Proper smart-ass response to...

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theworst22

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your inpatient Internal Medicine team that won't stop whining about how bad the ER is at diagnosing, testing, and treating patients: They did a CT for that? They did a VQ for this? Why did they want to admit this guy? What antibiotic did they start !?!?!
They then look at me, knowing my interest in ER and say, "Don't be like that." I normally pride myself on my sarcasm, but I've been coming up empty so far.
 
Ask them the last patient they gave steroids to.
Ask them about anything dermatological.
Ask them to run a code.
 
Also, ask them about having to manage more than one patient at a time, and having to make actual decisions at the drop of a hat instead of after mentally masturbating about the causes of hyperkalemia for hours on end.
 
Dr. Will said 'mentally masturbating'...

sweet.
 
Dr. Will said:
Also, ask them about having to manage more than one patient at a time, and have to make actual decisions at the drop of a hat instead of after mentally masturbating about the causes of hyperkalemia for hours on end.
Click to expand...

that one pt at a time also takes an hr to admit.....boo hoo we had 8 admits overnight.....guess what, I sent you all of those with the workup and plan basically completed and saw 22 other pts in the same time period.......
 
theworst22 said:
your inpatient Internal Medicine team that won't stop whining about how bad the ER is at diagnosing, testing, and treating patients: They did a CT for that? They did a VQ for this? Why did they want to admit this guy? What antibiotic did they start !?!?!
They then look at me, knowing my interest in ER and say, "Don't be like that." I normally pride myself on my sarcasm, but I've been coming up empty so far.
Click to expand...


Ask them if they'd like to see the 70% of patients that don't get admitted, but are sent home with appropriate follow-up. If they'd like to remove that decision-making from us, I'd be more than happy to let them take over all my patients (provided I still get paid).
 
My favorite...

Internal Medicine: This patient should not be admitted.....

EM doc: Why not?

Internal Medicine: The last time I admitted a patient with this condition, it took four days to discharge him.

EM doc: Why did it take you four days to discharge him if he didn't need to be admitted?

Internal Medicine: ....(silence)......
 
Look people get annoyed when they do work. The few experiences I have had with regular community docs is nothing like this. They just that you cause thats how they put food on the table.
 
On a similar note.. So at about 5 am I call G Surg to eval a 50-ish female who was febrile with a bili of 2.6 (yellow) and a fever to 39.... She also happened to get diagnosed with a UTI 3 days ago and is on abx.

I call G Surg for a consult and assume the pt will be admitted the

G surg resident "Are you sure the fever isnt from the UTI?"
Me: WTF? "Uh no... I dont know what the source of the fever is but she has only been febrile for 24 hours or so"?

I mean if I could look at a big bad red wound thats one thing.. but I dont know why she is febrile.. I told him I guess it is from the GB (as she has no e/o a UTI.)
 
Anyways as a student I think you have little leeway since your grade is in play. As a resident when I go off service I get this same stuff. Of course you see some stuff that makes you wonder but at the same time I can tell you there are times I want to admit a patient and the admitting service resident doesnt think the person is sick enough.. then they talk to their attending and are like.. wow that person is real sick and needs to come in..it goes both ways and we are residents who are all still learning.
 
theworst22 said:
your inpatient Internal Medicine team that won't stop whining about how bad the ER is at diagnosing, testing, and treating patients: They did a CT for that? They did a VQ for this? Why did they want to admit this guy? What antibiotic did they start !?!?!
They then look at me, knowing my interest in ER and say, "Don't be like that." I normally pride myself on my sarcasm, but I've been coming up empty so far.
Click to expand...

I hope this comment does not bring the wrath of the gods (or more specifically pandabear) down upon my head...

While I agree this sort of thing is annoying, I also think it's pretty important to keep your radar up for tidbits of information. I just finished IM and I saw multiple instances where the ED work-up was just simply incomplete and (please don't hit me) sloppy. Example: elderly pt's transferred from nursing homes and placed on antibiotics for community aquired infections.

