Why is there an EM residency?

[ruralsurg4now]

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So the only patients they get are yours and they just can't seem to get it right.

I actually didn't say that, so I'm not sure why you're being so defensive. What was being discussed was "why physicians send patients to the ER" and I answered why. You disliked my answer, so I elaborated. Now you're replying with a histrionic response.

 

[Brigade4Radiant]

Interesting considering EM has higher board scores than all the services they admit to...(i.e. peds, IM, family, etc)

EM isn't a little about a lot.


EM is a lot about a lot.

No it doesn't EM's last board score was 223. There are some rumors that it's in the 230s but that's BS there are more EM spots being offered today than in 2011. EM is the 4th most populated residency.

 

[Siggy]

This is a business. Some docs/med students embrace that - I've found most to ignore or despise that. EM serves the purpose to get lots of people through the doors, admit those that can profit the hospital and discharge those that can't. That's why so many EDs use customer service surveys. They want people coming in those doors.

...and yet EMTALA mandates that we screen everyone who comes through the doors for a life threatening condition or labor and treat those who have it without regard for their ability to pay. That's a terrible business mandate, it's like if a steak house was required to screen for everyone's nutrition status and feed those who were malnourished even if they can't pay.

 

[happygilmore]

Yeah, it actually is. Sorry to break it to you.

I agree here. Performance today is based on what you did the last few years - so you can't extrapolate that a great med student is a great attending 10 years from now.

Sure, but people only "embrace" the business aspect of medicine that they want to embrace. Many dermatologists went to medical school to treat acne and wrinkles, they take cash only, and they work very little while generating large salaries. When that is pointed out, people say "it's a business, deal with it." But if a Cardiologist refused to treat your father who was in florid CHF because he was uninsured, you wouldn't say "this is a business." You'd demand that someone force him to treat your father, then sue him merely out of spite even if he did. We have a very dichotomous medical care system where the most important people get paid the least and are expected to treat everyone while the least important people get paid the most and are allowed to treat selectively. That's why I don't buy the "this is a business, learn it" argument.

Well, what happened here is that the government drove down the costs of those "important" doctors. I don't really agree with the most important, least important doctors argument. It's just a huge system - some care is to sustain life and other care is for cosmetics. Look at FM, they get paid the least but arguably could have the largest impact on American health (excellent preventative care and regular PC visits would greatly lower late interventions and emergency care costs). But hey, the government decided orthopedics is highly important and family medicine isn't important at all. FM docs are in the highest demand also - but get paid the least... ??? Government economics.

In your scenario, the person who has CHF that was uninsured, yeah - in an emergent situation, he should be cared for. Does that mean that people starting cash practices are immoral because they don't have to accept all patients? I don't buy it. Obviously, physicians who are doing activities to prevent death will be called upon to act in emergent situations - but there is no law that says cardiologists must take all patients. They can open a cash practice if they want to. It's not immoral to do so. Unfortunately, physicians in large part have decided to "just focus on the medicine" - leaving business matters to hospitals CEOs, insurance companies, pharma and the government. Well, guess who is profiting off of hard working physicians now? Ignore at your own peril. Btw, focus on the business aspect doesn't mean you practice immorally or take advantage of patients - which is the old fashioned idea that has allowed all these other enterprises to destroy medicine.

That may be, but I would say that being respected by your peers is quite important to most people, including EM. That's often what bothers them the most, I find, is the lack of respect they are given by other physicians.

"I don't know the key to success, but the key to failure is trying to please everybody."

Great if it happens, but honestly - trying to please or earn respect of the egos in medicine is a fool's errand.

...and yet EMTALA mandates that we screen everyone who comes through the doors for a life threatening condition or labor and treat those who have it without regard for their ability to pay. That's a terrible business mandate, it's like if a steak house was required to screen for everyone's nutrition status and feed those who were malnourished even if they can't pay.

Sure. Emergencies require different rules. A private practice *insert virtually any specialty* doesn't have this problem.

