Thoughts?

[HemeOncHopeful19]

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They actually gave me a choice. I went to deposition with their lawyer/family, spent prob 3 hrs in all. I spent prob 5 hrs before looking through all the records to make sure I didn't miss a Gotcha. Deposition was actually scheduled a month before the actual and I had to switch/give up shifts to accommodate. Guess what, plaintiffs couldn't make it so had to change to new date. Giving up/switching shifts prob costs me 5K and a schedule I didn't want.

I could not imagine what a trial would be like. Maybe more depositions? Maybe more schedule changes? Maybe wasting a few dys or even week in trial? Getting my care dragged through the mud and not able to say a word? Sitting in a room for days being bored to death? Losing 10K in missed shifts and pissing my partners off who had to cover me? I had 3 young kids at home and having to put my wife through a trial?

I am too pragmatic to die on this hill just to be proven right. I walked away from this lawsuit settlement with the same confidence/integrity regardless if I won or lost the case. From my POV, the case would not have changed a thing.

Concerning the NPDB, I have been through many MEC/credentialing meetings and a case like this on a doc practicing 15+ years would have not moved a needle. This case never prevented me from getting credentialing anywhere.

On the brighter side, maybe the family used the money on the mom's kids and they got a good college education out of it.

More likely the case gets dropped when they realize you won’t fold. Seen it happen a few times.

 

[Mount Asclepius]

The post above you: blunt instrument, crayon
Your post: fine and refined. A fountain pen

Feel free to discharge all the tachycardic patients you want. The lawyers love that. Perhaps they’ll serve you with papers written in crayon. At least that might make you laugh a little, which is sometimes all that you can do as a response in the ED when a tragedy like this happens and perhaps no one is at fault. There aren’t enough details to adequately MMQB this case and even that wouldn’t do it justice when we all know that the system including admitted boarding patients, low nursing staffing levels, and an overwhelming volume of worried well also might have affected this case. I applaud the father for seeking a path in health policy instead of placing his entire focus on litigation. At least it’s a search for a solution in a mess of a system. This site could use a little more of that and a little less toxic negativity. Perhaps, more crayons.

 

[hoot504]

Feel free to discharge all the tachycardic patients you want. The lawyers love that. Perhaps they’ll serve you with papers written in crayon. At least that might make you laugh a little, which is sometimes all that you can do as a response in the ED when a tragedy like this happens and perhaps no one is at fault. There aren’t enough details to adequately MMQB this case and even that wouldn’t do it justice when we all know that the system including admitted boarding patients, low nursing staffing levels, and an overwhelming volume of worried well also might have affected this case. I applaud the father for seeking a path in health policy instead of placing his entire focus on litigation. At least it’s a search for a solution in a mess of a system. This site could use a little more of that and a little less toxic negativity. Perhaps, more crayons.

In my experience and practice, I generally do not discharge adults with a consistent HR above 110 without a very clear explanation. Yes the number is mostly arbitrary but if you’re discharging people with last documented HR above that you’re just asking for trouble. We’re paid in part based on our judgement and if I have someone with truly persistently abnormal vitals, I generally start digging and wouldn’t think twice about placing them in observation. It’s actually rare that I have a patient like this who would otherwise be discharged (nothing else concerning or abnormal found during the evaluation). I consider it one of the cardinal sins of EM to discharge grossly abnormal vital signs.

 

[WorkNoteEmergency]

I read the article when it came out and whole time I was imagining how the conversation with an admitting hospitalist/medicine resident would have gone but if I had decided I wanted to admit I would have done more workup. I think it's important to note that the autopsy, and remember the kid was found dead 2-ish days after ED discharge, couldn't identify a cause of death and who knows to what extent those autopsy findings were present at the last ED visit. That kid was dead man walking most likely. College students showed up in my ER every place I worked in my career and a bounce back for a viral syndrome usually got an expanded workup if not improving in a couple of days. I always, and I mean always, offered to call parents and if the kid declined, made sure to document. Made sure the kid had also the student health clinic info and sometimes on the bounce backs would communicate with the student health like a PCP office. I think an honest conversation with his parents at the time of the second visit may not have headed off a lawsuit but would have made this scenario look very different.

 

[Zebra Hunter]

I read the article when it came out and whole time I was imagining how the conversation with an admitting hospitalist/medicine resident would have gone but if I had decided I wanted to admit I would have done more workup. I think it's important to note that the autopsy, and remember the kid was found dead 2-ish days after ED discharge, couldn't identify a cause of death and who knows to what extent those autopsy findings were present at the last ED visit. That kid was dead man walking most likely. College students showed up in my ER every place I worked in my career and a bounce back for a viral syndrome usually got an expanded workup if not improving in a couple of days. I always, and I mean always, offered to call parents and if the kid declined, made sure to document. Made sure the kid had also the student health clinic info and sometimes on the bounce backs would communicate with the student health like a PCP office. I think an honest conversation with his parents at the time of the second visit may not have headed off a lawsuit but would have made this scenario look very different.

