Sunday, March 16, 2008

ER vs everyone else: Where's the love?

I have to say that there is no love between the emergency room and the rest of the hospital. The main reason is because when the ER decides to admit patients, they are creating work for the residents on the wards and in the ICU. While sitting upstairs, it's easy to criticize the emergency room staff. We criticize them for admitting patients who look too well, and we criticize them for not doing more for the very sick. What I had not realized until working down in the ER was how difficult it can be to make judgment calls about a patient when they come in. Sure, the next morning when you know how the patient did, it's easy to say what should have been done. However, in the ER, sometimes there are so many patients in the waiting room, that you can't wait to see which way the patient is going to go. You make a clinical decision--you admit the patient to the hospital or you send them home with some good instructions on what should bring them back. And then you pray that you erred on the correct side.


Anonymous said...

Post residency there is much less acrimony. The ER is a source of referalls and is also there to help take care of your patients sunday morning at 2am.

doc Russia said...

Welcome to the trenches! The blessing and curse of being an emergency physician is that you are second best at everything and second-guessed by everyone. You are the uninvited consultant. What would drive me nuts is having a patient coming in "in extremis," who I work my butt off to turn them around, and then, after having dragged them back from the brink, the admitting resident, who only sees them once stabilised, looks at this patient and then asks why they need to be admitted. My most memorable example was a fellow who coded, and we managed to resuscitate. well, by the time the resident for the ICU showed up, we had actually extubated him (it was a very minimal code, but he did get compression), and the resident asked why we thought he needed to come into the ICU, I shot back that it was my policy to admit patients that were dead to the ICU no matter how long since they pulled a 'Lazarus' on us.

Ian Furst said...

It get's better -- in a second tier hospital it's pretty friendly - we don't complain and they don't page us a 2am unless it's really warranted. If you break the unwritten code you will be paid back in kind. Good blog - look forward to reading it. Ian.

TheNewGuy said...

The first comment nailed it right out of the gate. Outside of academia, good ER docs are appreciated far more than by your average chronically-exhausted, and bitter-at-having-to-see-yet-another-patient resident.

Most of my admitting docs are more than happy to send their patients to the ER for a workup... and my reply?

"Send them on... I'm happy to see them. Want me to call you when I'm done, or just talk to the hospitalist?"

That's the way it's done in the real world. We provide a place where they can send their patients at 2AM... and we only call them if it's necessary.

the ER-to-house-staff relationship is a great example of where academia gets it wrong.

Intelinurse said...

from the nursing side its the same way, you are correct, we are bringing them work and they have no clue what its like down here in the ED. sometimes I have to politely remind an ICU nurse (to whom I am giving report)that 20/20 hindsight is not all its cracked up to be, we do our best and now its their turn to do their best.

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