 

[deleted128562]

Not really. What happens as a surgeon when we send people into the ER is that when they arrive, they get basic labs, usually a random CT scan, and then we get called back with the results. If it's the daytime and we send someone in from the office, we send them with instructions on what we want done. If we don't, then as soon as they arrive, our office gets a call about "the guy you just sent in" and we are asked what we want done.

I'd love it if the ER was a place for me to randomly send people for accurate and quick workups without my direction or supervision, but even EM guys in their own forum will protest that they "aren't here to diagnose." What you are demonstrating is that you don't want the responsibility but you want the credit. That doesn't usually occur.

Yeah I suppose those things kinda happen sometimes. I'll tell you what else happens - your patients often tell me how funny or frustrating it is that you don't ever seem to know what to do with them except send them to the ER.

 

[ruralsurg4now]

the government decided orthopedics is highly important and family medicine isn't important at all. FM docs are in the highest demand also - but get paid the least... ???

Those are sort of apples and oranges, though. FM is important because they're the "first line." Therefore, they will see literally everyone, which is why they are in the highest demand. It's basically a numbers game. But it's not because they do the "most important job," unless you mean "being a gatekeeper," which is only important in the context of our current healthcare system. Similarly, in the context of our current system, EM is probably THE most important specialty, since they are in charge of the cash flow of the hospital, but that's entirely separate from their importance in terms of actual health care, which is fairly low.

 

[ruralsurg4now]

Yeah I suppose those things kinda happen sometimes. I'll tell you what else happens - your patients often tell me how funny or frustrating it is that you don't ever seem to know what to do with them except send them to the ER.

Possibly, but I'd assume that they'd stop seeing me and seek out another surgeon if that were the case. I know I would.

 

[happygilmore]

Not really. What happens as a surgeon when we send people into the ER is that when they arrive, they get basic labs, usually a random CT scan, and then we get called back with the results. If it's the daytime and we send someone in from the office, we send them with instructions on what we want done. If we don't, then as soon as they arrive, our office gets a call about "the guy you just sent in" and we are asked what we want done.

I'd love it if the ER was a place for me to randomly send people for accurate and quick workups without my direction or supervision, but even EM guys in their own forum will protest that they "aren't here to diagnose." What you are demonstrating is that you don't want the responsibility but you want the credit. That doesn't usually occur.

They aren't there to diagnose. They are there to bring $ into the hospital via admissions - all the while avoiding lawsuits. It's really that simple.

 

[Rendar5]

That may be, but I would say that being respected by your peers is quite important to most people, including EM. That's often what bothers them the most, I find, is the lack of respect they are given by other physicians.

Eh, most of us get over it once we're attendings, especially in community places where we do get the respect. sure, there's behind doors talk, but we also talk about others behind our own closed doors😉

 

[ruralsurg4now]

They aren't there to diagnose. They are there to bring $ into the hospital via admissions - all the while avoiding lawsuits. It's really that simple.

I know. We're in agreement.

 

[ruralsurg4now]

Well on that we can agree!

So what's the issue? 🙂

 

[link2swim06]

Those are sort of apples and oranges, though. FM is important because they're the "first line." Therefore, they will see literally everyone, which is why they are in the highest demand. It's basically a numbers game. But it's not because they do the "most important job," unless you mean "being a gatekeeper," which is only important in the context of our current healthcare system. Similarly, in the context of our current system, EM is probably THE most important specialty, since they are in charge of the cash flow of the hospital, but that's entirely separate from their importance in terms of actual health care, which is fairly low.

The DM and HTN management FM does will reduce M&M more than you will EVER do in your OR. I say that not to downplay the importance of surgery but to show you that other specialties are vital too.

You should try to have a more open mind.

 

[happygilmore]

Those are sort of apples and oranges, though. FM is important because they're the "first line." Therefore, they will see literally everyone, which is why they are in the highest demand. It's basically a numbers game. But it's not because they do the "most important job," unless you mean "being a gatekeeper," which is only important in the context of our current healthcare system. Similarly, in the context of our current system, EM is probably THE most important specialty, since they are in charge of the cash flow of the hospital, but that's entirely separate from their importance in terms of actual health care, which is fairly low.