Viral syndrome college kids is like 3 patients a shift during flu season w/ probably 1/4th of them bouncing back to an ER within a few days because they aren't feeling better. Absolutely no way I'm calling the parents of an adult and kind of wild to document that an adult with capacity to make their own medical decisions is declining you calling their parents. Yeah, I would too and would be offended by that question. That seems...aggressively over-paternalistic.

 

[WhatJobDoIPick]

Maybe it’s just me but I’m not sure if you’ve ever made a post where you didn’t voice your displeasure for EM and medicine in general. While medicine (and EM) has its warts and it’s easy to fall into a negative attitude around SDN, I look forward to the day where you finally practice what you preach and leave the field. I hope you find the happiness you’re looking for but you seem like a chronically unhappy person.

Nice victim shaming.

I am a leader in my group, and consistently rated as someone other people want to work with.

I have my own wins and I'm happy about them; I am not chronically unhappy despite your gaslighting. I'm actually pretty happy at baseline, likely higher than the average American. EM has given me many, many things to be grateful for, but the juice isn't worth the squeeze.

I'm here to make sure lurkers know the truth about this field. People like you recommending it to students is malpractice.

 

[WorkNoteEmergency]

Viral syndrome college kids is like 3 patients a shift during flu season w/ probably 1/4th of them bouncing back to an ER within a few days because they aren't feeling better. Absolutely no way I'm calling the parents of an adult and kind of wild to document that an adult with capacity to make their own medical decisions is declining you calling their parents. Yeah, I would too and would be offended by that question. That seems...aggressively over-paternalistic.

Maybe if you tried it, you’d get fewer bounce backs.

 

[JacobMcCandles]

Nice victim shaming.

I am a leader in my group, and consistently rated as someone other people want to work with.

I have my own wins and I'm happy about them; I am not chronically unhappy despite your gaslighting. I'm actually pretty happy at baseline, likely higher than the average American. EM has given me many, many things to be grateful for, but the juice isn't worth the squeeze.

I'm here to make sure lurkers know the truth about this field. People like you recommending it to students is malpractice.

I'm glad your online persona is different than your in-person persona but you must just show your happiness in a weird way online. It took about 45 seconds to find a handful of examples. Best of luck in your next chapter!

EM is very agitating to me and even when I'm off I find myself not fully present sometimes, so the sooner I can get out, the better.

Reason # 3758 why EM sucks.

Honestly awful. The amount of moral injury and external fire we take is unbelievable. I can't wait to get out.

EM is trash tier.

Get out ASAP.

EM sucks.

Don't do it.

EM is trash tier.

Run away and never look back.

This field is seriously a joke.

Another data point in the barrel of data points that show how done this field is.

EM is trash tier.

I'm happy that I only have a handful more years going full-time at this.

 

[HemeOncHopeful19]

 

[RustedFox]

@WhatJobDoIPick may complain a lot on here (so do I), but what he says is true.

It's as if the laws of common expectations for any reasonable line of work don't exist in EM, *and* we're told that if we don't like being kicked in the teeth, then that's an "us" problem. Nobody else in any other line of work would tolerate our special variety of horse$#it.

 

[JacobMcCandles]

Again, I'm not disagreeing that EM has problems but you'd be hard-pressed to find any industry without issues. My friends who aren't in medicine who are well-compensated all have various stressors and complaints and each of them would trade places with me in a heartbeat. When you deal with life and death, as we do in medicine, there's always going to be some unnecessary amount of BS that goes with that. While I'm not going to actively encourage my children to go into medicine, I'm not going to actively discourage them, either. You'll find people in every specialty (industry, actually) who will give the same advice as @WhatJobDoIPick. We all need to vent a little and express our frustrations but constant negativity just gets old. I guess this is my venting about constant venting.

 

[emergentmd]

We should stay on point in this thread and there are many other threads that are great for complaining about EM.

I am not going to say if EM is a good or bad job BUT I bet you most EM docs who are unhappy would not trade their job for 95% of their friend's jobs. I also bet they would not trade it for 50% of medicine jobs out there. Primary care is the most common job and I bet the vast majority of EM docs would not trade. I know I would never do Primary care so I have it better than 30% of docs.

