Just got finished with an EM rotation at my city's largest and busiest ED. Had a dude who was transported via ambulance from his PCP's office with a chief complaint of high platelets. Dude was 34, healthy, no past medical history, taking no meds, felt great. Apparently a routine CBC came back with a platelet count of 620K, and the PCP had never seen one that high so he had the patient rushed over to the ER for further evaluation. The best part was when my attending had to call the PCP and explain to him how ridiculous the situation was.
During a routine physical/lab work, one girl's PCP found her blood glucose to be 260. Completely asymptomatic except for a little polyuria and some increased thirst, the doctor, upon getting the result back, calls the fam and tells them that they should proceed direclty, do not pass go and collect your money, to the nearest ED for further work-up. And I thought the primary would have been the better to do the diabetic screening... Show's what I know.
was probably the easiest pt your attending saw that day. be thankful the guy swasn't stroking out, lol. i used to really dislike the "fluff" cases that would come into my clinic. but now i can see/diagnose/treat/type my note and be done and work on catching up on other things or have some spare time for real patients. isn't it kinda the same in the ED? they might be annoying, but they buff your numbers without really adding that much workload. . . --your friendly neighborhood system working caveman
I see about 10 of these a week. High INRs, low H/H, even a low Mag last week. Homunculus is right. That kind of expensive silliness does pay well. It's just annoying when I'm backed up. It also shows that whenever a PMD in the community thinks something might be wrong they quickly turf it to the ER. In the real world where the PMDs have to see 4 pts/hr NO MATTER WHAT they send everything but the truly worried well to the ED. There is certainly no workup and diagnosis happening outside the hospital and the only portal to the hospital is the ED. The direct admit is a dying entity. It goes to show how idiotic the smug and dismissive attitude of certain trolls with active threads right now really is.
so my thread is being compared to that one? if so, then that's ******ed. I was simply pointing out how ridiculous the PCP was for sending to his patient to the ER for high platelets. Not sure how much the EM physician made considering we did not work the patient up - simple H&P and a swift discharge.
Yeah, dude, docB was taking a stab at the IM idiot that was trolling here a few days ago. Don't worry, I've never seen him rag on a legit EM person, and if he did I have a feeling it would be fairly obvious.
Very true. I wasn't comparing your thread to the troll's. I was noting that PMDs depend on ER docs whenever they think something might actually be wrong.
Is it considered trolling when bashing other specialties on your own forum? There are scary incompetent physicians in EVERY specialty, including primary care and EM.
It might not seem like this is true but I'm not bashing the PMDs who send stuff into the ED. Fact is that they've gotta see 4-6 patients per hour and they can't handle a chest pain or SOB in the office. I'm not saying they're incompetent. I'm saying they can't get a stat CT scan or a stat US or even stat labs. And they don't want to. They want to punt and have me call when I'm done with my evaluation and stabilization.
The main take away point is that this is appropriate and we don't mind taking care of their patients, however, they can't have it both ways. You can't come in here bashing us, saying we aren't 'real doctors' or calling us 'glorified triage nurses' then send all your sick patients (or not sick ones) to us and expect us to gladly do your job for you. Take your pick, either we're a valuable resource for you or we're a pimple on the face of medicine.
My personal take is that practicing community physicians rely on the ED just as docB and others pointed out and the ED bashing trolls are over-worked, under-appreciated residents that have no idea what life is like outside the protected confines of academia. There are probably a few arrogant, I'm God's gift to the world and my specialty is the only legitimate one in the house of medicine attendings feeding the bias...
Good point. You rarely hear a private practicing clinician complain about the damn ER. Except the hospitalist, but that's they're job so screw 'em.
Actually we have about 4 hospitalist services at our hospital. They all compete to get agreements from all the PMD's to be "their" hospitalist of choice. Amazingly, they all also fought a pitched battle for the right to admit patients without a PMD. In the end the most powerful group won the right to take all unassigned patients 24/7. They actually fought for this because even with a decent chunk of these patients being uninsured, homeless, substance abusers who are a disposition nightmare it was still a net financial gain for them to take all unassigned patients. They claim to love hearing from us no matter when we call and I love having them.
