Hospitalists demanding complete workups before admission? 911DOC has some strong words about that:
By insisting on this level of completeness from me the hospitalists, internists, and many surgeons have aced themselves out of caring for the critically ill and are losing their clinical judgement and skills for lack of use. In the meantime my skill and knowledge base is increasing. Hell, internists in my town don’t even manage the sorta-ill or the kinda-ill anymore. Like most things in life, true gut-knowledge comes through repetition. If you haven’t run a code in three years then I understand why you don’t want to run one today. I don’t know why they don’t see this but they don’t. Job security for me? Sure. But I’d rather do Emergency Medicine.
(via GruntDoc)
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I moved 3 “stablized, completely worked up” patients from the floor to the ICU today.
It’s not so much we want the workup done, it’s that we want to know a doctor did something medical after calling us to admit.
Our view from the wards (and the ICUs) is simply that once the ER has a disposition, they quit doing anything.
Sometimes we have to remind them the morgue is also a disposition.
Not to be a slam on hospitalists and internists, but I believe they have forgotten that the ER is controlled chaos. Its as if you are a waiter on a 8, 10, or 12 hour shift that does not end, only lives are at risk. when we make a disposition whether it be to the floor or the unit, we are turning over the care of that patient to you. We may have two or three other “critical” patients we are caring for. your timely action is expected….. Now I am not saying that we should stop providing time sensitive, directed care for the septic patient, But I do believe that once disposition is made, those accepting admission should stop rounding, eating, watching television….Just long enough to tuck in your patient. My hats off to those of you that understand the importance of moving patients out of the ER in a safe, time effective way so that we may provide care for the next arriving batch of patients
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