Archives for August 31, 2006

ED video

A really cool ED video, from ImpactEDnurse:

ED video: People often ask me why I continue to work in the Emergency Department despite the ongoing hazards of overcrowding, access block and the high stress levels. Its a difficult question to answer in words. A while ago I tried to answer it in a video clip….
Team ED
WARNING: this is a large movie file (15.5MB)

Jerk Consultants and Telephone Etiquette

Pediatrician Flea posted about feeling like the jerk he was on the telephone with an ED physician.  (I was going to type colleague, but one doesn’t behave boorishly to a colleague).  He says they ‘have a history’ which explains why the ED physician was near tears during their phone call. 

Flea’s been subject to nearly enough derision in the comments of his own post, and those on Kevin, MD (which is where I found the Flea post) and I have nothing more to add on that individual interaction.  I do have something to say about the telephone and its use with the ED Consultant.

 The vast majority of the consultant physicians I call are collegial, knowledgeable, and helpful.  I personally don’t care if they’re “friendly” on the phone, but it’s a plus of they are.  Typically I only have about 33 other things I need to get done while placing calls, so it’s a to-the-point quick presentation, respectful of the consultants’ time, and trying to use mine productively.  I usually have a plan, lay it out, and we come to a conclusion that benefits the patient.

And then there are the four consultants in my practice history whom I utterly detest calling, as they’re condescending jerks of the first order (four in the entire history, and just two active now).  After my usual presentation, which is the same as I give to everyone else (and, I do my utmost to keep my prior irritation hidden from them on the phone; no sense letting them know their awful behavior gets to me), it starts.  Usually it’s the ‘why are you calling me?’ in a decidedly whiny tone, and when it’s explained (problem clearly in your specialty, you’re on call, etc) then comes the attempt to get me to change the diagnosis so it’s not their problem.  Playing 100 questions, we go back over all the history, the physical (pertinent and not), labs, etc.  Many ‘gotcha’ moments are tried with stated holes in the above, all in attempt to put me on the defensive, to defend the entire interaction and workup, not to help the patient but to get themselves off the hook.   This doesn’t work with me, and I stand my ground.  They get to do their consulting bit, and the patient gets appropriate care.  And I hate calling them.  To me they are physicians in title only; oh, they’re fully trained and qualified, but don’t embody what I’d call a physician.

 There was one occasion with a consultant on the phone wherein the belittling of my ED and ultimately my personal professionalism and judgement wouldn’t stop.  Finally I asked the consultant to come in and do their own eval, and before we hung up I asked him to feel free to repeat his diatribe to me in person.  I was avoided when they came to the ED, and no direct confrontation occurred.  I don’t think anyone had stood up to this jerk before, and we now have a civil working relationship.  We’re not Christmas card pals, but we work together effectively.

Finally, the consultant who generates an acrimonious relationship with the ED is not doing himself or his patients any favors.  We need each other to take effective care of our patients.  And boorish behavior is for boors, not Physician Colleagues.