Which is a good perspective, you need to look at specialties in terms of care and economics. FM has the ability to drastically change the economics of medicine - but since they don't have any lobbying power with medicare - they get paid the least. I think you hit the nail on the head though, some of the people in this profession only pay attention to the care side of the coin and not the economic side.

 

[Nasrudin]

I actually didn't say that, so I'm not sure why you're being so defensive. What was being discussed was "why physicians send patients to the ER" and I answered why. You disliked my answer, so I elaborated. Now you're replying with a histrionic response.

I am being defensive because I've worked for ED docs for years and I got sick of the guff they would get for no reason by people who are eminently comfortable Monday morning quarterbacking their every decision. When my instincts for these docs working in well controlled environments tells me they would loose their **** in the multi-tasking hailstorm that is a a busy ED shift. M

Your narcissism is beyond reproach here. Reasoning with you is pointless.

It's depressing though. Because here's what happens. The OP follows you around and takes on your attitude like a lap dog to a bully. And because they don't know any better they mistake your bravado for actually being a bad@ss such that they puff their chests out trying to emulate you. And the whole ignorant process of bashing each other just keeps going round and round.

Congratulations. Take the OP back to the bro cave and teach him the Kung fu of bad@ssness.

 

[ruralsurg4now]

The DM and HTN management FM does will reduce M&M more than you will EVER do in your OR. I say that not to downplay the importance of surgery but to show you that other specialties are vital too.

You should try to have a more open mind.

Why would you think that I didn't think other specialties are vital? All I stated was that the fact that there is great demand for FM doesn't necessarily mean it is because of what they do, necessarily. By the way, at many places FM doesn't come into the hospital. That would be IM.

 

[happygilmore]

The DM and HTN management FM does will reduce M&M more than you will EVER do in your OR. I say that not to downplay the importance of surgery but to show you that other specialties are vital too.

You should try to have a more open mind.

Our healthcare system may collapses based on this.

Late expensive interventions, with no care to HTN, obesity, hyperlipidemia, exercise, etc. America's collective fat ass is too expensive and it doesn't want to take care of itself.

To add to that, all the focus and finance is on late interventions - with a distaste for preventing people from getting to the OR in their 50's + 60's. Can you imagine how much cost all these overweight people will have on the system in 20 years? Game over. Save your money guys - this dream is collapsing.

 

[ruralsurg4now]

I am being defensive because I've worked for ED docs for years and I got sick of the guff they would get for no reason by people who are eminently comfortable Monday morning quarterbacking their every decision.

Right, but that goes back to the fact that they're not really qualified for diagnosis, although you may find that insulting as a statement. In other words, they don't have the same knowledge as a Pulmonologist -- so to expect them to be able to diagnose at the level of one would be silly. However, the Pulmonologist isn't going to get up and drive in every night for every patient. The compromise, therefore, is coverage by someone who has some rudimentary (comparatively) knowledge of a wide range of medical fields. But it's not "Monday morning quarterbacking" in the sense that we actually know more about our fields and can diagnose and treat far more effectively and efficiently than an ER physician can. If you think otherwise, you are sadly mistaken.

 

[deleted128562]

Right, but that goes back to the fact that they're not really qualified for diagnosis, although you may find that insulting as a statement. In other words, they don't have the same knowledge as a Pulmonologist -- so to expect them to be able to diagnose at the level of one would be silly. However, the Pulmonologist isn't going to get up and drive in every night for every patient. The compromise, therefore, is coverage by someone who has some rudimentary (comparatively) knowledge of a wide range of medical fields. But it's not "Monday morning quarterbacking" in the sense that we actually know more about our fields and can diagnose and treat far more effectively and efficiently than an ER physician can. If you think otherwise, you are sadly mistaken.

