Time Flies When You’re Having Fun

And nowhere is this more true than when I’m working in the emergency room. Unfortunately, my time is half done and I’m already dreading the return to ward medicine. Particularly when my next rotation is pediatrics.

That’s certainly not to say that my rotation has been without it’s low points. One of the doctors I’ve been assigned to work with frequently is a huge advocate of the ABC’s… or at least insofar as they stand for Airway, Breathing and Consult. He’s so quick to hand patients over to other services that I actually feel like I lose out on learning about patient management. When I’m on with this staff I can guarantee that anyone requiring a pelvic exam will be referred to gyne, anyone over the age of 75 will be referred to medicine and anyone complaining of low mood will end up in the hands of the Emergency Psychiatric Team. It definitely gets frustrating.

This may be a direct result of the fact that the hospital where I work has it’s emerg docs billing fee-for-service. Most of the other teaching hospitals in the area are on salary, which is intended to encourage teaching but discourage efficiency. Studies have shown that fee-for-service emergency rooms result in shorter wait times, and I can attest that there is no shortage of teaching at my hospital. In fact, when multiple residents are on shift at once, many of the emerg docs simply make themselves comfortable in the back and don’t see patients—they just review the patients with the residents and make suggestions regarding their treatment plans. We get more done, they bill more patients, people don’t wait as long… in short, everyone wins.

The biggest limiting factor to that approach, however, is that you have to be working with residents that you trust. Not always a given. Not everyone has the insight to know when they’re in over their head, or the guts to admit that they don’t know how to approach a particularly sticky problem. Not that I’ll be naming any names…