Wednesday, 25 July 2012

Stereotypes

I've heard it said before that stereotypes are rooted in reality.  Sure, stereotypes are over-simplified generalisations that can be grossly inaccurate - the dumb blonde, the drunk Irishman, etc.  But my stereotype of ER doctors being morons is based on innumerable interactions with these people, and I'd say my conclusion is rather accurate, with a few exceptions.  I'm sure I've made my utter disdain for most emergency physicians clearly evident, but there's a damned good reason for it - they suck.  Seriously, they all suck.  I promise that I haven't developed this point of view for no reason.

I got a call from a frantic ER physician for a patient with an acute abdomen.  Just to give some background, saying the words "acute abdomen" to a surgeon is like a ship telegraphing "SOS" - it means someone needs surgery RIGHT NOW, and we come running.  I did exactly that - I happened to be in the hospital making rounds, so I ran down to the emergency department and looked for the patient on the registration board.  I got nervous when I couldn't find his name - Was I too late?  Had he died already?  It had only been a couple of minutes!  SHIT!

The ER doctor was nowhere to be found, so I asked several of the nurses if they knew where I could find Mr. X (not his real name), but they all assured me that they had no earthly idea whom I was talking about.  That's when I remembered I was dealing with an ER doc.

My suspicion began to take over.

After I assured myself that Mr. X (still not his real name) was not yet checked in, my panic subsided and I wandered over to the waiting room and asked for Mr. X.  A very comfortable-looking middle-aged man raised his hand, and he was happy to tell me that he had been having abdominal pain for about a month, but it was just a bit worse today.  He couldn't get an appointment with his doctor for a few weeks, so he came to the emergency department instead to get checked out.

When I asked the ER doc about it, he told me very matter-of-fact that he had overheard the patient telling the receptionist that he was having "a really bad stomach ache", so he assumed it was an acute abdomen and called me right away.  No blood work, no X-rays, no CT scan.  He hadn't even looked at the patient, let alone examined him.

So what do you think?  Think my opinion is justified?

9 comments:

  1. Yes Doc. You're opinion is justified.

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  2. Definitely justified. I think the stereotype is equally accurate here in Finland. I've been back and forth between the university hospital an hour away and the smaller hospital in this town four times this night. Four! Why? A sprained ankle. The first doctor was sure it was broken and sent me to the uni-hospital to see a surgeon. The surgeon said it wasn't broken, just sprained. I was sent back. The third doctor (a Russian who can barely speak Finnish)is sure it's broken. Or I have cancer. The fourth? "Eh... I dunno. Are you depressed? Here's some pain meds, take them and get more with this prescription."

    The only good part is that I don't live in the states anymore. Free healthcare, I don't have to pay a thing! *And sorry for my rant, sitting in a hospital for the entire night must have put me in a bad mood.*

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  3. Well, that ER doc is an idiot - there can be little dispute over that. As for the general population of ER doctors ... well I think you'll just have to keep posting about their stupidity until you convince us ;-)

    One thing that I find maddening with all of these things is how little attempt is ever made to coordinate anything. It is as if every person in a hospital, or wherever, is acting entirely independently. It would not be difficult with current technology for your ER doctor to dictate a 30-second message saying "Emergency - middle aged male patient presenting with ABC concerned this may mean XYZ". You could listen to this even as you dash across the hospital and would have some idea of what to expect when you arrived.

    Similarly, it would be helpful if central administrators had some tools to assess the availability of the resources they are supposed to be administering. Here in the UK, we have an out-of-hours telephone service that is supposed to advise and coordinate on medical issues when your primary doctor is unavailable. We called this a month or so ago on a Saturday evening because our 6-year old had had stomach cramps for a couple of days and was starting to pass a little blood. Rather than send her for a timed appointment at the out-of-hours doctor 2-minutes drive away we were referred to the A&E (ER) unit at the hospital a half-hour away because they had a pediatric unit. However, when we got there, the ped's unit was closed (as you might expect at 11:30 on a Saturday night) and so of course we had to be triaged and sat with the drunks and bums for 3 hours before being seen. Surely the person making these appointments should have some idea when the damned unit is open. Ho Hum.

