Consultants and Transfers

If you’re a consultant doc to an ED, and the ED doc gives you a courtesy call that they’ve accepted a very critical patient for you to take care of, because a)you’re a doctor, b)it’s your specialty and c)you’re on call for that specialty, feel free to say “Thanks”, or even “OK”. A two minute tirade on how life is unfair, demonstrating that your mom obviously didn’t love you like your sibling, or that your undies are too tight isn’t really necessary. It is, in fact, painful and embarrasing to listen to, and we’re embarrased for you.

In fact, should you be a consultant in a system where the ED doc makes all the transfer acceptances, perhaps you’d like to change that system and take all the transfer calls for your specialty yourself, at all hours of the day or night, should you be on call. If not, perhaps you could act more like a professional, a physician and a colleague, and less like a spoiled child with a good vocabulary and a bad attitude. That’d be great, and everyone around you would be glad to work with you. The ED Doc would be glad to be out of the middle of that system, believe me.

So, you do your job, and we’ll do ours. Do your job without making ours painful, and we’ll help. Do your job with even a hint of a good attitude and we’ll go out of our way to help you out. We’re not your enemy, we’re ED docs.

also posted to LingualNerve


  1. I might add that if you are the surgeon on call, please don’t come in hungover 4 hours after the pt has already been prepped for you in the OR (awaiting your “CONSULT”) and please don’t mercilessly pimp the assisting Resident and student who have already been awake for 36 hours. Oh yes, please don’t throw your instruments on the floor of the OR during a tantrum.

  2. I feel your pain, y’all. ;)

  3. Amen! I am going to forward this to some of my less friendly consultants.

  4. Ah. well– let me play devil’s advocate to all of you ER docs who believe you walk the moral high ground. I am speaking from the point of view of a general surgeon in solo private practice.
    Remember the following things when you are angry with us for our unpleasantness.
    1) You go home at the end of a 12 hour shift and I have been on call three days and nights in a row
    2) When I see a patient you have accepted in transfer if the patient is ‘private pay’ and sick I am likely to spend twenty hours caring for and operating on them in the next two days and not only not get paid one dime for my efforts, but will not be able to sleep or see my family. So sympathize with me- please and forgive me for my utterances for in my heart I am mad at the system and not at you. We both know that.
    3) You will get paid at least something (by the hospital) whether or not the patient is insured- such is definitely not the case for me.
    4) If you say I do this by choice I say to you that when I chose to be a surgeon we were well respected and well paid for our training, our sacrifices and our skills- we are no longer. I barely have enough to pay my office staff anymore and despite working 100 hrs plus a week barely bring home a six figure income.
    So next time you want to accuse me of being ungentlemanly. Stop, take a breath and give me some empathy rather than your vitriol.

  5. Dear JDB,
    You presume too much. I get paid NOTHING if my patient pays nothing. I, and all my colleagues in my ED practice live on what we collect: we get no subsidy. Therefore, I monthly give away 40% of my efforts. Cry me a river about your one private-pay patient.

    Secondly, this isn’t a payment issue, it’s a “grown-up” issue. How is “my life is hard” any doing of the ER doc, and what makes the ER doc the designated target of your selfish whining? Be a man (or a woman), be a professonal, and keep your crying to yourself. You don’t get paid to whine, I don’t get paid to listen to anyone but patients whine, so it’s just lost, lazy effort. Trust me, nobody ‘forgives’ you for having to listen to the kind of purile whining we’re all subjected to.

    Just say thanks, or even OK. That’s all that’s necessary.

    BTW, the moral high ground is lost fastest by whining about how unfair your life is to me (see above).

  6. Grunt Doc-
    Your point is well taken and I agree with you wholeheartedly- there is never an apppropriate time to be rude or disrespectful of a colleague. Please don’t my take my post as a justification of that kind of behavior- it is clearly unjustifiable. My point was merely to humanize the individual at the other end and remember that if you understand us better you might be more inclined to forgive us. Many, many times I have been that mean, nasty person as I pull my tired brain out of Stage IV sleep and I always regret it. Do I know that life is unfair? Yes, but I only get through the day hoping that it will get better. It is not about me and my collections or my sleep or my family– I agree– it is about simple respect and courtesy for everyone we work with and doing our best for our patients. Sometimes, however, we reach our limits and in those situations- if I don’t apologize for it then, I am doing so now.

  7. Thanks!

  8. Game, set, match – GD!!

    What do you expect from a squid Doc who use to hang around with the Corps? a carpet?!?!

    Sheesh, some people!!! :-)

  9. Goat Whacker says:

    I’m probably stirring the pot here, but I have worked full time ER and also full time family practice. In my experience, I have had much more trouble with ER docs who’ve called me than I had with consultants I called while working the ER myself. Just my own experience, some one else’s may be the opposite.

  10. White Dude, M.D. says:

    Grunt Doc: You must be at a tertiary or academic center, where you must accept transfers from the LMDs at the small St. Elsewheres. Nobody’s very happy with these; train-wrecks abound.
    When I was interning at Charity Hospital New Orleans, I tried to impress the ortho resident on call, who exhorted me to get ” hips, hips, I must have hips.” I accepted a “hip” that night from the boonies. It was a hip alright. It was also a day 3 post-op blunt trauma on the respirator, with a large penrose to the the lesser sac.
    Nowadays,of course, I can’t just accept a transfer and hand it off to the surgeon on-call. I must convince him, after the patient arrives, that he should take over and admit: often a difficult task of persuasion.
    The only thing the ER doc (me) can do is present the case honestly, funded or not.
    The only thing the consultant can do is accept the case, or offer some help at making a disposition.

  11. I like to think we have “evolved” to a better system where the consultants take all these calls, day and night, for any transfers. They used to bitch and moan AT us for accepting every train wreck in the state. Now they bitch and moan TO us because they have to stay up all night accepting every train wreck in the state. We just smile and nod. No moral high ground here, just deep seated satisfaction.

  12. Darren,
    I’d really like to hear how you got that done.

  13. Just another concern on the same topic. I was a surgical RN for 5 years before I realized being verbally abused by the surgeons wasn’t part of my job description. We had a well known plastic surgeon that very good and no doubt he worked long hard hours. He also cussed us up one side and down the other every time we went into an OR with him. In the beginning I thought he was a nut case and should not even be operating on people. Then I started paying attention to what he was doing and realized all this cussing and screaming was his stress reliever for the tedious work he accomplished. The hospital put up with him because he was such an excellent surgeon and we soon learned we had no choice but to put up with his abuse as well. I never got used to it and eventually transferred out of OR. I do understand that it was never anything personal but it just wasn’t something I was willing to listen too. I wondered if the tables were turned and I was having a really stressful demanding day, if it would ever be alright to call a surgeon a sorry bastard? I doubted it very much..


  1. Consultants and Transfers