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- Dec 4, 2011
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I gotta go with having to call around to get an acceptance. It's painful.
Similar to @valianteffort I think the worst part is the 5% of my patients who take up 25% of my time because of some combination of anxiety, entitlement, or just plain stupidity where I am unable to discharge them in a timely fashion.
"Doc, bed 8 has more questions and is refusing to leave until they see you again"
Patient: Some question that I already answered 3 times.
Me: No, I don't know why your right middle toe has been tingling for the past 6 months. Yes, your tests look fine. You need to followup with your PCP or any number of the specialists whom you've already seen for this exact same issue, just like I said the last time I left this room. Yes, I heard that you want an MRI of your foot. No, you can't have one here today.... etc... etc.... etc.
Sometimes I'll tell the nurse to let the patient know that I'm very busy seeing sick people and I'll come back and talk to them, but that it might take up to an hour. I then simply never go back and wait until they leave of their own volition. This obviously only works when I have the bed to spare.
IDK why but this sounded like a poem to me. Could be made into a haiku or something. Well saidEntitled, rich ppl. This burns me to a crisp. Annoyed when you don’t find something wrong. Expecting you to call their doctor and XYZ specialist. What do you mean you’re not admitting me for a colonoscopy, they couldn’t schedule me one for 3 weeks and I’ve had this abdominal pain for 2 months? 3 CT abdomens in 3 weeks. 3 negative work ups. Sure here’s XYZ test even though I’m fighting a losing battle for my press ganey and satisfaction bonus. These mother****ers constantly turning their nose up makes me most toasty.
Would very much agree. I have noticed that the days that I discharge most of my patients, I tend to leave work happy. The days that are consult/admit heavy, I tend to leave work feeling burnt out.For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.
The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.
Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.
I have at least a couple of these a weak and are always miserable.
Dead children.
Sorry but nothing even comes close.
The noises that come from the parents after probably do, assuming they weren’t the cause, but that probably counts as part of a lump sum of general crapinessDead children.
Sorry but nothing even comes close.
I took it as what is the worst thing you have to deal with on a daily basis.Dead children.
Sorry but nothing even comes close.
Yea dead kids are probably the worst thing we ever have to see but luckily is pretty darn rare. And I would argue that seeing those occasional terrible things is part of what you sign up for being an EM doc. Most of us do still take some pride in being trained to act even in those horrible situations.I took it as what is the worst thing you have to deal with on a daily basis.
For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.
The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.
Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.
I have at least a couple of these a weak and are always miserable.
Truly nothing is worse than having to simp to consultants with less than zero respect for you and your specialty as the par for the course approach required to get STANDARD OF CARE medicine to your patient.
EM isn't medicine, it's a SALES and MARKETING job.
Sell this patient's problem to a consultant
Sell BS studies, labs, and CT scans to the patient
Sell the admit to the hospitalist
Sell the discharge reasoning to the patient's angry daughter
Sell your soul to the devil
You just connected some synapses and helped me better understand my negative feelings in EM.Truly nothing is worse than having to simp to consultants with less than zero respect for you and your specialty as the par for the course approach required to get STANDARD OF CARE medicine to your patient.
EM isn't medicine, it's a SALES and MARKETING job.
Sell this patient's problem to a consultant
Sell BS studies, labs, and CT scans to the patient
Sell the admit to the hospitalist
Sell the discharge reasoning to the patient's angry daughter
Sell your soul to the devil
Me too. I've always thought that being in sales would be my version of hell, and it never occurred to me that that's what EM is.You just connected some synapses and helped me better understand my negative feelings in EM.
The sales and marketing aspect, or said differently, the waiting tables at Denny's aspect
THIS
+1
I would have this feeling when I worked at an urban hospital with crazy volumes and high acuity. It went away when I switched to a low volume place and also as I became more experienced. I would never work at such a place.Caveat not in the field anymore, and no intention of returning.
For me the worst part was the feeling before a shift, and no matter how much time I had before that shift it started ~ halfway to being back.
If I was off 3 days it usually started 1.5 days out, if I was off 7 days (rare, I probably worked too much) it started 2-3 d out.
It reminded me intensely of the feeling I had before a fight when I was younger and dumb enough to think that was a good recreational activity. I would start constantly cycling through worst case scenarios I had seen and might see e.g. dead baby (or worse yet almost dead baby who might be saved), pregnant trauma pt, shoulder dystocia or twins or footling breech, jet ventilation for peds, etc
I also took 1-2 d to “come down” after a shift
That’s why I don’t do that anymore
I think the major thing that really ruins my shift is patients that don't understand the concept of the emergency room aka to rule out EMERGENCIES. I work in a highly affluent area which is just not the clientele I prefer. Back when I worked inner city downtown, this was a rarity. Ultimately, I think we are all in the field (for the most part) to help people and I try not to disappoint. However, we will not be able to solve your 3 year long troubles with abdominal pain after you have seen GI ,cardio, rheum and endocrine whom have all told you it is unexplained. Telling this to the patient, then to the mother and father whom walk in after your explanation, then to grandpa ,etc is a real killer. Then patients will be upset that they spent xxx amount of money for 'no reason'. No maam, you have reassurance there isn't an emergency. Truly stuff like this wears on me the most.
Similar to @valianteffort I think the worst part is the 5% of my patients who take up 25% of my time because of some combination of anxiety, entitlement, or just plain stupidity where I am unable to discharge them in a timely fashion.
"Doc, bed 8 has more questions and is refusing to leave until they see you again"
Patient: Some question that I already answered 3 times.
Me: No, I don't know why your right middle toe has been tingling for the past 6 months. Yes, your tests look fine. You need to followup with your PCP or any number of the specialists whom you've already seen for this exact same issue, just like I said the last time I left this room. Yes, I heard that you want an MRI of your foot. No, you can't have one here today.... etc... etc.... etc.
