The Training of Emergency Medicine

[southerndoc]

Last night I appreciated my training in emergency medicine. When I called the ICU team for their third admission of the night, I was actually told "I can't see 3 patients at once."

Oddly enough, just that night, within a matter of 15 minutes, I had managed to intubate 2 people, manage a massive lower GI bleed, control an AFib with RVR, and juggle 4 other patients at the same time.

I'm glad I didn't go into medicine. At least EM teaches us how to multitask and see patients in parallel rather than in series.

---

Members don't see this ad.

 

[beyond all hope]

Just decompressed my first tension pnemo last night. Scary stuff, but it's good to have the skills when you need them.

 

[jashanley]

I'm glad I didn't go into medicine. At least EM teaches us how to multitask and see patients in parallel rather than in series.

I know plenty of IM docs who can multitask with the best of them.
Remember your goal of stabilization is different than their goal of total care.
He may have an entire unit on top of the 3 admissions you gave him to care for. If he has 10-15 beds. He may have 10-15 unstable or only relatively stable patients. Plus the floor consults along with your ED consults. Give him some slack. It is more difficult than people think. Most days I appreciate the ability to eventually give up my unit patients to the MICU resident.
I do appreciate my ED training, especially on the floors, but I find my IM training in the ED useful as well. It goes both ways. I'm glad you love what you do. We should leave it at that.

 

[docB]

I know plenty of IM docs who can multitask with the best of them.
Remember your goal of stabilization is different than their goal of total care.
He may have an entire unit on top of the 3 admissions you gave him to care for. If he has 10-15 beds. He may have 10-15 unstable or only relatively stable patients. Plus the floor consults along with your ED consults. Give him some slack. It is more difficult than people think. Most days I appreciate the ability to eventually give up my unit patients to the MICU resident.
I do appreciate my ED training, especially on the floors, but I find my IM training in the ED useful as well. It goes both ways. I'm glad you love what you do. We should leave it at that.

I'd say what this is really about is getting lip from consultants about their workload. You can't see three pts at once? No kiddin'. Well you can add 'em to your list and see 'em when you can because I'm done and they're yours. Life sucks so go ahead and take another big bite of the crap sandwich called healthcare that we all gnaw on all day long. Oh and BTW I can't go out to the lobby or the ambi bay and tell the 60 arriving pts that I can't see all of them but I'm sure you don't want to hear my griping.

 

[ERMudPhud]

I'd say what this is really about is getting lip from consultants about their workload. You can't see three pts at once? No kiddin'. Well you can add 'em to your list and see 'em when you can because I'm done and they're yours. Life sucks so go ahead and take another big bite of the crap sandwich called healthcare that we all gnaw on all day long. Oh and BTW I can't go out to the lobby or the ambi bay and tell the 60 arriving pts that I can't see all of them but I'm sure you don't want to hear my griping.

Somebody must have had a really bad weekend

 

[Scrubbs]

ICU admits sort of amuse me when the residents start getting snippy about the numbers they have. Our program runs a 22 bed ICU at one of our hospitals - no medicine residents. When we get unit players in the ER there, we're admitting to OUR residents... and noone ever blinks an eye when you call with 2 or 3 in a row. Yes it can suck, and the patients may not have any labs back, but if they're tubed, they aren't going to tele. So I go to the ER and write admit orders as quickly as possible to get the patients out of the department, usually writing my notes up on the floor.

That's what your job is. The medicine folks don't always seem to understand this. If you spend 10 minutes b!tching about it, the patient isn't going to miraculously be stable enough to downgrade... so suck it up and get them out of my ER!

 

[The White Coat Investor]

This morning I got 4 CCU admits in the hour before rounds were to start. The medicine residents on my team were surprised that I had all the H&Ps done and the admit orders in the computer. The beauty of learning to see multiple patients at once.

The best part of it was picking up the fact that one of them was a hot chole. Ooohhh.....that made the ED attending feel bad, especially since he's our US guru and didn't even think about doing one.

 

[docB]

Somebody must have had a really bad weekend

Yeah. It's been raining and snowing in Vegas. Vegas drivers can barely keep it together as it is. These idiots are the kings of the "This looks bad. I better go even faster so I can hurry up and get out of this." attitude.

 

[VentdependenT]

I'd say what this is really about is getting lip from consultants about their workload. You can't see three pts at once? No kiddin'. Well you can add 'em to your list and see 'em when you can because I'm done and they're yours. Life sucks so go ahead and take another big bite of the crap sandwich called healthcare that we all gnaw on all day long. Oh and BTW I can't go out to the lobby or the ambi bay and tell the 60 arriving pts that I can't see all of them but I'm sure you don't want to hear my griping.

Heyyyyy! I want a crap sandwich!