1.28.2008

Confessions.*


There are a few things that many EM docs don't openly discuss 'else they subject themselves to criticism and judgment. Here are few of my confessions -


I think leaving acute patients to 'see quickies' in an attempt to clear out the waiting room contradicts the very essence of emergency medicine...and I don't do it.
In every emergency department there is (supposed to be) some sort of triage process. Where sick people are seen first, and not-so-sick people...wait. Well, our nursing staff (as wonderful as they are), will frequently ask me if I would 'come out and see some of the quickie, non-sick people, to clear out the waiting room.' If I'm sitting around surfing the net...then sure. But I'm never not busy at work. Never, ever. I rarely get to go urinate, much less grab a bite to eat. So, I don't do it. I can't justify in my mind, leaving my sick patients to go see not sick patients. And all to "clear out the waiting room?" That's really not my goal. My goal is to keep people who shouldn't die, from dying...and to get the rest to their proper destinations. When my shift is over...I leave. Waiting room full...or not. Why should my goal be to clear the waiting room? If I valued an empty waiting room...emergency medicine would be a poor choice of specialty.


I think that speeding thru patients, and subsequently rewarded for it, is a bad idea.
It annoys me when doctors brag about their half-ass workups in an attempt to seek reward for speeding thru patient encounters. Our patients wait, sometimes in excess of 6 hours, to see us. They deserve 10-15 minutes of face time. Even if the problem is straight forward and you only need 90 seconds. This interaction with patients (listening to them, talking with them) is why I love medicine. Minus the patient encounter...what's left?

Sure, I understand being efficient is important...but seeing 3-4 patients an hour is not good for the patients you see. They won't like it...and you won't like it. Something will be missed. A something that won't be missed if the doctor just takes a minute, grabs a chair, and spends 15 minutes with a patient. Additionally, taking a minute (or 5 or 10) to look up information (for yourself or for the patient) is totally appropriate, but doesn't lend itself to "speeding thru" cases. Finally, very important thought processes would be clear if time was spent documenting this information *in real time.* Not to mention more defensible in court, and basically just better communicates (as a medical record should) with other care providers.


I hate reading history and physical assessments written by people who are more concerned about capturing all the "elements" for full reimbursement, rather than actually documenting what the hell's going on with the patient.
There are so many docs now who chart based solely on reimbursement, that very key information is not included in the documentation. I do understand the need to get paid...but it's just as important to communicate effectively for the well-being of our patients. And simply putting "4 elements" in the HPI...doesn't quite do the job.


I hate dictating.
In the ED so many of my tasks are accomplished piece-meal. I may do the HPI in the patient's room...fill in the physical once back at my desk...and document the labs/xrays as they become available. I'll later fill in consultants names, times called, and their responses. Medical decision making usually follows. Finally I have a "diagnosis" and disposition. If I dictate, I can not do it in real-time. Otherwise I'd constantly be calling the dictation line back adding "addendums". Not to mention the time it would take to dictate "Dr. Cardiologist paged at 12 pm; no answer." (click) Then call back: "Dr. Cardiologist paged again overhead at 12:20." Or what about when patient has a change in condition? I can type over 75 wpm. I can write on the paper chart standing at the bedside. I can get distracted, and return to the charting very easily. But dictating...every chart...is unreasonable. Dictating looks pretty, and after the final disposition has been obtained, perhaps going back and dictating on selected patients would be helpful. But, I think it's a bad idea to do essentially no charting (scribbling notes to yourself on the paper chart with the intent to go back and dictate, *isn't* charting) until after your shift (sometimes *days* after your shift). I think that's a set-up for disaster.


I like to leave on time after my shift.
What's wrong with saying that? If I'm scheduled to be off at 4pm...I wanna leave by 4:45 (really right at 4, but I do understand expecting to stay up to an hour later to wrap things up). For some reason, some people think you're being lazy if you get out on time. On the contrary. It takes crazy planning to get out on time...and still see new patients up until the last 30 minutes or so of your shift...AND not sign-out a whole bunch of shit. It's an art, really.

I do not like being made to feel guilty because I actually have a life outside of the hospital. Not to mention that staying late isn't compensated time. I don't like to stay late (or come back on my day off) to chart on previous patients...not to mention that this isn't best medicine, IMO. And I expect oncoming colleague to take a reasonable sign-out without bitching and moaning. Of course staying is sometimes unavoidable. Of course some sign-outs are inappropriate. But I'm not talking about an occasional late day...or defending docs who chronically dump on their colleagues. I'm talking about a general attitude that everyone is expected to stay 2 hours late (cuz if they don't it means they were "slacking" during their shift and not seeing patients near the end...or didn't see as many patients as they "could have" because they completed their charting within the shift.) Neither is necessarily true...and on the contrary, docs who are efficient enough to finish their work on time...should actually be rewarded (rewarded with going home on-time without comments from the peanut gallery).