I see that the arguments have been made above of breadth of knowledge and the management of multiple patients, both of which are the strengths of EM. I think these are 100% valid.

That said, if the ED made the wrong call they made the wrong call, and as future EM physicians, we owe it to ourselves to try to learn from it.
 
AmoryBlaine said:
I hope this comment does not bring the wrath of the gods (or more specifically pandabear) down upon my head...

While I agree this sort of thing is annoying, I also think it's pretty important to keep your radar up for tidbits of information. I just finished IM and I saw multiple instances where the ED work-up was just simply incomplete and (please don't hit me) sloppy. Example: elderly pt's transferred from nursing homes and placed on antibiotics for community aquired infections.

I see that the arguments have been made above of breadth of knowledge and the management of multiple patients, both of which are the strengths of EM. I think these are 100% valid.

That said, if the ED made the wrong call they made the wrong call, and as future EM physicians, we owe it to ourselves to try to learn from it.
Click to expand...

100% correct but.. There is a nice and polite way to do this and more importantly why dont I yell and scream and belittle the IM or G Surg resident when I am wrong? Also Amory.. it is important to know that what IM considers an "incomplete" workup may not always be an "incomplete" ED work-up. The goals of the fields are different.

When I am wrong I apologize. My 2nd shift as a resident I attempted to admit someone with a Cr of 3 or 4, I failed to look up the previous Cr. I sincerely apologized cause I did my job wrong...FWIW they never apologized to me for screwing up...

BTW I didnt quite get your example?
 
theworst22 said:
your inpatient Internal Medicine team that won't stop whining about how bad the ER is at diagnosing, testing, and treating patients: They did a CT for that? They did a VQ for this? Why did they want to admit this guy? What antibiotic did they start !?!?!
They then look at me, knowing my interest in ER and say, "Don't be like that." I normally pride myself on my sarcasm, but I've been coming up empty so far.
Click to expand...
Granted, speaking as an RT here, but when I get some IM or FP doc who forgets they are not a pulmonologist and proceeded to try to belittle me from a clinical knowledge standpoint; I always ask them to explain the role of dynamic hyperinflation in acute COPD exacerbations or something similarly relatively obscure but important factor in whatever is wrong with the patient.....normally that draws a blank stare and some stammering and then I get my orders for the vent/medication/etc changes I need. What's even funnier is if the staff pulmonologist/CCM doc at one hospital I worked at saw me do this he'd start to laugh at the other doc.
 
I saw this often while off-service in residency.

My thoughts (rarely actually voiced) were that in the time they've spent in rounds or morning report dissecting every possible "mistake" the ED made, we would have evaluated, treated and dispoed several patients.

Another is that I would honestly and sincerely invite anyone else from another service who thinks they can do my job better than me to come on down and do it! I'd love to see any of them come down to our busy ED and work one shift start to finish. I think then the truth would set them free. I know it would be ugly.

The internist, surgeon and other specialists could do many aspects of my job as good or better than I could. None of them could do all of them nearly as well. Not even close. That is the point that is always lost on the critics.
 
It goes both ways. I got called to the ER for a possible case of "necrotizing fascitis". I thought, wow that's pretty wild I haven't heard that thrown around in awhile and I was in the lounge so I didn't ask any questions and checked it out.
Patient had a high WBC count and shoulder pain and they couldn't figure it out and had to have an ortho consult. No skin lesions or cuts, no swelling, full range of motion of the shoulder and elbow. I asked one question to the patient.
When does your shoulder hurt? They replied, "Only when I cough or take a deep breath."