Well OK then. That seems pretty fair. The Pulmonologist knows more than I do, absolutely. But he's also not going to drive over at 3AM which is why I have to be the one to intubate and stabilize his severely ill asthma patient. The Cardiologist knows more than I do, but he isn't awake or in the hospital at midnight, which is why I have to be the one to decide whether to call the MI alert or not.

The OP's question was why we have EM residencies, and I think you just answered his question pretty well. Do we know as much as the specialists? No, of course not. But on the other hand, would you expect the Pulmonologist to treat his asthma patient while in the same hour reducing a fracture, managing a septic patient, delivering a baby in the ambulance bay, and dodging a crack addict's fists? No of course not. So everyone has their place. Why the hating then?

 

[link2swim06]

Right, but that goes back to the fact that they're not really qualified for diagnosis, although you may find that insulting as a statement. In other words, they don't have the same knowledge as a Pulmonologist -- so to expect them to be able to diagnose at the level of one would be silly. However, the Pulmonologist isn't going to get up and drive in every night for every patient. The compromise, therefore, is coverage by someone who has some rudimentary (comparatively) knowledge of a wide range of medical fields. But it's not "Monday morning quarterbacking" in the sense that we actually know more about our fields and can diagnose and treat far more effectively and efficiently than an ER physician can. If you think otherwise, you are sadly mistaken.

Will an EM doc diagnose berylliosis at 2am? Unlikely. Even if they did would the management change at all? Probably not.

The point of the ED is to diagnose emergencies (think status asthmaticus). EM docs are more than qualified to do this. That is the entire point of the specialty.

 

[ruralsurg4now]

Well OK then. That seems pretty fair. The Pulmonologist knows more than I do, absolutely. But he's also not going to drive over at 3AM which is why I have to be the one to intubate and stabilize his severely ill asthma patient. The Cardiologist knows more than I do, but he isn't awake or in the hospital at midnight, which is why I have to be the one to decide whether to call the MI alert or not.

The OP's question was why we have EM residencies, and I think you just answered his question pretty well. Do we know as much as the specialists? No, of course not. But on the other hand, would you expect the Pulmonologist to treat his asthma patient while in the same hour reducing a fracture, managing a septic patient, delivering a baby in the ambulance bay, and dodging a crack addict's fists? No of course not. So everyone has their place. Why the hating then?

I'm not "hating." I'm making statements, some of which are not terribly complimentary to EM, but which are not untrue. As you see, if you step back and don't become enraged by what you perceive to be an "attack," I'm being reasonable. I'm a pretty unbiased person, believe it or not.

 

[Rendar5]

lol, med students going into EM, trust me, you will care less and less about what other people think about your field as you go forward. Haters gonna hate, but most people actually don't hate on us. Our job just happens to be dealing with the obvious and the emergent. (And I get to explain this to many patients who I discharge without a clear diagnose, our resources are not designed to deal with complex diagnostics, if it's obvious or acute life-threatening, I can tell you what's going on most of the time. If it's neither category, please follow-up with your doctor since that's what they're there for).

We're paid to get people to where they need to be, and to get them there in one piece. As one of my directors mentioned (and a brilliant guy to boot), our job is to connect the right patient with the right doctor in the right setting.

We're also paid to be careful, not to be accurate. >2% chance of death, 98% chance of nothing too bad? in the hospital with ya. Many of our admissions end up being BS, great, we caught the one that was gonna die.

And ruralsurg isn't too far off the mark with his comments. A surgeon sends his patient in, you're damn right I'm gonna call him and do the workup he requests. There's so many ways to deal with anything in medicine, that if he's going to ultimately treat the guy, he gets whatever tests he wants done. Now, if he doesn't want particular tests and I'm concerned about something, it's my job to go the extra mile and do those tests anyway (e.g., he swears there can't be a bloody pericardial effusion, it's still on me to order the echo). But the patient isn't in limbo. They already know the patient better than me, so if they wanted him to come in for a CT, I'll discuss it with him and probably order it, or at the least find an appropriate w/u regimen in conjunction with them.

