Everybody wants to be a hater...

[Angry Birds]

Our shared enemy is the hospital administration. Though one surgeon might have made the list yesterday.


--
Il Destriero

Yeah I agree, it's not right to stereotype. It's not fair to the other 1% of surgeons when we only talk about the 99% that are a-holes.

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[ERRES2288]

These kinds of threads drive me nuts. Why are physicians so insecure that they must constantly go around bashing other specialties all the time? I don't think there has been a day gone by when I have not heard one physician bash another physician in a different specialty. It seems often times we are worse to our own than the lawyers are. All the while the large management companies and hospital administrators slowly gain more and more control.

 

[womp]

As an orthopod who deals with both gas and ED docs on a daily basis, I will say I trust the anesthesiologists way more to handle the difficult airway, just like the gas docs will trust me to reduce and cast their distal radius fx in the ED over an ED doc. This is not even remotely a close call.

The ED has its role and the specialists have their roles. The dissing of general surgeons in this thread really got on my nerves (and I'm not even one). Gen surgeons are probably the single most overworked and underappreciated specialty in the entire hospital. To be fair, they have every right to be annoyed at the ED resident who just started his shift and is calling in a consult without having even seen the patient (this happens daily at most academic EDs, admit it).

 

[Makati2008]

As an orthopod who deals with both gas and ED docs on a daily basis, I will say I trust the anesthesiologists way more to handle the difficult airway, just like the gas docs will trust me to reduce and cast their distal radius fx in the ED over an ED doc. This is not even remotely a close call.

The ED has its role and the specialists have their roles. The dissing of general surgeons in this thread really got on my nerves (and I'm not even one). Gen surgeons are probably the single most overworked and underappreciated specialty in the entire hospital. To be fair, they have every right to be annoyed at the ED resident who just started his shift and is calling in a consult without having even seen the patient (this happens daily at most academic EDs, admit it).

Yea I'm going to disagree with you. How can I make a diagnosis without seeing the patient (a surgical one at that.)




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[Psai]

Yea I'm going to disagree with you. How can I make a diagnosis without seeing the patient (a surgical one at that.)

A lot of times, people will sign a patient out to the oncoming resident and leave without calling the consult. Or they will admit a patient but by then time you go down to see the patient and try to discuss the admit, all you get is "I just came on, the guy who admitted him already left and just signed out that the patient is admitted"

 

[e30ftw]

As an orthopod who deals with both gas and ED docs on a daily basis, I will say I trust the anesthesiologists way more to handle the difficult airway, just like the gas docs will trust me to reduce and cast their distal radius fx in the ED over an ED doc. This is not even remotely a close call.

The majority of us work in places where anesthesia and ortho do not set foot in the ED. Every difficult intubation or displaced fx that comes through the doors/bay is managed by the emergency physician. I have never had anesthesia intubate a patient or (outside of residency) ortho come in to reduce a fracture. When a physician comes into the ED with a colles fx I'm the anesthesiologist for the sedation while at the same time playing orthopod with the reduction/molding. They follow up outpt for casting like everyone else...

If I had to imagine a scenario where I had an expanding neck hematoma and the choice of either a random anesthesiologist or a random EP performing the intubation, I'd choose the anesthesiologist, because that's their *specialty*.

Takes nothing away from our skill set.

 

[deleted859535]

If I had to imagine a scenario where I had an expanding neck hematoma and the choice of either a random anesthesiologist or a random EP performing the intubation, I'd choose the anesthesiologist, because that's their *specialty*.

Takes nothing away from our skill set.

My feeling as well. We're not primary care doctors, but we're not the traditional definition of a "specialization." So when I talk to someone who "gets it" -- the idea that our specialty revolves on rapid diagnosis and management of a huge breadth of conditions as a jack of all trades, master of emergencies and resuscitation, where there will almost always be someone who knows more about that thing but perhaps not about other things -- it warms my jaded little heart.

 

[westdescartes]

A lot of times, people will sign a patient out to the oncoming resident and leave without calling the consult. Or they will admit a patient but by then time you go down to see the patient and try to discuss the admit, all you get is "I just came on, the guy who admitted him already left and just signed out that the patient is admitted"

Hey, so I've seen EM do this a lot - call an admit before sign out and sign out they're admitted + a one-liner if they are stable. Could you tell me more about what you want to know after they are already admitted/when you come down to discuss the admit? I'd like to know what things are important to you to include in the sign-out.

 

[Angry Birds]

As an orthopod who deals with both gas and ED docs on a daily basis, I will say I trust the anesthesiologists way more to handle the difficult airway, just like the gas docs will trust me to reduce and cast their distal radius fx in the ED over an ED doc. This is not even remotely a close call.

The ED has its role and the specialists have their roles. The dissing of general surgeons in this thread really got on my nerves (and I'm not even one). Gen surgeons are probably the single most overworked and underappreciated specialty in the entire hospital. To be fair, they have every right to be annoyed at the ED resident who just started his shift and is calling in a consult without having even seen the patient (this happens daily at most academic EDs, admit it).