Sometimes I'll tell the nurse to let the patient know that I'm very busy seeing sick people and I'll come back and talk to them, but that it might take up to an hour. I then simply never go back and wait until they leave of their own volition. This obviously only works when I have the bed to spare.
Misaligned expectations on the patient's part.
I would have this feeling when I worked at an urban hospital with crazy volumes and high acuity. It went away when I switched to a low volume place and also as I became more experienced. I would never work at such a place.
The peri-shift "Dread" @RektCaveat not in the field anymore, and no intention of returning.
For me the worst part was the feeling before a shift, and no matter how much time I had before that shift it started ~ halfway to being back.
If I was off 3 days it usually started 1.5 days out, if I was off 7 days (rare, I probably worked too much) it started 2-3 d out.
It reminded me intensely of the feeling I had before a fight when I was younger and dumb enough to think that was a good recreational activity. I would start constantly cycling through worst case scenarios I had seen and might see e.g. dead baby (or worse yet almost dead baby who might be saved), pregnant trauma pt, shoulder dystocia or twins or footling breech, jet ventilation for peds, etc
I also took 1-2 d to “come down” after a shift
That’s why I don’t do that anymore
I've been finding that setting expectations early helps.
"We're probably not going to find the reason why XYZ symptom happened to you today but we're going to make sure you're safe and try to make you more comfortable while you're here."
This seems to work 99% of the time. If it doesn't , the interaction was likely fuxxored from the start and there was no way you were going to win.
"Man I wish I could get you that MRI but I'm not allowed."
I like saying "I'm not allowed" because it puts the situation into terms the 9 to 5 muggles who have a "boss" can understand.
Did either service evaluate the patient?For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.
The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.
Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.
I have at least a couple of these a weak and are always miserable.
Did either service evaluate the patient?
The single worst thing about EM ? It's like trying to decide which form of death do you prefer: Cyanide? drowning? hanging? Death by a thousand cuts?
If you'd ask the single best thing about EM, then for me the list becomes incredibly short: 100% schedule control. That's it.
"The number one cause of burnout is the patient."
I’m working rural hospital and don’t mind the patients. They are actually nice."The number one cause of burnout is the patient."
Okay im going to break away from my normal pessimism from EM and add a few good things about EM:
1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.
I'm not EM but I changed to a rural CAH job from an urban academ-ish place last year and while it's not all rainbows and unicorns, the patients are never the biggest problem anymore.I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.
Okay im going to break away from my normal pessimism from EM and add a few good things about EM:
1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.
Entitled, rich ppl. This burns me to a crisp. Annoyed when you don’t find something wrong. Expecting you to call their doctor and XYZ specialist. What do you mean you’re not admitting me for a colonoscopy, they couldn’t schedule me one for 3 weeks and I’ve had this abdominal pain for 2 months? 3 CT abdomens in 3 weeks. 3 negative work ups. Sure here’s XYZ test even though I’m fighting a losing battle for my press ganey and satisfaction bonus. These mother****ers constantly turning their nose up makes me most toasty.
I think the major thing that really ruins my shift is patients that don't understand the concept of the emergency room aka to rule out EMERGENCIES. I work in a highly affluent area which is just not the clientele I prefer. Back when I worked inner city downtown, this was a rarity. Ultimately, I think we are all in the field (for the most part) to help people and I try not to disappoint. However, we will not be able to solve your 3 year long troubles with abdominal pain after you have seen GI ,cardio, rheum and endocrine whom have all told you it is unexplained. Telling this to the patient, then to the mother and father whom walk in after your explanation, then to grandpa ,etc is a real killer. Then patients will be upset that they spent xxx amount of money for 'no reason'. No maam, you have reassurance there isn't an emergency. Truly stuff like this wears on me the most.
I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.
Okay im going to break away from my normal pessimism from EM and add a few good things about EM:
1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.
I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.
I’m not a fan of medicine in general and wouldn’t have done it but I still think EM was a good choice for me based on what you said here. Additionally, I think rural EM is so much better, especially if you can find a high paying gig like I have.
Right.
I'm actually much happier these days as I'm getting close to my FIRE number thanks to the stock market has been hot the last 3 years. I guess the cure for EM pessimism is achieving FI?
Yeah Im coast FI at 2M net worth and 35 age. 3M fulfills our 4% rule and i think I’m only 3 years from that.
Im starting to fantasize about turning my w2 job into a PRN gig in 2-3 years and being credentialed at 3-4 places where i only work prn as i choose. Financial independence is definitely freeing.
$2M net worth by 35 can be done in a normally performing stock market without a spouse’s help. You’ll need a good job and high savings rate. Most won’t for reasons but it’s doable.2M at 35 is impressive. How? Married well?
This reminds me of a patient who kept yelling from his room, "I need something to calm me down!" That was when I learned there are people who externalize even something as (to me) internal as that. I kept thinking, "You do have something. It's your own brain. You can use it to calm yourself down." So many of people's problems have free, easy, non-medical solutions, but everyone wants a pill or even better, a shot.There has been total medicalization of every aspect of American life: constant commercials that tell you to consult your doctor or go to the nearest ED for any trivial issue. People show up expecting that all of their life's issues can be solved, they can be provided with a note to get them out of their troubles and that somehow insurance is supposed to cover any and every expense, procedure or intervention most of which are only done for medicolegal reasons anyway
$2M net worth by 35 can be done in a normally performing stock market without a spouse’s help. You’ll need a good job and high savings rate. Most won’t for reasons but it’s doable.
2M at 35 is impressive. How? Married well?