Most of my patients don't come from surgeons offices though, so most of the time, it's just me and the pt. And scratching my head on why the PA from the FM office felt the need to send in the asymptomatic pt with a BP of 190/100.

 

[happygilmore]

Well OK then. That seems pretty fair. The Pulmonologist knows more than I do, absolutely. But he's also not going to drive over at 3AM which is why I have to be the one to intubate and stabilize his severely ill asthma patient. The Cardiologist knows more than I do, but he isn't awake or in the hospital at midnight, which is why I have to be the one to decide whether to call the MI alert or not.

The OP's question was why we have EM residencies, and I think you just answered his question pretty well. Do we know as much as the specialists? No, of course not. But on the other hand, would you expect the Pulmonologist to treat his asthma patient while in the same hour reducing a fracture, managing a septic patient, delivering a baby in the ambulance bay, and dodging a crack addict's fists? No of course not. So everyone has their place. Why the hating then?

Great analysis.

Appreciate everyone's unique role and work together. Unfortunately some people use the fact that EM knows less to hate on them. No need. That's not their purpose.

 

[Siggy]

Why do we have emergency physicians and emergency residencies? Because the other specialties need heroes too. After all, why do they keep referring their patients to the ED either in discharge instructions or over the phone?

 

[colbgw02]

It wasn't that long ago that Harborview's ED wasn't staffed with EM physicians. Reportedly, it worked quite well, but obviously that model is not sustainable outside of large medical centers.

http://seattletimes.com/html/localnews/2002177303_erdocs11m.html

 

[Porfirio]

What I like most about EM is not getting the exact diagnosis, but an idea.

I like to come up with an idea of the diagnosis, and someone else prove it. I would rather have someone else do all the menial work. I find it boring having to hunt for every little detail, sit and wait for all the lab tests to come in, plan all the follow-up, and most of all surgery is too much like being a mechanic. The OR just makes me yawn. The only exciting thing to happen in the OR is to watch the surgeon throw a temper tantrum.

EM offers a fast paced variety, and I actually like the chaos of the ED. The patient interaction is acute, and there is no telling what will come in the door. You see people from all walks of life. There are some crazy, fun, and memorable stories to be found in the ED.

 

[ruralsurg4now]

I like to come up with an idea of the diagnosis, and someone else prove it. I would rather have someone else do all the menial work. I find it boring having to hunt for every little detail, sit and wait for all the lab tests to come in, plan all the follow-up, and most of all surgery is too much like being a mechanic. The OR just makes me yawn. The only exciting thing to happen in the OR is to watch the surgeon throw a temper tantrum.

See, this is the amusing part. I get the feeling you're trying to "turn the tables" on the other physicians, but all you're really doing is demonstrating a total lack of understanding of medical care. You say that you come up with some ideas and then other people have to "prove it." The reality is that people don't really care about what your idea is, nor are they trying to prove it. It's basically you making up some fantastic story about how you're running the hospital when it's actually the opposite. The way most physicians approach the ER -- I'm not joking -- is that they literally ignore everything they were told by the ER physician. So you could come up with any diagnosis you want, but nobody is actually paying much attention.

Then you say that you "find it boring" to hunt for details and wait for lab tests. That's amazing because that's called "data." All you did was state that you like to make wild guesses, which is what people accuse EM of doing. So all you're doing is validating the negative statements being made.

Lastly, you say that surgery is like being a mechanic. Except the most important part of surgery is knowing when NOT to operate, something that is lost on many people who aren't surgeons. (I don't blame someone for thinking that way, however, as it is an easy thing to do. It's also easy for people who aren't surgeons to simply view surgery as "why don't you just cut?" )

 

[EsTxDr]

Then why are you on a thread trying to project a positive viewpoint about yourself?

I haven't "projected a positive viewpoint" about myself or anyone else. I simply stated I find the thread amusing and disagree that EM docs are bothered by your perceived "lack of respect".