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  4. No, it is not justified. Just because that ER doc (and the others mentioned in this blog) is an idiot doesn't mean all of them are.

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    Replies
    1. Enid..... are you sure you're not just an er doc yourself?

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    2. No, I am not, but just because Doc has come across a few incompetent ER docs doesn't mean all of them are incompetent as well. If they all were then most of the population that has visited an ER would be dead.

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  5. I don't think they're all morons, they tend to just get lazy and cut a lot of corners to push patients out of ED. I don't know about where you work but in Australia they're trying to introduce a four hour rule where patients must be seen and admitted or discharged within four hours of presenting to ED. That's just going to amplify the situation where patients aren't being worked up to an adequate degree before being shafted off. There are some really good ED doctors out there though, who are thorough and diligent, and it's unfair to paint the whole specialty with the same brush. Medicine already has a huge divide with each specialty thinking they're the greatest.

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  6. The last time I visited an ER doctor I almost died. I had already been through a 6 hour surgery to remove the rest of a massive tumor, that had fully engulfed my left sinus cavity, that resulted in a brain fluid leak and other instances. I woke up swallowing masses amounts of blood and as soon as I stood up it started flowing from my nose, so I grabbed a bath towel and drive myself to the ER. The nurses saw me massively bleeding from the head and put me in a room, after 10 minutes of sitting and bleeding. I even heard one of them ask "who do we call?!" at that moment I was thinking what in the bloody hell do you mean "who do we call?!" so they finally get the ER doctor in and he's like we're going to have to pack your nose. This mofo didn't even know HOW TO PACK A NOSE. I had to instruct him on how to do it. I'm a senior in college for computer frickin science, I shouldn't have to instruct a doctor in how to pack my nose! Needless to say my mom had to rush (105mph) to come 75 miles to get me and take my to my experienced ENT for an emergency surgery. I just KNEW I was going to die in the ER that day. Therefore I agree, ER doctors are incompetent!

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  7. Hope you read this, DB.

    I worked at a small rural hospital. The hospital had just "upgraded" to "ER specialists" manning the ER, instead of the local family practice guys. These ER specialists worked at "doc in the box" facilities (walk-in urgent care) when they weren't with us.
    Late one afternoon, I found myself on an ambulance with a paramedic, trying to get an IV established in a 16-year old very obese girl's body... anywhere. She'd been in a roll-over accident and was trapped in the car for 45 minutes, restrained by seat belt, but with car upside-down. Her airway had been pinched off all that time, her head wedged against the car's ceiling. The paramedic unit had been on scene for at least 35 or 40 minutes, waiting for the jaws of life to extricate the girl from the car. I guess you can say hers was a witnessed arrest, as she never moved on her own, or breathed on her own all that time.

    After a jaws of life had been used to cut away the car, and cervical spine precautions taken, the seatbelt was cut. Her body gave one gasp and that was it. We were 5 minutes from the hospital. She had no palpable BP and a very slow heart rate (no monitor on the paramed rig at the time).

    By the time we got there, I'd gotten a large-bore needle into her antecubital. We put her on the cardiac monitor, and the rhythm was classic textbook agonal. The doctor looked at the rhythm, and asked "WTF is that?" Two nurses and a paramedic, fresh from ACLS training, said in unison "Agonal." Doctor: "What does it mean?" Us: "It means she had no oxygen for 45 minutes and the heart is dying." Doctor: "What's the treatment?" "Let her go." Finally the paramedic grabbed an ACLS book, found the section on agonal rhythm, and showed it to the doctor, who refused to believe this poor unfortunate soul was likely severely brain damaged (obviously intubated) and on her way out. He wanted to start an isuprel drip, just to see what happened, but we convinced him otherwise because we knew the down time.

    Yep, he was a pretty dumb guy.

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