Why is there an EM residency?

[Doctor Bob]

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Personally...

It amuses me when other docs send their patients to the ED, and call me to tell me what tests to order.

I gently remind them that once the patient walks through my door they are now my patient and I will order whatever tests I feel are necessary to workup their current ailment. I am happy to hear their suggestions but often they want me to do things that I feel are unnecessary. If they want to determine what testing is done, they are free to direct admit the patient to the hospital. When the patient is in my department, the primary doctor is now a consultant and just as in anywhere else in the hospital the primary team would get upset if the consulting service demanded specific testing.

I do not run a convenience clinic. My primary function is to stabilize and intervene on acute life threatening issues. Anything beyond that does not belong here. I consult other services a lot less than some of my colleagues because I ascribe to the philosophy of "don't let someone else do your job for you". If I have to call in a surgeon to do a physical exam on someone to determine if they have an acute abdomen then I've failed. When I call a consultant it is to let them know what I need them to do that I am unable to do myself (take the person for a procedure, admit for a therapy, etc).

In general...

Every other field of medicine is a field of specificity. EM is a field of sensitivity.
Everybody else is paid to be right. I am paid to not be wrong. It is a subtle but meaningful difference.

 

[neusu]

I do not run a convenience clinic. My primary function is to stabilize and intervene on acute life threatening issues.

I'd be interested in seeing the census of patients/diagnoses and treatment rendered from your last shift to support this statement.

EM physicians are no less knowledgeable than general internists... So how come general internists don't get as much flack as EM docs ?

Certainly EM and IM have many similarities. Perhaps the difference in general opinion of the two is the former run around like cowboys with an inferiority complex and something to prove.

 

[badasshairday]

EM exists so every other doctor can play Monday morning quarterback and criticize ED docs. This allows them to stroke their own egos while they get to analyze an emergency situation after the fact at their own leisure. "Oh, those dumb ED docs, why didn't they think this instead of that..." while that patient is on the verge of death.

Everyo specialty is guilty of bad mouthing EM; surgical specialties, internists and their subspecialties, radiologists, etc. It is ridiculous. Mad respect to the ED doctors out there. Much love from a radiology resident who appreciates what you do out in the trenches as the front line.

 

[EsTxDr]

Perhaps the difference in general opinion of the two is the former run around like cowboys with an inferiority complex and something to prove.

 

[Doctor Bob]

I'd be interested in seeing the census of patients/diagnoses and treatment rendered from your last shift to support this statement.

My discharge instructions for most patients I see reads as follows: "You have received a Medical Screening Exam and have been found to NOT have an Emergent Medical Condition. It is advised that you follow up with your assigned Primary Care Provider." Over the last month, about 60% of my patients leave with that.

Certainly EM and IM have many similarities. Perhaps the difference in general opinion of the two is the former run around like cowboys with an inferiority complex and something to prove.

I try to maintain an equality complex; we all graduated from medical school; we all have a role to play in the healthcare system; we all have diseases and conditions that we are specially trained to treat. I only change my tune when people from other fields try to tell me how to do my job. I am not better than other fields at the practice of medicine in general, but I am better at the practice of emergency medicine.

Mad respect to the ED doctors out there. Much love from a radiology resident who appreciates what you do out in the trenches as the front line.

And we respect radiologists for what they do (good lord, the way you pick some of those findings out of CTs, MRIs, etc, after just glancing at the films for a few seconds amazes me... I could look at them all day and still not see much of the things you do); we respect surgeons for what they do; we respect pediatricians for what they do, etc, etc, etc. The respect between the specialties is much more even in non-academic medicine.

 

[Dr. USMLE]

I have a lot of respect for ED docs, just find that the specialty lends itself to burnout too easily.

 

[happygilmore]

Personally...

It amuses me when other docs send their patients to the ED, and call me to tell me what tests to order.

I gently remind them that once the patient walks through my door they are now my patient and I will order whatever tests I feel are necessary to workup their current ailment. I am happy to hear their suggestions but often they want me to do things that I feel are unnecessary. If they want to determine what testing is done, they are free to direct admit the patient to the hospital. When the patient is in my department, the primary doctor is now a consultant and just as in anywhere else in the hospital the primary team would get upset if the consulting service demanded specific testing.