I find your viewpoint amusing, especially coming from a surgeon. 😎

But dont let me stop your broad assumptions and generalizations. Feel free to continue telling me how I feel. 😉

 

[ruralsurg4now]

I haven't "projected a positive viewpoint" about myself or anyone else. I simply stated I find the thread amusing and disagree that EM docs are bothered by your perceived "lack of respect".

You actually said more than that. Go back and re-read your post. 🙂

 

[KnuxNole]

Will an EM doc diagnose berylliosis at 2am? Unlikely. Even if they did would the management change at all? Probably not.

The point of the ED is to diagnose emergencies (think status asthmaticus). EM docs are more than qualified to do this. That is the entire point of the specialty.

The patients should learn about this. A good amount of patients think the point of the ED is to cure their sniffles or get pain medicine refilled 🙁

 

[Stellar Clouds]

The patients should learn about this. A good amount of patients think the point of the ED is to cure their sniffles or get pain medicine refilled 🙁

This is true. It's sad how much the ED is used as a PCP.

 

[TooMuchResearch]

that is a correct answer, but I was being rhetorical on how to confuse an ED attending is to ask them how insulin is dosed, since we don't normally dose it.

I know. I hang out in the EM forums enough to catch the humor. The original answer I was going to put down was "One insulin???"

 

[TallScrubs]

. The way most physicians approach the ER -- I'm not joking -- is that they literally ignore everything they were told by the ER physician. So you could come up with any diagnosis you want, but nobody is actually paying much attention.


Lastly, you say that surgery is like being a mechanic. Except the most important part of surgery is knowing when NOT to operate, something that is lost on many people who aren't surgeons. (I don't blame someone for thinking that way, however, as it is an easy thing to do. It's also easy for people who aren't surgeons to simply view surgery as "why don't you just cut?" )

Yeah, surgeons love that quote...knowing when NOT to operate. It's funny that two of my surgery attendings said that was literally the easiest part of their job, 'if they have an acute abdomen, you operate; if not, you don't.

 

[ruralsurg4now]

Yeah, surgeons love that quote...knowing when NOT to operate. It's funny that two of my surgery attendings said that was literally the easiest part of their job, 'if they have an acute abdomen, you operate; if not, you don't.

That's actually not the easiest part of their job. In fact, they were just being flippant for amusement. We surgeons like to do that. 🙂 (Most people don't get our humor, either. We're not terribly funny.)

 

[Porfirio]

See, this is the amusing part. I get the feeling you're trying to "turn the tables" on the other physicians, but all you're really doing is demonstrating a total lack of understanding of medical care. You say that you come up with some ideas and then other people have to "prove it." The reality is that people don't really care about what your idea is, nor are they trying to prove it. It's basically you making up some fantastic story about how you're running the hospital when it's actually the opposite. The way most physicians approach the ER -- I'm not joking -- is that they literally ignore everything they were told by the ER physician. So you could come up with any diagnosis you want, but nobody is actually paying much attention.

Then you say that you "find it boring" to hunt for details and wait for lab tests. That's amazing because that's called "data." All you did was state that you like to make wild guesses, which is what people accuse EM of doing. So all you're doing is validating the negative statements being made.

Lastly, you say that surgery is like being a mechanic. Except the most important part of surgery is knowing when NOT to operate, something that is lost on many people who aren't surgeons. (I don't blame someone for thinking that way, however, as it is an easy thing to do. It's also easy for people who aren't surgeons to simply view surgery as "why don't you just cut?" )

No, I am not "turning the tables." I am simply stating my opinion just like you, and we are in disagreement. Neither one of us is right or wrong.

Wild guesses? I keep hearing from dinosaur physicians that 95% of the diagnosis is in the history. That is the whole point of taking a thorough history.

A mechanic knows when to remove a spark plug and when not to… What is your point?

Your novel of a response was not very interesting to read.

 

[TallScrubs]

That's actually not the easiest part of their job. In fact, they were just being flippant for amusement. We surgeons like to do that. 🙂 (Most people don't get our humor, either. We're not terribly funny.)

Damn, you must be good if you're reading someone's tone whose word's you've never heard....color me impressed.

