Who makes the ED run? The Secretaries

Having been threatened reminded of their contribution I have decided to expound upon the unsung heroes of the ED: The ward clerks/secretaries.

Most people don’t realize the power the ward clerk has over everyone in the ED: patients, nurses and most especially doctors. ED clerks/secretaries (I will use the term interchangeably, and always with the greatest respect) make the place function. A bad one can completley ruin your day, and a good one can make you look better than you deserve.

Let’s go over the duties I know of for clerks: order supplies, answer the phone, order lab tests and tell jokes. Sounds simple, doesn’t it? Well, here’s how it works: while entering 12 lab tests and the same number of xrays for a critically injured patient they’re overhearing the doctor yell for the neurosurgeon to be called, while taking the call from the on call specialist for another doctor, not forgetting the other two calls to doctors (which aren’t really calls to doctors, they’re to answering services, who seem to delight in thwarting our efforts to contact their doctors). This doesn’t prevent them from calling to get the light repaired in the view box, paper towels in the bathroom and vomit mopped in the halls. Oh, and remember where the joke telling stopped so we can pick it up when things slow down.

It has never occurred to most doctors that the clerks don’t know every medical abbreviation, have never heard of the Kleihauer-Betke and don’t know what it does, and will look on, flabbergasted, when the “spiral chest CT for PE” gets entered as a regular chest CT (they look for different things, and aren’t necessarily interchangeable). This isn’t their fault, and the experienced/smart ones shine when they make the doc/nurse look good (I knew you wanted a pregnancy test on that patient, so I added it on), to our eternal gratitude. (Eternal measured in ED minutes, which last about 10 seconds, or until the next time they’re needed).

I cannot imagine running an ED with inexperienced ward clerks, and I offer the following as an illustration: I worked in an ED that moved from the clerk-runs-the-world system to one in which the ED docs entered all the orders on a computer. It worked fairly well, but there wasn’t a second set of eyes seeing the entries, leading to the inevitable delays wherein needed tests are belatedly entered. The real fun began when the computer went down, and the clerk wasn’t one of the heavily experienced ones. Suddenly the entire load of the ED went onto their untrained shoulders, and it wasn’t pretty.

I’m glad we have the system we have, and I appreciate our clerks, and fully understand the hell we’d be in without them. Thanks, folks!