I do not run a convenience clinic. My primary function is to stabilize and intervene on acute life threatening issues. Anything beyond that does not belong here. I consult other services a lot less than some of my colleagues because I ascribe to the philosophy of "don't let someone else do your job for you". If I have to call in a surgeon to do a physical exam on someone to determine if they have an acute abdomen then I've failed. When I call a consultant it is to let them know what I need them to do that I am unable to do myself (take the person for a procedure, admit for a therapy, etc).

In general...

Every other field of medicine is a field of specificity. EM is a field of sensitivity.
Everybody else is paid to be right. I am paid to not be wrong. It is a subtle but meaningful difference.

My discharge instructions for most patients I see reads as follows: "You have received a Medical Screening Exam and have been found to NOT have an Emergent Medical Condition. It is advised that you follow up with your assigned Primary Care Provider." Over the last month, about 60% of my patients leave with that.



I try to maintain an equality complex; we all graduated from medical school; we all have a role to play in the healthcare system; we all have diseases and conditions that we are specially trained to treat. I only change my tune when people from other fields try to tell me how to do my job. I am not better than other fields at the practice of medicine in general, but I am better at the practice of emergency medicine.



And we respect radiologists for what they do (good lord, the way you pick some of those findings out of CTs, MRIs, etc, after just glancing at the films for a few seconds amazes me... I could look at them all day and still not see much of the things you do); we respect surgeons for what they do; we respect pediatricians for what they do, etc, etc, etc. The respect between the specialties is much more even in non-academic medicine.

Great answers here.

Especially the bold. Everyone has a role to play.

People hate on EM because they want EM to play the role every specialty instead of just being EM doctors.

 

[Renaissance Man]

I'm not sure why people are even responding to the "surgeon" troll dude, but anyways...EM doctors are the gate-keepers to the entire hospital. They are paid to make sure that people do not suffer serious injury or death during the short duration that the patient is in the ER. They triage, make quick decisions, take care of multiple patients at the same time (with a constant source of more patients in the waiting room), and then have their work judged by everyone else.

In my experience other doctors get pissed that EM physicians are actually able to "wash their hands" of patients at the end of shifts and constantly call other specialties (plus they make good $$$ for shift work). No one likes the hand that always is giving out more work, but thats how a hospital works. I can't believe this thread is even still open. Read Doctor Bob's responses as the voice of reason.

 

[VA Hopeful Dr]

I'm not sure why people are even responding to the "surgeon" troll dude, but anyways...EM doctors are the gate-keepers to the entire hospital. They are paid to make sure that people do not suffer serious injury or death during the short duration that the patient is in the ER. They triage, make quick decisions, take care of multiple patients at the same time (with a constant source of more patients in the waiting room), and then have their work judged by everyone else.

In my experience other doctors get pissed that EM physicians are actually able to "wash their hands" of patients at the end of shifts and constantly call other specialties (plus they make good $$$ for shift work). No one likes the hand that always is giving out more work, but thats how a hospital works. I can't believe this thread is even still open. Read Doctor Bob's responses as the voice of reason.

I find him very reminiscent of an old anti-EM surgeon named Kinetic...

 

[Southplains]

I think this sparked an interesting discussion that I've enjoyed reading, but it was totally a "rock the boat" on purpose thread and I just want to tip my hat at JP for succeeding. Has he even posted once since his laughably short and inciting OP?

 

[evilbooyaa]

JP, damnit man, you stupid butthole. Why does this forum let him do this? And this ruralsurg4now guy, he came alive in this thread and you all fed him.

Respect all others in their residency decisions, we can all benefit from each other's specialties, blah blah, kumbayah my lord, kumbayah.

/thread PLEASE. This is nothing but a troll thread (JP) followed by troll responses (ruralsurg)

 

[Siggy]

/thread PLEASE. This is nothing but a troll thread (JP) followed by troll responses (ruralsurg)

 

[Winged Scapula]

JP, damnit man, you stupid butthole. Why does this forum let him do this? And this ruralsurg4now guy, he came alive in this thread and you all fed him.

Respect all others in their residency decisions, we can all benefit from each other's specialties, blah blah, kumbayah my lord, kumbayah.

