Respect

[Born2baDoctor]

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Do EM docs get less respect from consultants and admitting physicians? Is this more so in academic or private practice?

 

[st0rmin]

Do EM docs get less respect from consultants and admitting physicians? Is this more so in academic or private practice?

Less respect? Compared to who? Other physicians in the hospital? Does it really matter what other docs think of you if you do you job as well as you can?

One observation I have made while rotating through other services in the hospital is that when the ED calls, the physician immediately begins to complain. "Oh, it's the ER again." "What do they want now?" "Do I really have to go down and admit another patient?" I believe that in most locations, at least in the few that I've worked at, the Emergency Department is the entrance point to the hospital. Very few, if any, admissions come from areas in the hospital other than the ED. So whenever we call one of the admitting teams they have to complain, because we are bringing them more work. The important part to remember is that you did not make the patient sick, it's not your fault that 12 people needed admission tonight, no matter how well you do your job someone is always going to complain about having to admit someone. And just think that when someone says "Thank you for this interesting consult..." they might actually mean it.

 

[Hawkeye Kid]

So whenever we call one of the admitting teams they have to complain, because we are bringing them more work.

This is true in residency, because the page from the ED is exactly what you said, more work. In the real world, the page from the ED is usually business and you're less likely to catch flack for it, but rather a simple "ok, admit them and I'll see them in the AM."

 

[DeLaughterDO]

This is true in residency, because the page from the ED is exactly what you said, more work. In the real world, the page from the ED is usually business and you're less likely to catch flack for it, but rather a simple "ok, admit them and I'll see them in the AM."

Exactly - in residency, a call from the ED is seen as more work for the lowly admitting intern/resident who wants nothing more than to go to bed and sleep through the night and forget this horrible thing called "on-call."

In the "real world" a call from the ED means an admission, which means more work and more billable hours which = revenue. The whole construct is different outside the world of academic medicine.

However, a call from a nurse in the middle of the night is bad, no matter where it happens (this is from a registered-nurse-turned-physician-in-3-weeks, so no flames!)...

🙂 and

jd

 

[Telemachus]

Just about every specialty has the potential to disrespect other specialties, generally regarding competence/ignorance. But such is the nature of specialties -- you know more about your area than an outsider, it's kind of the whole point.

I think that physicians who are honest with themselves will generally acknowledge that people in other specialties have a lot of useful and hard-earned knowledge and skill. Some people, however, are unable to recognize that their learning of a fact or skill does not mean that every physician in every specialty need to have that knowledge or skill to be a good physician.

 

[AlienHand]

The issue of respect used to bother me a lot. While it's true that every specialty criticizes every other specialty, I think the ED gets a disproportionate share of criticism. There are many reasons:

- As others have noted, a call from the ED usually means more work.

- Emergency physicians perform rapid assessments of the patient, with an emphasis on excluding the most dangerous conditions. Our diagnoses are sometimes proven wrong hours or even days after the patient leaves the ED, as more data becomes available. This is normal and expected, but does contribute to criticism of EPs.

- Emergency physicians know less about each medical specialty than specialists. What specialists seem to forget is that we know something about nearly every specialty and can perform useful diagnostic and therapeutic interventions for almost any acute problem.

- EPs are also criticized due to the perception that we order unnecessary consults. When we consult a surgeon for a patient with a questionable surgical abdomen and the patient turns out not to require surgery, the surgeon may criticize us. However, what the surgeon doesn't see are the 10 previous patients with abdominal pain for whom we didn't order a consult.

The more I learn about and experience emergency medicine, the less I care about criticism from other specialties. I like having the chance to be the first physician to evaluate the patient, as well as the variety of patients and conditions, and the emphasis on acute care. To me, that more than makes up for any criticism I may receive from specialists.

 

[Jeff698]

Now that I'm almost through with my intern year, I've become increasingly aware that the only smart physician is the one offering the opinion. Everyone else is pretty much an idiot, regardless of specialty.

I just finished my MICU month. I was prepared for the 'stupid ER' comments because I get them everywhere (for the reasons described above). What I wasn't all that ready for was how much criticism there was of ALL other specialties. Actually, EM didn't come out all that bad from a complaint standpoint.

I now realize that there is no winning. This respect game is truly a no win situation. The only way to 'win' is to quit caring and do what you think is best.

Take care,
Jeff

 

[southerndoc]

When I was in medical school, I noticed this trend as well. The last person to see the patient is always the smartest and always the most critical of the patient.

I'm very happy where I am a resident. I've seen and heard of ICU attendings DEFEND EM residents when a MICU admitting resident starts to complain about ED management. Likewise, the hospitalist attendings and university attendings are usually supportive of EM residents and physicians. They all realize how chaotic of circumstances we work under, and they also realize that residents are too idealistic about their patients being perfectly packaged and their course of hospitalization already set by the time they get to the floors.

