Comments on: The Consulter http://erstories.net/archives/159 ER Stories Real Life Tales from the Emergency Room Thu, 11 Mar 2010 14:55:29 +0000 http://wordpress.org/?v=2.3.1 By: TK http://erstories.net/archives/159#comment-266 TK Wed, 20 Feb 2008 02:58:05 +0000 http://erstories.net/archives/159#comment-266 Well, in my group, I would say about 50% of us are pretty good a getting elderly people out of the ER if they have a non-serious complaint. I like to think I am one of them... However, there are sometimes when one just does not have the time to do what is necessary to safely discharge the patient - and often social work is involved. In our hospital this pretty much means an admission - we have no way of dealing with the droves of elderly mildly demented people who live by themselves and have no nearby family. They fall down - they get admitted. It is sad but the truth. The main point of my post though was that some of these bumbling internists need to utilise our hospitalists to minimize unnecessary consults. They are more up on inpatient medicine (obviously!) and are more comfortable in dealing with patients who have complaints outside a narrow spectrum. Many of these guys just are too old school and won't give up the control.... Well, in my group, I would say about 50% of us are pretty good a getting elderly people out of the ER if they have a non-serious complaint. I like to think I am one of them…
However, there are sometimes when one just does not have the time to do what is necessary to safely discharge the patient - and often social work is involved. In our hospital this pretty much means an admission - we have no way of dealing with the droves of elderly mildly demented people who live by themselves and have no nearby family. They fall down - they get admitted. It is sad but the truth.
The main point of my post though was that some of these bumbling internists need to utilise our hospitalists to minimize unnecessary consults. They are more up on inpatient medicine (obviously!) and are more comfortable in dealing with patients who have complaints outside a narrow spectrum. Many of these guys just are too old school and won’t give up the control….

]]> By: Harried Hospitalist http://erstories.net/archives/159#comment-263 Harried Hospitalist Wed, 20 Feb 2008 00:57:13 +0000 http://erstories.net/archives/159#comment-263 Reminds me of a lot ( not all) of the ED docs I work with who will not discharge home anyone over about 70 years old with ANY complaint, or any age adult ( even an 18 yo with a completely atypical story and no OBJECTIVE data to support anything other than a chest wall strain) with the complaint of chest pain without a medicine consult, including the patient with an OBVIOUS zoster rash. Some of them take one look at the patient and decide they need to be admitted no matter what and embark on running up to a gazillion dollars worth of tests until they find an abnormality of sufficient magnitude to justify the admission ( Why did you perform an EKG on a patient whose chief complaint is eye pain? I kid you not.) I suspect the admitting MD's who are compulsive consulters are either really lazy, really dumb, or more than likely really defensive. I suspect the same thought process ( or lack thereof) occurs with some of the ED MD's as well. Welcome to the world of defensive medicine. You've got to share the risk with someone. Reminds me of a lot ( not all) of the ED docs I work with who will not discharge home anyone over about 70 years old with ANY complaint, or any age adult ( even an 18 yo with a completely atypical story and no OBJECTIVE data to support anything other than a chest wall strain) with the complaint of chest pain without a medicine consult, including the patient with an OBVIOUS zoster rash. Some of them take one look at the patient and decide they need to be admitted no matter what and embark on running up to a gazillion dollars worth of tests until they find an abnormality of sufficient magnitude to justify the admission ( Why did you perform an EKG on a patient whose chief complaint is eye pain? I kid you not.) I suspect the admitting MD’s who are compulsive consulters are either really lazy, really dumb, or more than likely really defensive. I suspect the same thought process ( or lack thereof) occurs with some of the ED MD’s as well. Welcome to the world of defensive medicine. You’ve got to share the risk with someone.

]]> By: Nurse K http://erstories.net/archives/159#comment-260 Nurse K Tue, 19 Feb 2008 17:48:25 +0000 http://erstories.net/archives/159#comment-260 Hm, my link didn't show up. Let's see if this works: http://crasspollination.blogspot.com/search?q=egregious Hm, my link didn’t show up.

Let’s see if this works:

http://crasspollination.blogspot.com/search?q=egregious

]]> By: Nurse K http://erstories.net/archives/159#comment-259 Nurse K Tue, 19 Feb 2008 17:47:50 +0000 http://erstories.net/archives/159#comment-259 <a href="http://crasspollination.blogspot.com/search?q=egregious" rel="nofollow"> </a> Grrr.

Grrr.

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