Don't worry, you fall in the same category as a surgeon. Grumpy and rude from the start of the phone call. From hello. Before one can say something "annoying."

Yes yes, it's a generality.

EDIT: Anyways, I know I'm wrong here dissing other specialties. It's just been my experience that surgeons are often very rude and unfriendly, and this is from the start of the conversation, i.e. "hello." Before I've ever even talked to them.

 

[LaBusqueda]

Oh Good God.
Medicine is not so cut and dry.
EVERY "spaecity" has its hacks.
Sorry but it's true. EM has hacks, surg, anesth, etc. There are a lot of them. Either via burnout and a "don't give a f)&@@ attitude or an actual problem with skills.
I have worked in community med since out of training and I have gone to floor codes and saved pulm and aneth ass a few times with crich and DL. Big deal.
I've had specialties come down and help me out as well!
Academic/residency shops just don't count as residents are sore/tired aH0|$ anyhow.
If another specialist says something in appropriate that I can hear directly you better believe I call them out on the spot then and there (docs lounge, dept, after a section meeting, etc)!
Try it. Absolutely NONE of them in ten years are ready for it and look like scared little kittens when I get in their face in real time!!! NONE of them are badass when confronted!!
If more docs grew up in tough neighborhoods none of this crap should happen, at least not in the dept. I have seen college "take it" from this or that specialist and it makes me nauseated every time.
What POS DBags do in the safety of their little bubble is beyond repair!

 

[GeneralVeers]

Oh Good God.
Medicine is not so cut and dry.
EVERY "spaecity" has its hacks.
Sorry but it's true. EM has hacks, surg, anesth, etc. There are a lot of them. Either via burnout and a "don't give a f)&@@ attitude or an actual problem with skills.
I have worked in community med since out of training and I have gone to floor codes and saved pulm and aneth ass a few times with crich and DL. Big deal.
I've had specialties come down and help me out as well!
Academic/residency shops just don't count as residents are sore/tired aH0|$ anyhow.
If another specialist says something in appropriate that I can hear directly you better believe I call them out on the spot then and there (docs lounge, dept, after a section meeting, etc)!
Try it. Absolutely NONE of them in ten years are ready for it and look like scared little kittens when I get in their face in real time!!! NONE of them are badass when confronted!!
If more docs grew up in tough neighborhoods none of this crap should happen, at least not in the dept. I have seen college "take it" from this or that specialist and it makes me nauseated every time.
What POS DBags do in the safety of their little bubble is beyond repair!

You are just the kickass Dirty Harry of ED physicians aren't you?

 

[Birdstrike]

The nature of EM is that to the rest of the medical world, "Emergency Department" translates to "Unplanned interruption in my day."
Some consultants handle that better than others, and some EPs are better at the art of making the baton pass more palatable. But when overwhelmed consultants with personality disorders without financial incentive to work harder than they already are, cross paths with a overloaded EP, with a whiff burnout during a tough stretch of shifts, in dire need of a quick hand-off, it's inevitable that there will be periodic turbulence. The good news is that you get better at the art-of-the-hand-off portion over time, and as consultants get to know your patterns and have tested you over time, they will usually ease the pressure off some. That being said, it's likely those searching for an EM job where calls from the ED are routinely viewed with as much bright-eyed optimism as consequence-free gifts of goodness, will remain indefinitely on a long, frustrating search for that Holy Grail. If they do find it, it's reportable.

 

[LaBusqueda]

You are just the kickass Dirty Harry of ED physicians aren't you?

Been referenced as the EDs Bouncer once or twice


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[meister]

*slowly slithers back to the reading room*

*doesn't talk to a human for four hours straight*

*is thankful he's not an EP, surgeon or gasman every time some awful intra-abdominal CT nightmare pops up at 3AM*

 

[gro2001]

To be fair, they have every right to be annoyed at the ED resident who just started his shift and is calling in a consult without having even seen the patient (this happens daily at most academic EDs, admit it).

Honestly, I am always surprised when this is brought up by a surgery resident. They are generally very smart folks, so their apparent inability to understand why this happens is baffling.

Consider this: a colleague who is finishing his shift saw a patient shortly before the end of his shift. He examined the patient and suspected appendicitis. Ordered labs, made the patient NPO, ordered a CT scan. I am taking sign out on the patient, I've heard the story and know that this is more likely than not an appendicitis. I know I am waiting for a CT scan. My colleague goes home, I start seeing patients who have not been seen yet, especially as I keep having some sickies rolling in and all the patients from the previous shift are well tucked in (either admitted or awaiting a key test which will determine their disposition). At this point I have not had a chance to re-examine every patient yet because the ER is pretty busy with new, sick patients. As this is happening, I see the CT come back with clear appendicitis. Now, I ask you this, what do you think I should do?

a) Wait till I have a moment to come back an re-examine the patient I have not yet seen, update them on the results, and then call the surgeon
b) Call the surgeon now

Obviously option a) would be preferable. However, depending on how busy the ER is, how sick the new patients are, etc, I may simply not have the chance to do that until a bit later. Why would I delay the definitive treatment in the meanwhile? Especially if I know all the key info (basic story, WBC, CT, NPO)? To me, the answer is obviously b) in this situation. I think the answer is b) to most ER docs. I think the answer is obviously b) to most other docs. I think the answer is obviously b) to my grand mother. Why then, do some surgery residents say what you said above then? Is it not understanding that the above situation is an everyday occurrence? But you've seen how the ER works. Or do you guys really think that option a) is always the right answer? In which case, please explain why, and how do you see the cost/benefit trade off of the delay in definitive treatment.

