't call to give me a "heads up" between 2300-0600. Call if you need my help anytime but I don't need to know what I need to do in the am at 0200.

Once the new attendings learn that, we are good. The residents...well, their "heads up" calls are really consults cause they're nervous about something. So that's ok too (unless the attending said not to call, which actually happened last week. She was pissed, I was amused).

Most consultants take call for several days in a row and work many more hours than EM. We don't work nearly as many nights. If you can help protect our sleep, we really do appreciate it.

Fair enough!

 

[emergentmd]

There's only one thing an EM MD has to (not) do to keep me happy. Don't call to give me a "heads up" between 2300-0600. Call if you need my help anytime but I don't need to know what I need to do in the am at 0200.

Once the new attendings learn that, we are good. The residents...well, their "heads up" calls are really consults cause they're nervous about something. So that's ok too (unless the attending said not to call, which actually happened last week. She was pissed, I was amused).

Most consultants take call for several days in a row and work many more hours than EM. We don't work nearly as many nights. If you can help protect our sleep, we really do appreciate it.

I only do Heads up to make the specialists life easier. I would hate to be awaken b/t 12-7a and thus will almost never call them unless they need to come to the ED.

If someone I knows need a consult/admission and its 10pm and not everything is back? Ill page them, tell them that this pt will be admitted, and they can see them in the am. They love this.

 

[ThoracicGuy]

Out of curiosity, how do most of you handle when other specialities don't "respect" you? For example, I had a snarky colleague who recently said, "well ED physicians don't do much apart from consulting others in the hospital." I have found this to be highly offensive. I am an incoming EM resident and I know EM physicians do so much more than that. How do we change this perception?

As a former general surgery resident, the worst calls we would get would be calls just asking for us to "lay hands on the patient". Then when asked if they had any lab work, scan, etc done, the resident would act bewildered that we would want anything done. The next worst call would be if we get called about something and we ask a question about the patient and get told "I don't know, I'm just calling for the guy from last shift. I've not seen the patient."

The residents that took ownership of the patients and did their best to do a workup as far as they could go, I appreciated that. Even with the good consults, it was still painful to get these calls because it meant more work on a busy service.

Now as an attending doing thoracic surgery, I love our EM guys. They'll put in chest tubes that need to be done and will tuck patients in for us if we are admitting or send to the hospitalists otherwise and we can see them in the morning as long as they are stable. There's a big difference between getting that call as a resident and as an attending. Now those calls mean RVUs and potential surgeries. I'll take that any day.

 

[DrMcCoyDO]

The hospitalists at my hospital right now are fantastic. One of them will even admit a corpse if I ask him to.

Please tell me there’s a story behind this.

 

[arandazzo88]

I usually befriend the person. Get them to respect me as a person, and usually they begin to respect my profession because of the personal relationship. The other half of the time I just have to put my ego in check and do my job to the best of my ability.