There are times where we are so busy that we admit the elderly pneumonia patients without the CBC or chem-10 being back. The medical residents will sometimes give us crap about that. I'm sorry, the residents went to medical school and should know how to deal with a low hematocrit, hypomagnesemia, or other problem. None of these would affect disposition of the patient. Sometimes things aren't perfectly packaged, and we must all learn to deal with those things.

I've found that the ones who are most critical of other specialists/residents are usually the ones who are either insecure about their level of training and abilities, or who are unhappy with their line of work.

However, if I have inappropriately managed a patient, then I absolutely want to hear about it. If my diagnosis is incorrect and not included in my differential, then I want to hear about it. I learn from things like this and cannot learn if I do not know the outcome of the patient or changes in management. An incomplete workup for an admitted patient isn't inappropriately managing a patient -- the workup needs to be completed upstairs and not in the ED.

 

[EctopicFetus]

I've found that the ones who are most critical of other specialists/residents are usually the ones who are either insecure about their level of training and abilities, or who are unhappy with their line of work.

👍

To add the ED is as someone described to me a fishbowl. Everything that is bad about a hospital is seen there. Grandma waited 24 hours to be seen, well this is because the guy in bed 10 has been waiting 28 hours to be brought upstairs because there are no beds. There are of course no beds for any number of reasons. Meanwhile once grandma gets seen and has to be admitted she then gets to wait another 24 hours for her bed.

From her point of view it is all a problem with the ED. As far as other attendings and residents giving no respect to the ED it happens all the time. In some ways I think it is jealousy because we get to go home and as has been mentioned tons of times residents dont want to do more work than they need to. I could go on but i think the answers have been given.

 

[DR.IBN-JIZAN]

Do EM docs get less respect from consultants and admitting physicians? Is this more so in academic or private practice?

I believe,it doesn't matter whether they get respect or not
as long as they are doing their duty in a nice way...I think if
the patient is respecting EM doctors,that would be enough for them. 🙂​

 

[bartleby]

It can be tough as a resident, because you're often friends with the people on the admitting services. This is sometimes the case even as an attending. If you can do you job and still be buddies with the admitting teams and consultants, that's great...you should always be as pleasant and collegial as you can. But don't lose sight of the fact that you work for the _patient_, and your ultimate responsibility is to them. If it takes a bit of cajoling to get your colleagues to do the right thing on occasion, so be it.

 

[faviola]

Do EM docs get less respect from consultants and admitting physicians? Is this more so in academic or private practice?

I don't see how any kind of Doc woul get less respect from anyone else...Regardless of practice i'm sure they have earned their respect

 

[sweetfynesse]

I believe,it doesn't matter whether they get respect or not
as long as they are doing their duty in a nice way...I think if
the patient is respecting EM doctors,that would be enough for them. 🙂​

You make a great point, and it reminds me of a patient I had during my second year of EM residency. She was being admitted for pneumonia, and had a host of med allergies. After carefully going through her allergies and even calling her out-of-state private doc, I sat down with her and told her that there's a chance that the antibiotic we give you can cause an allergic rxn even though you have no documented history with this abx. She kindly agreed to take it, and of course she had a mild allergic rxn. When the medicine resident came down to admit her, she told the patient that we never should have given her that medicine and that we were all stupid. The patient motioned me over to furiously tell me what the admitting resident told her. Then she thanked me for all of my help and begged me to admit her to someone else bc she didnt like the admitting resident, stating she was very rude and totally inappropriate.

 

[AmoryBlaine]

I don't see how any kind of Doc woul get less respect from anyone else...Regardless of practice i'm sure they have earned their respect

uhhhhhhhhh, really?

 

[EctopicFetus]

I don't see how any kind of Doc woul get less respect from anyone else...Regardless of practice i'm sure they have earned their respect

I have to agree with the above poster.. Some fields dont garner the same respect. Im not saying it is right.. but it is true..

 

[Back34]

Do EM docs get less respect from consultants and admitting physicians? Is this more so in academic or private practice?

'nuff said

http://www.ebaumsworld.com/forumfun/whocares2.jpg

 

[MD Dreams]

'nuff said

http://www.ebaumsworld.com/forumfun/whocares2.jpg

Nice rug 😀

 

[Febrifuge]

Show me someone who goes into medicine looking for "respect," and I'll show you someone who is probably satisfied with being on the receiving end of people's deference.

Not to go all Yoda on it, or anything, but I think EM people tend to value true respect, but they don't live or die by anyone else's opinion. Do a good job, and you can live without the applause. A sincere "thank you" is worth more than an insincere attaboy from administration or the sucking-up of people who need a favor.

I know plenty of good EM docs who worry about what's good for the patient about 1000x more than how a consultant/ admitting physician feels. And, it should be said, the good admitting physicians are the same.

 

[randomedstudent]

I don't see how any kind of Doc woul get less respect from anyone else...Regardless of practice i'm sure they have earned their respect

Either you are joking or you are highly misinformed. There is a great variation in respect for different specialties....look at the crap the psychiatrists have to put up with ("you know you're not a real doctor"), and in general EM is not one of the more highly respected fields, compared to like cardio-thoracic surgery or something.