/thread PLEASE. This is nothing but a troll thread (JP) followed by troll responses (ruralsurg)

There has not been a single reported post from this thread. Outside of the SDN terms of service, users are responsible for setting the desired tone of their forums.

I agree, this thread and several others in this forum are very distasteful and make me embarrassed that some of you will be future colleagues. However, users need to use the report post button or simply refuse to engage trolls. If you don't report it, it can't be evaluated for administrative action.

 

[JP2740]

I think this sparked an interesting discussion that I've enjoyed reading, but it was totally a "rock the boat" on purpose thread and I just want to tip my hat at JP for succeeding. Has he even posted once since his laughably short and inciting OP?

Lmao.

This is my first post since. I'll be honest it's a pretty good thread and it did indeed spark a good discussion. Sometimes it takes that to get people to step out of their boundaries and post on here. I do admit I am not the one who thought of the original post. I heard those words from a physician during my IM rotation. I mean, of course, I admit it's a troll thread, but I think all of my troll threads have resulted in a enjoyable thread for everyone. I don't really care about administrative action go for it. I just find it funny that the most trafficked thread on the allopathic board is this one, and people are bitching because people won't go to the "have you started studying for step 1" derp thread

 

[JP2740]

I agree, this thread and several others in this forum are very distasteful and make me embarrassed that some of you will be future colleagues..

Whatever, most of us aren't in real life exactly how we are on SDN. You should be embarrassed by some of your current colleagues. People who go into certain fields so they can chill and let their skills and knowledge slowly deteriorate. Most physicians don't care about their patients. You should be embarrassed that they're your colleagues, not because someone posted a thread on SDN that you should actually laugh at rather than get super rustled. I'm sure quite a few people got a good laugh, and a handful more in their head remembered their IM rotation where they thought "...***** emergency doctors".

 

[Rendar5]

lol, backtalk to a mod, not the smartest thing I've seen all day.

 

[JP2740]

lol, backtalk to a mod, not the smartest thing I've seen all day.

Just because you quote a mod and don't kiss their behind, doesn't mean you're backtalking really.

 

[Winged Scapula]

Whatever, most of us aren't in real life exactly how we are on SDN. You should be embarrassed by some of your current colleagues. People who go into certain fields so they can chill and let their skills and knowledge slowly deteriorate. Most physicians don't care about their patients. You should be embarrassed that they're your colleagues, not because someone posted a thread on SDN that you should actually laugh at rather than get super rustled. I'm sure quite a few people got a good laugh, and a handful more in their head remembered their IM rotation where they thought "...***** emergency doctors".

interesting response given that I basically defended your right to post this thread.

in addition given the fact that I never mentioned which particular comments I found distasteful - yours or other users. Frankly I'm more worked up about a couple of different threads in this forum than this one.

And yes, there are many of my colleagues that I'm embarrassed by. Right now it takes the form of a certain infectious disease physician who can't seem to tell the difference between radiation changes and cellulitis in the skin of African-American women. Im embarrassed that I had to draw circle around the radiation changes that she's had for five years and that are unchanged and write on the patient "radiation changes" since he refused to read any of my notes or that of her plastic surgeon, radiation oncologist or medical oncologist. /soap box

 

[JP2740]

interesting response given that I basically defended your right to post this thread.

in addition given the fact that I never mentioned which particular comments I found distasteful - yours or other users. Frankly I'm more worked up about a couple of different threads in this forum than this one.

And yes, there are many of my colleagues that I'm embarrassed by. Right now it takes the form of a certain infectious disease physician who can't seem to tell the difference between radiation changes and cellulitis in the skin of African-American women. Im embarrassed that I had to draw circle around the radiation changes that she's had for five years and that are unchanged and write on the patient "radiation changes" since he refused to read any of my notes or that of her plastic surgeon, radiation oncologist or medical oncologist. /soap box

I know you did defend my right to post, I just thought you meant my initial post was distasteful, which I mean it kinda is but not that crazy or off the wall. I just wanted to make a point. I mean it's not like I questioned your knowledge of the difference between an oncologist, radiation oncologist, and cancer surgeon, or say that cancer surgeons only know how to operate on cancer patients and that's all (awared?)