 

[TooMuchResearch]

Lol

 

[EMdoc235]

This is the kind of content I look forward to

 

[VA Hopeful Dr]

We should stay on point in this thread and there are many other threads that are great for complaining about EM.

I am not going to say if EM is a good or bad job BUT I bet you most EM docs who are unhappy would not trade their job for 95% of their friend's jobs. I also bet they would not trade it for 50% of medicine jobs out there. Primary care is the most common job and I bet the vast majority of EM docs would not trade. I know I would never do Primary care so I have it better than 30% of docs.

Yep. I do primary care, enjoy it, and am paid shocking well to do it.

But, I would bet 90% of you wouldn't trade jobs with me given the chance.

 

[EctopicFetus]

Yep. I do primary care, enjoy it, and am paid shocking well to do it.

But, I would bet 90% of you wouldn't trade jobs with me given the chance.

The recent medscape survey had em at the bottom again. I can’t remember what it was asking like either satisfaction or If you would recommend the specialty. We can all say our bit but in the end while survey data has its weakness what can’t be doubted is how we are at the bottom of nearly every single survey. Yes it’s that bad.

 

[emergentmd]

The recent medscape survey had em at the bottom again. I can’t remember what it was asking like either satisfaction or If you would recommend the specialty. We can all say our bit but in the end while survey data has its weakness what can’t be doubted is how we are at the bottom of nearly every single survey. Yes it’s that bad.

I hear and get why some are so down on EM but I guess its all your prospective.

I grew up dirt poor. Parents minimum wage working on the railroad and cleaning homes. No vacations, never seen the inside of a restaurant, driving beaters. Poor throughout med school.

Residency sucked but that 35K/yr made me feel middle class. Had a nice apt, car with AC, and money to buy discretionary stuff.

Attending and my 1st bi monthly paycheck was I think 7K. Did the math, with taxes taken out it came to about 225K/yr Was promised more but still happy to be making 225k/yr. 2nd bi monthly check was like 20K so ended up about 350k/yr. Felt like a Rockerfeller.

Did 15 yrs in the hospital Pit, and always felt I had the best job making 1% money and working half the month. Sure EM and medicine in general has gotten worse but I still think EM is one of the best jobs compared to how I grew up.

Its like the rags to riches movies you see. Never did I think a 1st gen immigrant could put in the hard work and have one of the best jobs imaginable. Stopped doing hospital EM and now feel like I have the best job imaginable.

It is all perspective and even if I had to go back into the Pit, I still would think it is one of the best jobs. I have my health while making 400K+/yr in the Pit; I could put up with a lot.

 

[WhatJobDoIPick]

I hear and get why some are so down on EM but I guess its all your prospective.

I grew up dirt poor. Parents minimum wage working on the railroad and cleaning homes. No vacations, never seen the inside of a restaurant, driving beaters. Poor throughout med school.

Residency sucked but that 35K/yr made me feel middle class. Had a nice apt, car with AC, and money to buy discretionary stuff.

Attending and my 1st bi monthly paycheck was I think 7K. Did the math, with taxes taken out it came to about 225K/yr Was promised more but still happy to be making 225k/yr. 2nd bi monthly check was like 20K so ended up about 350k/yr. Felt like a Rockerfeller.

Did 15 yrs in the hospital Pit, and always felt I had the best job making 1% money and working half the month. Sure EM and medicine in general has gotten worse but I still think EM is one of the best jobs compared to how I grew up.

Its like the rags to riches movies you see. Never did I think a 1st gen immigrant could put in the hard work and have one of the best jobs imaginable. Stopped doing hospital EM and now feel like I have the best job imaginable.

It is all perspective and even if I had to go back into the Pit, I still would think it is one of the best jobs. I have my health while making 400K+/yr in the Pit; I could put up with a lot.

Was waiting for @emergentmd to say that EM is better than growing up and a Cambodian war prison

 

[emergentmd]

I was chief of EM for 8 years. Medical Director/Board for the past 8 years at out FSER. Managed many docs and nurses in different environments.

You always have a hand full of docs who always complain no matter what and no matter what changes happen. You have some that goes with the flow. You have the rest that are happy no matter what and do the best in all situations.

Same environment, same job, same pay but such a discrepancy in the attitude and levels of complaining. Typically a small minority complains and creates the vast majority of the drama. I have learned its not the job but the person and no matter what they will complain. I have a theory it has nothing to do with the job but their personal life. Happy personal life + happy marriage = Rarely ever complain on the job.

I choose to make the best of all situations. If I don't like something, know I can't fix it, and can't deal with the situation then I move on. The last thing I would do is complain, complain, complain and then go to work making everyone around me miserable. If you are the few who are miserable, then maybe its not the job?