I get really annoyed when folks show up to the ED talking a whole lotta crap.
If you haven't been in the ED all day, you are not allowed to stroll thru and pass judgment. Nor are you allowed to show up for your shift and pass judgment. If you have not been here, you don't know what's been going on. And looking at the chart rack, seeing 15 patients waiting to be seen, is no indication of how fast/slow, diligent/efficient, the staff has been working.

I wish that everyone could understand that everyone has a bad sign-out from time to time.
Sometimes, the patients are all actually sick. Sometimes the xray machine is broken. Sometimes the medicine consultant is stuck in the ICU with a coding patient...all day. Sometimes, you're just friking tired...and want to go home.


I don't think that physicians should be "time card punchers."
We are not time-card punchers. We spend hours of "extra" time in the hospital in a given month. Leaving 10 minutes early one day...is earned. A right almost. Especially if the sign-out is clean. Afterall, staying for the sake of staying (it's not like a new patient encounter is going to be initiated 10 minutes before you're off) is demeaning. I understand why high-school students stay on their Burger King shift until the clock strikes twelve. But I am no high-school student...and I am not at Burger King. Holding highly trained professionals (who give away tons of time for "free"), accountable for every minute (or ten, or fifteen...) is indeed a slap in the face...and shouldn't be done.


I kinda like that the patients see me as a nurse (or other non-doctor person) at times.
When patients start bitching and complaining....it's so easy for me to say, "lemme get your nurse." If they knew I was the doctor, I don't think that response would work quite as well. Also, looking like a clerk nurse cafeteria worker non-physician allows me to roam the ED in peace. Most of the time, this is kinda nice.


I hate it when patients lie to me.
I mean, it really annoys me. I can no longer trust them...and I no longer believe anything they say. I get urine tox screens on them. I don't spend as much time with them. I am less likely to give them what they're asking for. And I don't take the time to do the extra things (get blankets, cups of water, or even listen to their tale of woe about their inability to pay for a cab). I treat them, and disposition them.


I like male nurses.
Male nurses are fun. They rarely challenge me...and there is no animosity between us. Male nurses seem to become nurses because they wanted to be nurses. Sometimes, female nurses have this thing...where I get the impression they actually wanted to be physicians...and they are jealous of me? Or think they're smarter than me because they are older...perhaps they feel they have something to prove (like "I coulda been a doctor too, you know".) Maybe it's just too much estrogen. Either way, I love male nurses.


I like female physicians.
The guys tend to be immature, socially inept, sexist, arrogant, pompous little dick-heads. Racing their fast cars, and staying late to avoid going home to their wives and families. Rushing thru patients for bragging rights: "I saw 26 patients on my 8 hour shift yesterday dude..." They balance their personal/professional lives very poorly, and rarely have anything to talk about that matters (outside of medicine). It's no wonder they die off early. Whereas women tend to do a better job listening, and taking the TIME to figure out what's going on with the patients. They are not as concerned with playing the testosterone games the men boys play, and seem to be more patient focused, more balanced, and better adjusted individuals.


I don't like it when female ED staff cross boundaries with male physicians.
I'm not just talking sex here. I'm not even talking about dating (I'm okay with that). What I don't like is the gifts, the shoulder rubs, the playing with the hair, the flirty remarks the fawning...and the all around degradation of character they demonstrate when they pimp themselves out to these dick-head male doctors. It bothers me more when the men are married. Sometimes I'll comment. Is there no shame...?? These "hos" misrepresent women, they undermine family, and make it even more difficult for women to be taken seriously in the workplace. I say, be friendly at work...and a tiny bit of flirting may be fun. But leave the touching, and the gift-giving at the ED door.


I really envy the way the nurses organize potlucks, make Starbucks runs, and overall, make their work environment more 'friendly' by virtue of having involvement of more women.
If physicians had more female members in the ED, I'd bet our lounge would have plants, and family photos, cutesy posters, and the like. I bet we'd even have clean linen and tampons in the bathroom. And best of all...we'd have a strong union.


I hate colorful scrubs
You know the ones the nurses wear...with all the pictures all over them (dancing puppies, and little happy faced sunshines)? I don't exactly know why. Maybe because I can't wear them without looking like a complete fool...??