Notice I'm being flippant for amusement.

 

[ruralsurg4now]

No, I am not "turning the tables." I am simply stating my opinion just like you, and we are in disagreement. Neither one of us is right or wrong.

No, actually when you say that you formulate an idea and someone else proves it, you're wrong. Sorry. They're proving their own ideas and not really paying much attention to yours.

Wild guesses? I keep hearing from dinosaur physicians that 95% of the diagnosis is in the history. That is the whole point of taking a thorough history.

Oh, there is no question that the history is important. However, go to those "dinosaur physicians" and explain to them your theories of how diagnosis is "menial work" and it's "boring to hunt for details" or lab values are uninteresting. I'm sure they'll enjoy your thoughts.

A mechanic knows when to remove a spark plug and when not to… What is your point?

So all you proved there is that you think at a concrete level. Some day you will progress, however.

 

[ruralsurg4now]

Damn, you must be good if you're reading someone's tone whose word's you've never heard....color me impressed.

Notice I'm being flippant for amusement.

You can actually tell what they meant, based on what they were talking about. 🙂 Notice that they simplified things to discussion of an "acute abdomen" for you. In addition, even an acute abdomen does not necessarily indicate the need for an operation, depending on the condition of the patient and the clinical decision of the surgeon. It may be more prudent to not operate, but I'm quite sure your attendings know that and were just cracking a joke for you, otherwise they would have failed their Boards immediately.

 

[TallScrubs]

You can actually tell what they meant, based on what they were talking about. 🙂 Notice that they simplified things to discussion of an "acute abdomen" for you. In addition, even an acute abdomen does not necessarily indicate the need for an operation, depending on the condition of the patient and the clinical decision of the surgeon. It may be more prudent to not operate, but I'm quite sure your attendings know that and were just cracking a joke for you, otherwise they would have failed their Boards immediately.

Well of course it was simplified, but it doesn't change his message.

 

[ruralsurg4now]

Well of course it was simplified, but it doesn't change his message.

No, actually, it does. As proof, go back to those attendings and have a serious discussion with them, rather than just digesting what I am sure was just an off-the-cuff remark. Say to them, "so what you're saying is that knowing when to operate and when not to operate is simple?" You'll get like a ten hour lecture on how you're wrong and afterwards you'll think they take themselves too seriously. People who view taking people to surgery lightly run into trouble. 🙂

Oh, by the way, don't do that if you're a med student on the Surgery rotation because you'll also be labeled an idiot and probably receive a low clinical grade.

 

[TallScrubs]

No, actually, it does. As proof, go back to those attendings and have a serious discussion with them, rather than just digesting what I am sure was just an off-the-cuff remark. Say to them, "so what you're saying is that knowing when to operate and when not to operate is simple?" You'll get like a ten hour lecture on how you're wrong and afterwards you'll think they take themselves too seriously. People who view taking people to surgery lightly run into trouble. 🙂

Oh, by the way, don't do that if you're a med student on the Surgery rotation because you'll also be labeled an idiot and probably receive a low clinical grade.

Don't do what exactly?

 

[ruralsurg4now]

Don't do what exactly?

My suggestion where you go around telling attendings that the decision not to operate is simple. That's a good way to get destroyed and then you'll show up here complaining about how mean your attendings are.

 

[TallScrubs]

My suggestion where you go around telling attendings that the decision not to operate is simple. That's a good way to get destroyed and then you'll show up here complaining about how mean your attendings are.

Man, other people are right, you love to twist people's words...it really makes you seem like a tool. Find where I said that the decision not to operate is simple, and I will kiss your feet.

 

[ruralsurg4now]

Man, other people are right, you love to twist people's words...it really makes you seem like a tool. Find where I said that the decision not to operate is simple, and I will kiss your feet.

That's interesting, I thought that was the point of your little anecdote. What happened, reconsidered things?

 

[TallScrubs]

That's interesting, I thought that was the point of your little anecdote. What happened, reconsidered things?