I hope this doesn't come off as I am attacking you, honestly want to get some more perspectives on this.

 

[WilcoWorld]

I think that a lot of it comes from how the EP goes about saying that they haven't seen the patient.

EP1: "James in ED room 35 is a 21 yo male with 1 day of RLQ pain, a WBC = 14 and CT findings of appendicitis."
Surgeon: "What's his belly exam?"
EP1: "I haven't examined him personally, but Dr. Already Home said that James had focal tenderness at McBurney's without rebound. Would you like me to do anything more before you come see the patient?"

vs

EP2: "ED room 35 needs to be admitted for appendicitis."
Surgeon: "What's his belly exam?"
EP2: "I took signout on the patient."
Surgeon: "What's his white count?"
EP2: "I don't know, I just took signout on the patient."
Surgeon: "How old is he?"
EP2: "I told you, I only took signout on the patient. I never saw him. Are you refusing the consult?"

Don't be EP2.

 

[southerndoc]

I think that a lot of it comes from how the EP goes about saying that they haven't seen the patient.

EP1: "James in ED room 35 is a 21 yo male with 1 day of RLQ pain, a WBC = 14 and CT findings of appendicitis."
Surgeon: "What's his belly exam?"
EP1: "I haven't examined him personally, but Dr. Already Home said that James had focal tenderness at McBurney's without rebound. Would you like me to do anything more before you come see the patient?"

vs

EP2: "ED room 35 needs to be admitted for appendicitis."
Surgeon: "What's his belly exam?"
EP2: "I took signout on the patient."
Surgeon: "What's his white count?"
EP2: "I don't know, I just took signout on the patient."
Surgeon: "How old is he?"
EP2: "I told you, I only took signout on the patient. I never saw him. Are you refusing the consult?"

Don't be EP2.

Even better would be EP1 who actually examined the patient and got a brief history after informing them of the CT results. You already have to come into the room. I would imagine you wouldn't just talk to the surgeon and let the surgeon notify the patient he/she had appendicitis.

 

[TrailRun]

Isn't appendicitis a clinical diagnosis? What's the CT for jk I know surgery won't take them without it, but will then mock you for getting it.

I'm just a surgery intern (switching to EM by the way) but I wonder if it's truly necessary for the new EM doc to push the belly and cause pain, since surgery will do the same, and now at least 3 people will have poked this patient. Bedsides, it won't change management since even if the new EM doc questions the diagnosis they are likely going to the OR with these CT findings.

 

[Groove]

Meh... I think it's bad form to call a surgeon without examining the pt, even if it's a sign out. You KNOW they're gonna ask about the exam, you KNOW they're gonna ask about PSHX, you KNOW they're gonna ask about PMHX (pretending to consider direct admission, then realizing it would be most appropriate to punt to medicine based on their hx of controlled HTN. I actually enjoy the respect I've earned from the surgeons in my shop. They know my history, exam and dx is gold and I'm honestly a bit embarrassed to call them without examining the pt myself in case I get something wrong.

That being said, we're an RVU shop, so sign outs are much more infrequent. Most people want to hang on to their pt's and stick around for the dispo...

 

[deleted109597]

Isn't appendicitis a clinical diagnosis? What's the CT for jk I know surgery won't take them without it, but will then mock you for getting it.

I'm just a surgery intern (switching to EM by the way) but I wonder if it's truly necessary for the new EM doc to push the belly and cause pain, since surgery will do the same, and now at least 3 people will have poked this patient. Bedsides, it won't change management since even if the new EM doc questions the diagnosis they are likely going to the OR with these CT findings.

I **** you not, there are still doctors this day that say that we shouldn't give pain meds (or antibiotics) because it can change the exam. I cannot even...

 

[Birdstrike]

You know what, just do your job the way you were taught and if the surgeons don't like it, then tough crap. You're not a surgeon, you're an Emergency Physician. You're also not a hand holder for some snowflake professional who's prone to temper tantrums because every patient's not gift wrapped with a bow around it, for them. No surgeon would allow you to demand they behave like an EP, so why should you kowtow to their dogma?

You shouldn't.

You've done them a favor by consulting them and bringing them business to expand their practice (or expand their education if they're a resident). They should be happy and thank you for it. Although they never will. Regardless, don't ever lose ten seconds sleep over a surgeon's temper tantrum any more than you would over a toddler's. Both are a self defeating prospect.