I like seeing children more, now that I have my own.
I used to *hate* seeing kids. All they do is cry...and they provide no useful information. Just like being a vet. I didn't know what "fussy" meant...and I couldn't understand why parents brought their very well children to the very germy ED for a cold. I couldn't understand why it had to be at 3am? I couldn't understand why they even thought anything was wrong with the kid. Now...I understand better.

I have more 'feelings' for patients that I relate to.
I can easily tolerate people doing stupid, self-destructive things. This is what keeps us in business. However, when I can identify with the person on a personal level, I feel personally disappointed when they make bad decisions.


But, if I can relate to a patient, and they are ill...I feel sad. If a patient is a mother, for instance, I can talk to them for hours about their hopes and fears for their children. I'll fight back tears as I listen to her history. Then, once home, I'll take extra moments to smell the breath of my own children, and feel their soft baby cheek. And I remind myself that I am truly blessed.


I think emergency medicine is the coolest specialty ever.
I actually believe that those who talk negatively about EM...are simply jealous!!

Updated 4/2011
*Stating the obvious: there are many great female nurses that I just adore...many male doctors that are wonderful friends of mine; there are patients who lie that I still trust, and people who look like me (or that I can relate to), that I feel no emotion for. No one should dump on their colleagues by showing up habitually late for a shift, nor should one give shitty sign-outs consistently. I do go out to triage every now and then to dispo 'simple' patients...depending. I understand moving quickly, documenting to get paid, and needing to stay late to finish documentation (or whatever). I realize that in the ED, every patient will not get 10-15 minutes of face-time with the physician. Dictation is wonderful, and should be available...and a bit of innocent flirting at work is okay at times. I encourage people to find love, and have no problem with finding love at work. And I realize that not all men who work late are cheating on their wives (or otherwise avoiding them). I do get annoyed when I have to almost 'prove' I'm the doctor to people, when the white *male* is often 'mistaken' for being a doctor no matter what his role may be in the hospital. There are no absolutes...and I get this. You get this. I wrote this 'Confessions' entry with blanket statements to keep it interesting (and direct). Please don't argue the fine points (i.e. not all colorful scrubs are embarrassing). I know this. And remember, these are my *general* opinions. General. Opinions.

45 comments:

Anonymous said...

"I don't like it when female ED staff cross boundaries with male physicians."

Live and let live!

When I read your sentence first thing I though is: or you are very ugly or you are in someway unhappy with your marital status. Women that make critics to other women flirting with men (specially married ones) use to be not so confident with their fiancé.

ER doctor said...

hmmm...
...I just appreciate married men acting married.

You actually sound like a married man who thinks it's okay to disrespect his wife by allowing other women to cross boundaries at work.

Nurse Sean said...

Awesome post! Juicy stuff and fun to read. I agree with some (especially the colorful scrubs) and disagree with others. But we are all entitled to our opinions!

I definitely like males nurses better too...but I am one, so that makes sense! :)

ERMurse said...

WOW!!. You've said a lot. Thank you for defending the Triage process that puts sick patients first rather than the ones who get the survey. Thank you for feeling its important to spend a few minutes with patients rather than do your exam from the doorway in 30 seconds and writing a script that is not indicated just to get them out and make your door to provider time look good. Thank you for supporting documentation as you go that is meaningful to the next healthcare professional rather than only to the biller. And Thanks for liking Male Nurses!!! ERMurse

Anonymous said...

Nice post. I like male nurses better as well. Less attitude. However, I don't like the first snarky anonymous poster above. How can you say in the same comment live and let live and the insult the blog author. It is rare to see someone be so hypocritical with just two sentences.
b

Anonymous said...

It sounds to me like you have too many hangups and that your partners are probably subsidizing your income. You should be a PCP and run your own office the way you want it to be.

ER doctor said...

"It sounds to me like you have too many hangups and that your partners are probably subsidizing your income. You should be a PCP and run your own office the way you want it to be."

-I wonder how *you* fit into all this. Maybe the guy who stepping out on his wife? Maybe the jerk who 'treats em and streets 'em' with no compassion. Maybe the person with no life and loves to live at work. Or, maybe you're the one who does our profession a disservice by mistreating patients (providing subpar service, doing dangerous things, reckless, poor documentation, late documentation, etc.) Or maybe you're the ho who thinks it's cool to participate in the breaking up of families. Or maybe you like to give blow-jobs in the supply room and can't understand why many professional women would have this "hang-up"??

I wonder...???

Nurse K said...