The point of my anecdote was that I had two surgery attendings who directly contradicted what you said. I thought that was pretty clear.

 

[Porfirio]

No, actually when you say that you formulate an idea and someone else proves it, you're wrong. Sorry. They're proving their own ideas and not really paying much attention to yours.



Oh, there is no question that the history is important. However, go to those "dinosaur physicians" and explain to them your theories of how diagnosis is "menial work" and it's "boring to hunt for details" or lab values are uninteresting. I'm sure they'll enjoy your thoughts.



So all you proved there is that you think at a concrete level. Some day you will progress, however.

Why do you assume that I care about what someone else thinks about my own ideas? I hope the other physician (that I sent the patient to) comes up with their own ideas to finally narrow down a diagnosis for the patient. The goal is to help the patient - not boost my ego.

Additionally, thinking more concrete would be to respond to your statement by saying, "Yes, it is important for surgeons to know when and when not to operate. That's why we have Pathologists and Radiologists."

You are just fishing for attention at this point, good bye.

 

[TallScrubs]

Why do you assume that I care about what someone else thinks about my own ideas? I hope the other physician (that I sent the patient to) comes up with their own ideas to finally narrow down a diagnosis for the patient. The goal is to help the patient - not boost my ego.

Additionally, thinking more concrete would be to respond to your statement by saying, "Yes, it is important for surgeons to know when and when not to operate. That's why we have Pathologists and Radiologists."

You are just fishing for attention at this point, good bye.

I agree with this fine chap. Enjoy your life which, I can only assume, is spent watching 'Malice' over and over again.

 

[EsTxDr]

You actually said more than that. Go back and re-read your post. 🙂

This guy. 🙄

 

[unsung]

I don't follow this argument at all.

EM physicians are no less knowledgeable than general internists. I've seen hospitalists look for SIRS in every patient (when the patient is clearly tachycardic from pain) & give out antibiotics "liberally"... automatically put people on iron, call in heme for a basic anemia work-up... the list goes on. And let's not even talk about IM residents. I've seen patients who present with biliary colic get work-up with troponins x3 overnight by the resident without any other relevant labs... then shipped out next day. There's plenty of bad IM residents. Oy.

Basically in general IM... try out the common treatments for the common ailments.. and if none work, consult a specialist. Or, just as often, discharge them home without ever figuring out what's wrong with them... again, to follow up outpatient with the specialist. How is this any less of a triage situation compared to EM?

The difference is that EM physicians, on top of triaging like the generalists, also have a specialized skill set. They handle things when **** hits the fan. They run codes, multi-task, make DECISIONS quickly as a situation evolves. NOT everyone has the ability to do this... plenty of medicine folks wilt in these situations.

So how come general internists don't get as much flack as EM docs ?

 

[Kahreek]

In many countries EM doesnt exist as a residency.

 

[alpinism]

Right, but that goes back to the fact that they're not really qualified for diagnosis, although you may find that insulting as a statement. In other words, they don't have the same knowledge as a Pulmonologist -- so to expect them to be able to diagnose at the level of one would be silly. However, the Pulmonologist isn't going to get up and drive in every night for every patient. The compromise, therefore, is coverage by someone who has some rudimentary (comparatively) knowledge of a wide range of medical fields. But it's not "Monday morning quarterbacking" in the sense that we actually know more about our fields and can diagnose and treat far more effectively and efficiently than an ER physician can. If you think otherwise, you are sadly mistaken.

Lol not qualified to make a diagnosis?

For non-emergent pulm issues, of course they're not qualified. That's not the purpose of having an EP, nor should it be. The only reason they see pts like that is because of ED misuse (pts treating the ED like a PCP clinic).

EPs are specialists in life-threatening acute illnesses (emergencies). They should and often do know more about the emergent care of a pneumothorax, pericardial tamponade, or SAH than pulmonologists, cardiologists, or neurologists.

EPs are also experts in toxicology, hyperbaric medicine, prehospital medicine, wilderness medicine, and disaster medicine.