 

[link2swim06]

Whatever, most of us aren't in real life exactly how we are on SDN. You should be embarrassed by some of your current colleagues. People who go into certain fields so they can chill and let their skills and knowledge slowly deteriorate. Most physicians don't care about their patients. You should be embarrassed that they're your colleagues, not because someone posted a thread on SDN that you should actually laugh at rather than get super rustled. I'm sure quite a few people got a good laugh, and a handful more in their head remembered their IM rotation where they thought "...***** emergency doctors".

lol

Because everytime the ED calls it is more work for y'all to do?

 

[Winged Scapula]

lol

Because everytime the ED calls it is more work for y'all to do?

Exactly. That's why medical students and residents hate them. But as a consultant, in private practice, its just more money in my pocket.

 

[ruralsurg4now]

lol

Because everytime the ED calls it is more work for y'all to do?

Once you're beyond being a medical student, you'll find out that people make money from getting called by the ED. That's why a lot of the comments made on this thread by Medical Students who think they know what is going on are completely wrong.

 

[EsTxDr]

This is the thread that keeps on giving.

 

[Nasrudin]

Whatever, most of us aren't in real life exactly how we are on SDN. You should be embarrassed by some of your current colleagues. People who go into certain fields so they can chill and let their skills and knowledge slowly deteriorate. Most physicians don't care about their patients. You should be embarrassed that they're your colleagues, not because someone posted a thread on SDN that you should actually laugh at rather than get super rustled. I'm sure quite a few people got a good laugh, and a handful more in their head remembered their IM rotation where they thought "...***** emergency doctors".

Why is enticing people with insincerity fun? I don't get it. Never did. Trolls make no sense to me. I'm getting better at spotting them, given I wasn't raised on the Internet like most of you, but I still don't get where the fun is.

I think you are the person you are online. Maybe a bit more loose with the tongue like I am. But everything I type here is a thought in my head. Never once would it occur to me to be dishonest.

Anything that comes out of your mouth on this site is now total bull**** to me. I doubt you care about that. But for myself, such dishonor would be intolerable.

 

[Nasrudin]

Once you're beyond being a medical student, you'll find out that people make money from getting called by the ED. That's why a lot of the comments made on this thread by Medical Students who think they know what is going on are completely wrong.

Are you a troll too or are you serious? Idk what's going on in this thread.

 

[JP2740]

Once you're beyond being a medical student, you'll find out that people make money from getting called by the ED. That's why a lot of the comments made on this thread by Medical Students who think they know what is going on are completely wrong.

The original comment was quoted from a physician

 

[ruralsurg4now]

The original comment was quoted from a physician

I understand that. My comment wasn't directed towards you.

 

[alpinism]

Why is enticing people with insincerity fun? I don't get it. Never did. Trolls make no sense to me. I'm getting better at spotting them, given I wasn't raised on the Internet like most of you, but I still don't get where the fun is.

I think you are the person you are online. Maybe a bit more loose with the tongue like I am. But everything I type here is a thought in my head. Never once would it occur to me to be dishonest.

Anything that comes out of your mouth on this site is now total bull**** to me. I doubt you care about that. But for myself, such dishonor would be intolerable.

Its like being sarcastic or playing the devil's advocate in real life...

Often it can be interesting (and funny) to see how some people react.

I'll admit the thread was pretty damn entertaining.

 

[link2swim06]

Once you're beyond being a medical student, you'll find out that people make money from getting called by the ED. That's why a lot of the comments made on this thread by Medical Students who think they know what is going on are completely wrong.

Ok well I will be a physician in about 6 months...should I re-read my post then? lol

Of course I know people are getting paid for doing work.
I was responding to another medical student complaining about the ED.


Your understanding of the purpose of the ED is dismal at best. That is fine. I don't understand what you are getting by posting in this thread. Looking to stroke your ego or something?

 

[ruralsurg4now]

Ok well I will be a physician in about 6 months...should I re-read my post then?

You mean a resident. Or did you think I don't know how that works?

 

[link2swim06]

You mean a resident. Or did you think I don't know how that works?

What? Last time I checked a resident is a physician.

I didn't say I was becoming an attending in 6 months.

 

[Nasrudin]

Its like being sarcastic or playing the devil's advocate in real life...

Often it can be interesting (and funny) to see how some people react.

I'll admit the thread was pretty damn entertaining.