I don't think gender has much to do with whether an ER doc or doctor in general is "better" or "worse". It's totally individual. The best ER doctor, whether male or female, is a good blend of funny and laid back, yet smart, efficient, ****respectful of nurses/patients whether male or female****, and not afraid of hard cases or new protocols/equipment.

just a patient said...

You sound angry about a lot of things that as a patient I can't relate to, because as a patient, all I know is that I'm frightened and vulnerable and want the best care I can get. With your attitude as expressed here in your blog, I feel I would be in good hands with you.

ER doctor said...

"most malignant rotation was Ob/gyn because it had all women who were basically always ready to bite the head off anyone who said or did anything wrong aka not the way they would have done it."

Agreed.

In EM, however, my experience has been different. Usually the women who choose EM are different. They choose it b/c it does allow for a greater ability to balance work/family, aren't as defined by their jobs/career, and seem to be more fun in general. Likewise, I prefer male OB/Gyns and Peds.

"Now, go ahead and insult me just like you have to all the posters who haven't agreed with everything you said on your blog page."

It's easy to talk smack while posting anonymous as they did. I don't mind disagreement, but (pointing index finger at 'them') they insulted me first...

;o)

Anonymous said...

"I wonder how *you* fit into all this?"

Strike a nerve?

Sounds like maybe I am the guy keeping the nurses and patients happy by cleaning out the waiting room and getting things done. Or maybe the guy waiting to go home when you come in late. Or maybe the guy taking your crappy sign outs because you want to go home on time and spend half of my shift cleaning up your mess. Or maybe the guy having to pull extra shifts when you go on maternity leave. Or maybe the guy elevating your own earned hourly. Or maybe I am the single guy always getting nights, weekends, and holidays because you have a "family life", or giving you last minute trades so you can attend to your kids.

You know nothing about my compassion, competence, and care, but you threw out first insulting generalization

ER doctor said...

"You know nothing about my compassion, competence, and care..."

That's my point, Mr/Ms. Anonymous...I don't know.

I still wonder...

Toni Brayer MD said...

Great post and filled with true honesty! Keep it up, EM, Doc.

Anonymous said...

Wow, a lot of hostile people posted comments here!

I agree 100% about the flirting, shoulder rubs, etc. I'm in corporate america and it screws up the atmosphere whenever it becomes common. In offices where it is not the norm I feel like we are all just working together to do our best. If that teenage flirty crap is going on it introduces a somewhat sexual atmosphere that distracts from the work and divides people.

I disagree only on the cute scrubs. I think they are a great idea for nurses because they probably help relax children somewhat. For a kid to be sick and in a hospital envt is very stressful and cute puppies or cats or butterflies or whatever seem reasonable.

During a recent hospital stay I had only female nurses and all but one gave me great care. However, you might find it interesting that in an 8 day stay I only had one nurse who checked my drug allergy bracelet EVERY TIME she brought a med to be put in my i.v.

Lisa said...

As a medical frequent-flyer (zebra), I 100% agree with everything in your post. As FF, I'll go one step further:

I want a female ER doc and male nurses. I *wish* I would they'd have had male nurses in the Maternity Ward when I had my babies, the women were *horrible* to me (pre-zebra-diagnosis). During my second 53 hour labor, in a room next to the nurse's desk, a group of female nurses were openly mocking a woman that was enduring a natural birth [and crying out]. Niiice.

I have also noticed that there aren't many women physicians in advanced specialties. If you do find one: the basic rules do not apply, a female doctor in an advanced specialty usually has a nasty chip on their shoulder.

LTooLio said...

Those spongebob scrubs? How does someone expect to be taken seriously with spongebob all over them? Or bugs? Or Kittens? Or Teddy Bears?(I love spongebob, but his place isn't in the hospital)Totally unprofessional.
The flirting always drives me nuts. Backrubs to married/unmarried doctors are my favorite. It destroys my view of that nurse, red flags up all around.
Thanks for the post, I enjoyed it!
You sound cool to work with.

Anonymous said...

ER Doc:
My observation from reading your post's.

You have a lot of growing up to do.

LilyRN said...

ER Doc:

My observations from reading your posts:

You don't suffer fools easily and you take your work seriously. These are grown-up traits.

ER doctor said...

Thanks for the support...

Bostonian in NY said...

Medicine with out the patient encounter is Pathology

coffeeandtea said...

I'm a second year medical student and I loved this post! I'm thinking about going into EM and I'd love to hear any advice you could pass along! I agree with the jealous of the nurses starbuck's runs comment. Thanks for this post-really enjoyed it and it shed a lot of light on the specialty.

enrico said...

