Putting the Myths of EM Docs to Rest!!

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Kimberli Cox said:
I was muttering something while the nurse was in the room about putting a vac dressing on and she offered to put it on for me.
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Outside of teaching institutions you also find plenty of nurses who take great pride in what they do and the scope of their practice. At times, they can get a bit overbearing, but most of the time the best you can do is to stand back and let them do it the way it is done at that particular place.
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f_w said:
Right, but the RNs won't be able to make a decision about discharge, change in antibiotics or all those other little things licensed independent providers do.
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But they'll sure as hell make suggestions. Such as "when are you going to send XXX home?" "Why don't you switch to this ABx instead of the one you are on" (often this has to do with dosing frequency and or monitoring requirements).
 
Kimberli Cox said:
Its pretty amazing when you train at an academic hospital. I was moonlighting a few weeks back and saw the world's largest decub in consult. I was muttering something while the nurse was in the room about putting a vac dressing on and she offered to put it on for me.

Heck yeah I said, envisoning myself cutting sponges for 45 minutes to fit this beastly wound. She did a great job on it when I checked later.
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I was on the General Surgery service at the VA last December. I was on home call on Christmas and had to come into the hospital FOUR SEPARATE TIMES to reapply a patient's WoundVac (he kept taking it off). Yes, the patient had a sitter. Argh.
 
elwademd said:
here's a you tube clip of an episode of family matters, where steve urkel is wearing a bow tie! :)

http://www.youtube.com/watch?v=1qqYWDalS8k

another non bad ass wearer of the bow tie would have been carlton, from fresh prince of bel air. granted, he didn't wear the bow tie at all times.

castcrewalfonsoribeirokg1.jpg
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Alright, a pre-dent inserting useless statements here, but a poka dotted bow tie with a striped shirt simply looks like ass, not bad ass, you know what I mean? A striped shirt with a normal necktie or a plain bowtie, I think, would be okay.
 
Blade28 said:
I was on the General Surgery service at the VA last December. I was on home call on Christmas and had to come into the hospital FOUR SEPARATE TIMES to reapply a patient's WoundVac (he kept taking it off). Yes, the patient had a sitter. Argh.
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Yeah, but that's the VA. At a VA, if you put someone on "one to one" and happen to come to the floor in the middle of the night, you'll see the "one to one" sitting around chatting with the other nurses. VAs are notorious for having subpar nurses because they're government-run (which means unionized). One of my fellow interns found out that at night at our VA all of the nurses choose one nurse to remain awake and the rest of them go into various empty rooms and go to sleep. They rotate the "awake" duty. Unsurprisingly, we'll go on morning rounds and find that meds were missed or patients had fallen or were covered with stool. The nurses would act harried and overworked, but it was generally because they were trying to catch up on "fake charting" for the night.

Note: before all the nurses go ballistic, I've only ever seen things that bad in the VA. I'm not a fan of our main institution's nurses, but they don't do that stuff. However, it definitely DOES happen at our VA. It's a shame because our vets get extremely sub-standard care and yet the nurses are all paid six-figure salaries (we saw a pay scale chart, so don't say that it's because the nurses are all underpaid).

Oh, and just to get this thread back on course, I was called by the ER last night and told that "the doctor wants you to come see the patient in room 7." It was the charge nurse calling me. I asked to speak to the physician and she instead gave the phone to the patient's nurse, who refused to let me speak to the attending. The nurse didn't know anything additional except the patient's name, age, and gender and they were just getting the vitals. So I went down, saw the patient, and wrote up the consult. As soon as I put the consult into the chart, I saw a guy staring intently at me. I walked away and then turned around and saw him rush up to the chart rack and grab my consult. It was the attending, who hadn't even seen the patient. He then proceeded to dictate it into the computerized records almost word-for-word and his assessment was just the final diagnosis with "will r/o" in front of it. I'm not kidding. I wish I was. It was truly a low point for everyone involved. I'm serious when I say I was actually embarrassed to be associated with the institution he was at.
 
WOW,... I usually just kinda lurk around here,..great entertainment,.lots of food for thought and occasionally I learn something.

I find I grow weary on many of the nursing sites because of all the "cattiness" that I blamed on too many women congregated in one place. (yes,.I am female :D)

It appears that testosterone OD has similar effects!! You gentleman can definitely hold your own against the ladies!!:love: I'm quite impressed,.. carry on boys,.I love seeing the many diverse opinions,.I can usually find something worth thinking about,.or at least something to laugh at in even the most bizarre posts!!

BTW Kimberli,.you're in my prayers dear!!!;)
 
EDRN said:
I find I grow weary on many of the nursing sites because of all the "cattiness" that I blamed on too many women congregated in one place. (yes,.I am female :D)

It appears that testosterone OD has similar effects!! You gentleman can definitely hold your own against the ladies!!:love:
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The only difference is that women don't use measuring tape to settle disputes
 
EM crazy you fail
 
I think EM now need some love after this harsh thread.

This is a big bear hug from a Family Medicine resident

16933.JPG
 
...or we can "hug" another way...

USAKKT-00033.jpg


...If you are hot and have NO TESTICLES:laugh:
 
Just a reminder that the Mods don't necessarily read all the forums and would likely not be aware that there was an issue in the EM forums with a particular user.

If there is a concern about a user or a thread, please use the Report Post function or PM the Moderator of the forum directly (although the former is preferred as a first step).
 
I just found this thread and it was an interesting read. It's been beat to death but let me just say to the OP that that the true bada**es of the hospital are the people who really care about their patients and will go the extra mile for them. A few of these people are found in every specialty and in every other group of allied health workers. After all, patients are sort of the whole point of having a hospital, and our profession is one of service. After all, everyone says in their medical school applications how much they want to help people.
 