This is real life. We transmit our thoughts through code and satellites but they remain our thoughts or they wouldn't exist. All of the vicious people on YouTube are vicious. It's just that it shames them to be nazis in front of people so the do it under cyber cover.

If you are capricious with your own sincerity then you don't where it exists in your own heart. Conversation between human beings is not the insincere play thing of toddlers.

You can start conversation just as easily by being yourself being real and saying....dig this **** I heard my attending say...what do you think?

And if ruralsurgeonfornow is real then he has is platform to attack EM. And whatever comes of it can be real conversation and exchange of ideas no matter how irreconcilable. All trolling and insincerity does is make people wonder why they talk to people on the Internet to begin with.

I love to laugh. Need little impetus to do so. And the OP is not funny. Not even remotely.

 

[Nasrudin]

You mean a resident. Or did you think I don't know how that works?

Ok so given you don't have anything compromising your campaign against the existence of EM as a medical specialty. It's not the work they create for you.

And still. You're a ridiculous tool.

 

[ruralsurg4now]

What? Last time I checked a resident is a physician.

I didn't say I was becoming an attending in 6 months.

That's right. So why would you think that one day you're a medical student with no real understanding of how medicine occurs in the real world and the next day as a resident you do for some reason? Is your logical reasoning really that poor? If so, then feel free to re-read your post at that time, since nothing will have changed and I am sure you will therefore conclude there was nothing wrong with it and that you were right.

 

[link2swim06]

That's right. So why would you think that one day you're a medical student with no real understanding of how medicine occurs in the real world and the next day as a resident you do for some reason? Is your logical reasoning really that poor? If so, then feel free to re-read your post at that time, since nothing will have changed and I am sure you will therefore conclude there was nothing wrong with it and that you were right.

Haha whatever man. I will never come to an understanding with you. Nor will anyone else. Over my thousands of hours in the hospital/ED I have a pretty good knowledge of how medicine 'occurs in the real world.'


This is my last post in this thread.

 

[David Hasselhof]

Haha whatever man. I will never come to an understanding with you. Nor will anyone else. Over my thousands of hours in the hospital/ED I have a pretty good knowledge of how medicine 'occurs in the real world.'


This is my last post in this thread.

 

[Anastomoses]

For what it's worth, I appreciate when anyone makes a thread with an amusing premise or question. I come to SDN 75% for medicine-related entertainment and 25% for information/learning.

I gained an awareness on attitudes about things even from this "troll thread".

 

[evilbooyaa]

There has not been a single reported post from this thread. Outside of the SDN terms of service, users are responsible for setting the desired tone of their forums.

I agree, this thread and several others in this forum are very distasteful and make me embarrassed that some of you will be future colleagues. However, users need to use the report post button or simply refuse to engage trolls. If you don't report it, it can't be evaluated for administrative action.

Fair point. As long as people are entertained by these kinds of posts, then so be it. I didn't feel it was out of the terms of service, and thus did not feel the need to report anything in this thread. If I started reporting for people saying stupid/trollish things on this forum I wouldn't have time for anything else. I guess this is par for the course for JP. Post an inane, offensive comment that is sure to get a lot of responses. Must feel good to have your posts constantly blow up, right JP?

TL;DR - I don't really care. Carry on.

 

[Stellar Clouds]

Over my thousands of hours in the hospital/ED I have a pretty good knowledge of how medicine 'occurs in the real world.'

Couldn't resist.

Your eyes will open up more as a resident, but even still, I hear it pales in comparison to the real world...aka PP.

 

[JP2740]

I guess this is par for the course for JP. Post an inane, offensive comment that is sure to get a lot of responses. Must feel good to have your posts constantly blow up, right JP?

So jealous man. What are you my ex gf coming back to haunt me? Come on bro

 

[EsTxDr]

I gained an awareness on attitudes about things even from this "troll thread".

This is what frightens me about this place.

 

[styphon]

Seriously?

The OP is either trolling or is a complete tool. A medical student yapping about attending physicians who know what to do when the **** is hitting the fan and all hell is breaking loose. Gimmeaf'nbreak! There's not a 4th year medical student in the country who wouldn't **** their pants dealing with a fraction of what an ED physician is doing on a nightly basis.

Parroting your attendings' political battles just makes you look like a little poodle on a leash yiping at pit bulls.

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