I just started in the ER at the hospital I will be beginning my inpatient job. I did a ton of ER work in residency but things are just hard right now. Granted I'm in a different city/state than I did residency, but not knowing any local resources, the local laws, the way local cops interact, etc. is just so much. This feels like intern year all over again but with actual responsibility so it's just much worse. I'm not sure what I'm even making this post for. Maybe just support. I dont know. Things are not good right now...how long until it gets better?
I'm struggling badly
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It WILL get better. Hold on.
Just starting fellowship, after residency, I was shocked at how exhausting it was to learn a new hospital system. I was literally lost half the time in the buildings trying to do consults, and somehow epic was 90% similar but the 10% somehow mattered enough to **** with my residency workflows. Documentation styles and policies would be arbitrarily different in unexpected ways. The state laws were TOTALLY different. I was exhausted for the first month and I was still a trainee and well supported by my faculty. I also leaned on my former coresidents (and vice versa) as they went through the same thing in their new attending jobs.
If at all possible, seek out local mentors and peers to help clarify the local pracrice conventions. Often people are willing to help but don't necessarily realize the help is needed, particularly if they usually hire locally or internally. The most toxic emotion you can feel is to feel alone.
Just starting fellowship, after residency, I was shocked at how exhausting it was to learn a new hospital system. I was literally lost half the time in the buildings trying to do consults, and somehow epic was 90% similar but the 10% somehow mattered enough to **** with my residency workflows. Documentation styles and policies would be arbitrarily different in unexpected ways. The state laws were TOTALLY different. I was exhausted for the first month and I was still a trainee and well supported by my faculty. I also leaned on my former coresidents (and vice versa) as they went through the same thing in their new attending jobs.
If at all possible, seek out local mentors and peers to help clarify the local pracrice conventions. Often people are willing to help but don't necessarily realize the help is needed, particularly if they usually hire locally or internally. The most toxic emotion you can feel is to feel alone.
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It takes about a month and you will feel a lot more confident. The SWers should hopefully help familiarize you with the resources. When I started my first attending job it was also in a different state to where I did residency and people just expected me to get on with it. I was thankful the ER social workers gave me a little orientation re: resources. I was actually familiar with the laws, but it turned out the way the hospital worked was different to the actual laws which was very confusing as well. I would encourage you read up on the local civil commitment laws and learn the hospital policies regarding this and duty to warn/protect. That you feel out of your depth means that you care about doing a good job and that counts for a lot.
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i would have the same issue if i was in your shoes. Every state is different. Every hospital is different. It takes time to understand how each state/hospital does it.
1. See what the local community health centers are for f/us after the ER
2. learn about the involuntary hold process for your state
3. slowly learn your hospitals methods
these will take time. Its challenging at first and overwhelming.
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6-12 mos, and you'll forget what it was like to feel that way. Yeah, the transition to a new state, new system, new environment, on top of being an attending is rough and takes a long time. It'll come together though, and just like intern year, you'll forget why things were so hard.
For context, I also moved states, moved systems, and its completely different. I currently feel like I have some sense of all the resources available, I've put people on holds in this very different system, and I've figured out the people I need to communicate with for what. It definitely took a while though.
For context, I also moved states, moved systems, and its completely different. I currently feel like I have some sense of all the resources available, I've put people on holds in this very different system, and I've figured out the people I need to communicate with for what. It definitely took a while though.
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It's going to get better. Make sure to work with other psychiatrists to try and work with the social work staff to try and learn what is out there. I've worked in 3 very different systems in 3 very different states and never worked anywhere that colleagues and staff were not happy to help out. When it comes to resources and the law, I feel like the latter takes a few months to really know well, while the former takes a year or two to fully know the ins and outs of, depending on the complexity and cohesiveness of the local system
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You're judging your performance in a new environment, based upon your performance in an established environment.
On your first day, you should expect for your performance to be bad. Any other expectation will induce anxiety, and reduce performance further.
Example: Did you ever get lost in a new hospital? Would yelling fix getting lost?
On your first day, you should expect for your performance to be bad. Any other expectation will induce anxiety, and reduce performance further.
Example: Did you ever get lost in a new hospital? Would yelling fix getting lost?
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Many times I have yelled "Excuse me! How do I get to the ER from here?"
I think we would all feel EXACTLY the same way the OP does now. Just want to normalize it. Just a new hospital and EMR would be so much. I can't imagine new state laws. That said, it got better after intern year and it will after this too!
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Look, not even withstanding a new system and being a new grad, psych ED work is brutal work. There's a reason so many places make money staffing these things with telepsych (i.e. no one wants to do the work). Dealing with the complexities of access to appropriate disposition (IP, PHP, OP), insurance issues, dealing with ED attendings, and then seeing people on the worst day of their lives is a recipe for hard work. I loved the work as a resident, but it was hellish to do as an attending in a non-academic center with poor access to resources. A lot of it is people trying to dump patients as fast as possible with you taking as much liability as possible.
My absolute well wishes for doing the work at all, I think it makes a huge difference to have someone there in person being with people in their time of need. If no one has thanked you recently, thank you for what you are doing.
My absolute well wishes for doing the work at all, I think it makes a huge difference to have someone there in person being with people in their time of need. If no one has thanked you recently, thank you for what you are doing.
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Agree with everyone else that this sounds appropriate. Are there any other psychiatrists in the system who do ED work that you can tap to get an overview of how things actually work in your hospital/state/system?
Anyone who trained in MA will recognize that Section 8 law as written is almost completely different from how involuntary holds and transfer actually work in practice.
Anyone who trained in MA will recognize that Section 8 law as written is almost completely different from how involuntary holds and transfer actually work in practice.
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The social worker should handle or help you with referrals.
If you're at a place where the staff sucks get out of it. I've seen this happen. If staff sucks your power to fix it as a lone physician is limited. Where I did residency the nurse manager for ER psychiatry was dysfunctional and as a result the nursing for psych ER was mismanaged, The ER psychiatrist was a pushover and didn't fix anything herself. Nice lady but couldn't handle ER. The department should've made her do outpatient only but no one wanted to touch ER with a 10 foot pole hence they gave it to the pushover.
If the staff are good then it could just be a matter of you needed time to break into it.
ER psych is hard. Lots of dump jobs, malingerers (unless you're in a very good area of town), cluster Bs screaming in your face.
If you're at a place where the staff sucks get out of it. I've seen this happen. If staff sucks your power to fix it as a lone physician is limited. Where I did residency the nurse manager for ER psychiatry was dysfunctional and as a result the nursing for psych ER was mismanaged, The ER psychiatrist was a pushover and didn't fix anything herself. Nice lady but couldn't handle ER. The department should've made her do outpatient only but no one wanted to touch ER with a 10 foot pole hence they gave it to the pushover.
If the staff are good then it could just be a matter of you needed time to break into it.
ER psych is hard. Lots of dump jobs, malingerers (unless you're in a very good area of town), cluster Bs screaming in your face.
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Did I read this right?
You are doing Psych ER but you signed up for inpatient?
I'd be very stressed out if I was assigned a different duty to the one I signed up for.
You are doing Psych ER but you signed up for inpatient?
I'd be very stressed out if I was assigned a different duty to the one I signed up for.
The most effective places I've seen have the same psychiatrists do ED consults and then follow their ED admissions onto the attached inpatient unit. It leads to a lot less dumps, at least for the inpatient unit. Of course you need the staffing so as to have the psychiatrists actually carrying very few inpatients themselves to be able to actually see ED consults during weekdays.
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The model makes a ton of sense but I am not sure you can pull that off outside of academia.
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