WallowaWanderer said:
I just found this thread and it was an interesting read. It's been beat to death but let me just say to the OP that that the true bada**es of the hospital are the people who really care about their patients and will go the extra mile for them. A few of these people are found in every specialty and in every other group of allied health workers. After all, patients are sort of the whole point of having a hospital, and our profession is one of service. After all, everyone says in their medical school applications how much they want to help people.
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:barf:


sorry, i just had to:)
 
WallowaWanderer said:
I just found this thread and it was an interesting read. It's been beat to death but let me just say to the OP that that the true bada**es of the hospital are the people who really care about their patients and will go the extra mile for them. A few of these people are found in every specialty and in every other group of allied health workers. After all, patients are sort of the whole point of having a hospital, and our profession is one of service. After all, everyone says in their medical school applications how much they want to help people.
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Is your mom making you write this?
 
WallowaWanderer said:
I just found this thread and it was an interesting read. It's been beat to death but let me just say to the OP that that the true bada**es of the hospital are the people who really care about their patients and will go the extra mile for them. A few of these people are found in every specialty and in every other group of allied health workers. After all, patients are sort of the whole point of having a hospital, and our profession is one of service. After all, everyone says in their medical school applications how much they want to help people.
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Now you make me wish I could find mine...I wonder if <shudder> I actually wrote such tripe.:p
 
Winged Scapula said:
Now you make me wish I could find mine...I wonder if <shudder> I actually wrote such tripe.:p
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At my med school, there was a great tradition done during the Chief's Banquet. As each graduating chief was being roasted, his/her personal statement would be projected overhead (with key cheesy sentences highlighted) for everyone to read and laugh at. :laugh:
 
Blade28 said:
At my med school, there was a great tradition done during the Chief's Banquet. As each graduating chief was being roasted, his/her personal statement would be projected overhead (with key cheesy sentences highlighted) for everyone to read and laugh at. :laugh:
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Awesome! :idea:
 
EMCrazy said:
Ok,
...not one of you went to med school to deal with the eye or look at a transparent film. No, you all went because you all had that cool idea in your head from when you were a kid looking at the nice man or woman in the white coat who made you feel all better, not a derrmatologist or an opthamologist ...And I don't mean to just pick on radiology, but I use that as a gateway to reach all of the other fields which have so little to do with real medicine and are only filled because some sissy doesn't want to work hard during residency or is afraid of hitting a 40 hour work week as an attending. "OHHHH the Horror!!!"
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wow, just found this....sounds like someone didnt do well enough to get in to derm, ophtho, or rads....so he settled for one of the less competitive fields with a chill lifestyle.
 
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southerndoc said:
For the record, YaleEMDoc is not a Yale EM resident or physician. This is EMRocks, BarryMarshall, and Raphe, all of whom have been banned for trolling.

Going in 3... 2... 1...
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So his post is pulled down? What's up with that? Usually it just says "banned" but the post stays.
 
Tired said:
So his post is pulled down? What's up with that? Usually it just says "banned" but the post stays.
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Given this user's history, there was some feeling that he chose a particular school in his new persona in an effort to cause some trouble for that program (ie, he's a 4th year student going into surgery, who likes to either pretend he's going into EM or to outright bash them). Not good for EM, not good for surgery and not good for him to appear to be representing a certain school.

An unusual adminstrative move...but ya gotta mix it up every now and again, to keep things interesting.
 
Is the post by the OP real, or is this meant to be a 'flame?'
 
I also hate getting consulted when the requesting ER physician (1) hasn't performed an H&P, or (2) just looked at the triage chief complaint sheet and called for a consult based on that, or (3) maybe has done an H&P, but not a thorough one (e.g. didn't actually look at the unclothed abdomen, or didn't do a rectal), or (4) doesn't actually look at the ordered XR/CT (we all know the radiologist's final read is the final say, but you can at least look at the film! We stress this to all the med students/residents on our services).

Yep. Been there. I hate when they call with a consult, and they havent even laid eyes or hands on the patient themselves. I understand if they are busy with crashing patients but it doesnt take a long time to ask a couple of quick questions or to do a quick exam. To be fair, Ive worked with a lot or ER staff that have provided me a great synopsis of the patient over the phone and when I get there, all the workup has been appropriate for the ER setting.

But I think the GOMER mindset is pretty powerful and supercedes basic stuff that was taught in medical school: doing a simple H and P. As a consultant, it is unreasonable to expect a detailed H and P or workup which can take upwards of 30-40 minutes. A basic H and P isnt unreasonable though.


I guess I shouldnt complain. Sometimes Im lucky to even get the patient's name and the bed number when they call a consult. :)
 
Please let this thread die...

to the previous poster, the OP isn't actually an EM resident from what I understand and was just pretending to be one...
 
On the other hand, I have had several acute abdomens who were so obviously surgical candidates that you hardly even needed to do any labs. One turned out to be a perforation and the other turned out to be a acute appendicities. Both ended up in the OR.

When I called the resident they wouldn't come down until we got the CT with PO contrast, all of the labs, and who knows what else. We'll get all of that stuff but there is no point delaying the definitive treatment by working linearly. The surgeon can evaluate and assemble his team while waiting for the results saving valuable time. My attending called the resident and then the attending and we got it squared away. I understand that surgery residents are tired, overworked, and generally living ****ty lives but occasionally we need you guys to move fast.

And I have never, ever seen any chart with the order, and nothing else, "Consult Surgery." maybe you guys donn't know where we write the orders.
 
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