Everyone makes mistakes and no one is above 2nd guessing or a smart ass statement to the contrary. But that being said, laziness or lack of any sense of knowledge above the level of a MS3 will not grant any quarter from me.
 
theworst22 said:
your inpatient Internal Medicine team that won't stop whining about how bad the ER is at diagnosing, testing, and treating patients: They did a CT for that? They did a VQ for this? Why did they want to admit this guy? What antibiotic did they start !?!?!
They then look at me, knowing my interest in ER and say, "Don't be like that." I normally pride myself on my sarcasm, but I've been coming up empty so far.
Click to expand...

...not being an ass, but the truth is get over it. it's the rest of your life if you choose EM. develop tough skin and realize that they don't/can't choose not to do our job, so they don't have the right to "monday morning quarterback" us.

EM/IM is a constant battle as is IM/surgery, IM/Peds, etc..
 
DropkickMurphy said:
Granted, speaking as an RT here, but when I get some IM or FP doc who forgets they are not a pulmonologist and proceeded to try to belittle me from a clinical knowledge standpoint; I always ask them to explain the role of dynamic hyperinflation in acute COPD exacerbations or something similarly relatively obscure but important factor in whatever is wrong with the patient.....normally that draws a blank stare and some stammering and then I get my orders for the vent/medication/etc changes I need. What's even funnier is if the staff pulmonologist/CCM doc at one hospital I worked at saw me do this he'd start to laugh at the other doc.
Click to expand...

What's the air speed velocity of a swallow?
 
edinOH said:
in the time they've spent in rounds or morning report dissecting every possible "mistake" the ED made, we would have evaluated, treated and dispoed several patients.
Click to expand...


And, ever since we got that new Troybuilt Chipper-Shredder, we've been disposing tons of patients everyday! Seriously, I don't know how we used to get by before.
 
My favorite quote from my medicine attending:

"Those ER docs are horrible doctors. Sure, they save a lot of lives, but they're horrible doctors." (Emphasis added.)

Isn't that the point?
 
Yes, I see this all the time as an ER resident rotator. It comes with the territory of EM. I have heard something like "I'm sorry that the ED only did 90% of your work for you, we will try to do better next time". In reality who really cares what they think as long as they do what you want. I always love to pull out the "I'm sorry, I'm just a stupid ER doc but......" that usually ends up getting the patient onto the right service.

We do make mistakes too, just like everyone else. It is just that when medicine makes the mistake they are the only ones who notice. Our mistakes are noticed by everyone we may admit to.
 
theworst22 said:
your inpatient Internal Medicine team that won't stop whining about how bad the ER is at diagnosing, testing, and treating patients: They did a CT for that? They did a VQ for this? Why did they want to admit this guy? What antibiotic did they start !?!?!
They then look at me, knowing my interest in ER and say, "Don't be like that." I normally pride myself on my sarcasm, but I've been coming up empty so far.
Click to expand...


If I were in that situation, I'd ask them why or what they'd do differently (not in a smartass way, but because you want to learn). I've seen really good EM docs asking the IM docs questions all of the time.
 
I hate that see Im an EM/Im combo resident the EM's awesome the IM generally suc's and I love when one comes down to the er to work the night shift with, I have to handle all the trauma that comes in because he only does medicine what ever the he#$ that means+pissed+
 
I guess I'll bite.

The other day I admitted a patient straight from the ER. I usually like to go down and eye ball them but this one sounded legit.

The story was a 70-some year old man with COPD on chronic steroids, in excacerbation satting in the 80s in some amount of O2.

Sounds pretty legit, right?

Reality was that this guy came to the ER for something else (I forget what). He had IPF, was on home O2, felt like baseline. Had been on steroids for years. He was home the next day.

The med student on the team at that time was going in to EM. She actually pointed out how lousy that workup had been, which I thought was cool. I think the point is that some EPs ruin it for the great majority. Much of my distrust of the stories I get over the phone comes from the same one or two EPs that chronically over-sell every patient.

Honestly, I think it's just one symptom of an overworked health care system. IM, G surg and EM all work long, hards, sometimes thankless, hours and that's what's causing the friction.

I'm just working on growing thick skin. Living well is the best revenge.
 
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