Musings of a Dinosaur: How to Really Piss Me Off

Musings of a Dinosaur: How to Really Piss Me Off

Aah, those dang stupid, stupid ER docs.  If only everyone were as smart or as clever as office docs, the world would be such a better place.

Where’s the cheese?  Seriously, if we’re going to start a series of whines about inappropriate calls and silly treatments I’ve got a box full of “‘just go to the ER’s” that I’d be glad to trot out.


  1. I left Dino a little something to think about

  2. I’m going to be nice…you guys have your job and I have mine.

    This is my second admission month of my intern year. I’ll just say it’s been an eye-opening experience. I’ve helped blocked many an admission these months for a variety of reasons. Some b/c we shouldn’t have been called (wrong admitting team)–others b/c they just weren’t sick enough.

    There’s certainly a turf war around my place…but I think we all try to make the best of it.

  3. Well, Dino’s little rant will be filed in my “Rants I care little about” file.
    Jump up and down and rant until you’re red in the face, I don’t care. I got things to do.

  4. The House Whisperer says:

    Is that really this guy’s biggest problem? Sheesh.

  5. Wow.

  6. Goatwhacker says:

    Having worked on both sides of this issue I would say that both the ED docs and the FP make some good points. Ten years ago I would write out a plan for my chronic migraine patients and send a copy to the ED, so everybody could be on the same page. Now I’m told that is a HIPAA violation.

    I am now a solo FP on call 24/7 and although I sometimes disagree with the ED docs I will say that most of them would not have have called me at 4:30 AM for this kind of thing. You could make the case “hey you’re on call 24/7 so tough shit if I woke you up” but in reality there should be some respect for the on-call doc’s time, and judgment has to be used when deciding whether to wake him up or not. I work in a small city and maybe things are different in the larger hospitals.

    The FP in this instance seems to be overreacting, and if he rants about relatively minor things like this he’ll eventually go nuts.

  7. I think a lot of what he’s complaining about is the timing of all this. There are some who are just who just are not considerate about the time of day.
    I keep wondering why so many ER calls come just as I’m falling asleep. You know by that time the patient has been in the ED for hours, and JUST NOW we get that final urinalysis result to be able to make that call. You just have to wonder how much is a change-of-shift phenomenon — things happen slowly, then the guy signing off or signing on wants to get rid of all the dead wood.
    This is something shift workers should keep in mind — what would it be like to be wakened from a dead sleep at home to tell you something you could be told when you got to work? “Uh, Grunt Doc, I just wanted to remind you that you said you’d work an extra half-shift for me next week.” And a lot of these “informational” calls are in that same category.

  8. The House Whisperer says:

    Greg, there is only too early or too late. If you prefer too early (ie incomplete workups) then make your preference known.

  9. Good heavens! Can’t a poor old dinosaur rant once in awhile? I really don’t do it very often. The dozen posts before this one were:
    * a patient funny
    * an essay on Healing
    * a pharmacy rant
    * my anniversary
    * a lawyer funny
    * a priest funny
    * how shit happens
    * flaunting the Phillies (yeah, yeah; now you can rub it in)
    * a patient funny
    * a pediatric funny
    * a family funny
    * a clinical case

    Certainly there are many ER doc (and nurse) bloggers who spend plenty of time bitching about stupid PCPs. It was definitely a timing thing. Who said anything about a series? (But thanks for the linky-love.)

  10. The House Whisperer says:

    #1 Dino, your blog is quite good and mostly free of rants. I’ll be checking in occasionally. I’m wondering if between the lines of that 430am phone call was a suggestion that you find a way to keep your patient out of the ER. I know, easier said than done. Regardless, the ED Doc should have either dropped you a voice mail or waited until he or she got off duty at 730a. Keeping those wheels greased makes it better for everyone.

  11. Parcho,

    Did I read right? You are an intern and you are blocking admissions? No offense, but if you are an intern that means you are a physician in training for less than 4 months and you are already blocking admissions from the ER? Wow, they start you guys early now. Do you think you can make an accurate assesment of a patient’s potential morbidity and mortality with your limited experience?

  12. The House Whisperer says:

    Anon, that’s how it works–intern year builds some confidence and instills some cynicism. When you’re an R2 is when you realize how quickly the sht hits the fan and how unpredictable and perilous this business is. If your resident is good, the book knowledge and clinical experience are tempered by humility and sometimes outright fear sometime around Christmas of third year.

  13. wow, i think one of the anonymi that got all pissed at me for my recent joke about how to deal with asswipe consultants ( took my advice and started his own blog. you know me doc, not trying to flog my blog, but read the comments and tell me i’m wrong. also, panda is a good one to read re the difference between being an office doc and an EM doc. i just don’t get the anger here, if this dude does not understand that we have a fundamentally different approach to diagnosis and treatment than he does, and for good reason, then i don’t know what to say to him. we just can’t miss something and we don’t know his patients like he does. whatever. off to drain an abscess on sunday afternoon on a local FP guy’s patient who failed antibiotics.

  14. dino,
    sorry. didn’t see your comment. you are certainly free to rant and you do undoubtedly have the right to complain about some of my colleagues. i try to do complete workups and establish relationships with the local guys. hugs.

  15. I’d love to trot out my list of favorite hospitalist whines, but I can’t. It would violate my number one rule for safe non-anonymous blogging: never blog about local issues. ;)

  16. I’ve got to agree about the intern blocking admissions…as a resident, it is typically not my call (not fully) about whether or not a patient should be admitted. Therefore, that means there’s an attending physician above me. Not an infallible one, but an ATTENDING PHYSICIAN. You are an INTERN. To term it “blocking admissions” and to say that they are inappropriate (doesn’t need to be in the hospital) is saying you know more than the attending physician. Would you ever give the same disrespect to one of YOUR attendings? Or is it that ED physicians aren’t worthy of the same respect at any level?

    The whole term “blocking” admissions bothers me. Admissions aren’t blocked…the admitting/consulting team discusses with the ED an appropriate care plan (maybe MORE appropriate, I’ll admit it…I’m not a generalist, and you are better at that job than I am), and that care plan may not include admission. But…it’s not a “block.” That says, “The ED wanted them to come in…but I stopped it.” So…what did you suggest we do with the patient? How should we treat their problem? When will they follow up? If I thought they needed admission, and you “blocked” it, then you are responsible for any outcomes, right? If we discuss the patient, and compromise, and can arrange for good follow up (any patient that was initially thought to be an admission probably needs close follow up, not just “see ya”), then the risk is reduced.

    To have that attitude so early bodes poorly for your relationship with your ED colleagues. We will know you as a “blocker” so you can expect a fight every time you want to do it. I’m much less likely to compromise with the residents who ALWAYS “block” than I am with the ones who give me and my attendings the respect we deserve for the job we do, and who attempt to assist in care when they feel that the patient does not meet admission criteria.

  17. Parcho,
    In about 2 years you will realize how little you know at this point and will cringe when you think of some of the admissions you “blocked”. Keep your mind, eyes and ears open and you might learn something…

  18. “Is that really this guy’s biggest problem? Sheesh.” Guy? she ain’t no guy. Now go tell her you hope she had a happy mothers day on Sunday!