Awesome, honest, and touching post. Funny how all the truly negative commentary came from anonymous commenters. I mean, of course there is room to disagree--this is only your opinion--but the 'nerve' that was hit clearly shows how true a lot of what you said is.

Nice. :)

ERP said...

I agree with many of your comments - I don't know why but I never have had attitude from a male RN (I am a male) - Most female RN's don't give it either to me but I definitely see them give it more with my female MD colleauges. I don't know why this is. Eventually everyone ususally gets along but it takes longer for female MD's and RN's to warm up to each other.

I personally like other MD's based on personality, work ethic, and willingness to come in a see patients more than their gender. I have gotten just as many crappy sign outs from male MD's as female. Unfortunately, I have had to give them sometimes too. When the sh** hits the fan one hour before you are supposed to leave, charts back up, calls don't get made, dispos get delayed.



As for the flirting, unfortunately it is a fact of work life. We are sexual beings and it is going to happen. I don't think over sexual innuendo is appropriate, but god, I gotta say, I love back rubs! LOL. - and it is often the married/engaged female MD's that offer it (or ask for it) just as much as the RN's! I also don't think that this sort of thing necessarily leads to sex, affairs, or home wrecking, most of it is harmless.

I also HATE those goofy scrubs. I think kids react more positively to a friendly face than to a grumpy one with teddy bears on their clothes.

Surfie said...

"I hate dictating."

Guess what -- I hate transcribing the crap you dribble out of your mouth.

Yes, there IS a PERSON that actually TRANSCRIBES this shit. I have to listen to you munch, fart, shit, shuffle papers, hork snot, giggle with co-workers, and take care of your kids (that's when you must get to your late charts because you are being threatened with loss of privleges due to laziness).

I don't get paid by the hour. Did you know that? I presume not. Do you know how I am paid? Again, probably not. Do you care? Most definitely not.

Here's a tip from the handy clue bat: Tell your transcription company or manager that you have "normals." DICTATE THEM. Then REFER TO THEM. Young healthy adult? NORMAL PE and ROS. Young healthy kid? NORMAL PE and ROS.

Say! What if not every system or finding is normal? What would I do?

Dictate, "Use my normal PE except for the lung exam," then dictate the abnormal findings.

We transcriptionists KNOW that you dribble the same PE and ROS for each and every system/exam and patient.

Use it to your advantage, please, and save us your piss-poor attitude and enunciation while we try to earn a living. We'll both be happier.

AND? The icing on the cake is that the DICTATED reports are used for YOUR REIMBURSEMENT! Ask your friendly neighborhood coder if you don't believe me.

ER doctor said...

"I hate transcribing the crap you dribble out of your mouth."

-So we agree, dictating sucks
;o)

ERP said...

ER Doctor, you need to get a computerised system! The T-sytem is faster than dictating and it prompts you for what to document. I almost never stay more than 10-15 minutes past a shift to do any documenting.

Carol said...

"I like to leave on time after my shift" Amen! I am a pharmacist and recently worked in a medical clinic. The doctor expected the pharmacy to stay open because SHE was working late. um, just because you want to stay late doesn't mean I have to. duh. I wound up quitting.

Anonymous said...

Oh yes anon 07:54 making obnoxious comments about Dr's and RN's based on there sex now that's really grown-up. How would you (and ER doc) like it if people start making comments based on other people's race? Probably not very much I bet. Really not that much of a difference in this disgusting steotyping is there now?

Conclusion: stereotyping is rather childish and ER doc needs to growup.

Anonymous said...

Surfie:
I personally hate reading all that crap normal "canned dications". It may be easier on you and easier on dictating doc, but you know what, it is not easier to actually read that shit and figure out what is best for the patient. Remember them? The ones we all should be caring for. Personally, I find those canned ER dictations utterly worthless when trying to figure out what happened. Three pages of utter shit to glean out the two or three dictated sentances that actually explain what is going on. Well, as long as the billing is correct who cares about the medical end of things right?

Anonymous said...

transcriptionist,

You need to get a new job. Actually your days are already numbered. We outsourced our transcription to India. They are doing fine. Many have already gone to voice recognition systems.

Surfie said...

Dear 2 anonymous fools,

Like reading "canned dication," try transcribing it like a monkey on a keyboard day after day. Most, if not ALL doctors dictate a "canned" job.

It's MY JOB to do this, not yours; so, please don't tell me what I hear 8 hours a day 7 days a week.

My J-O-B is to TRANSCRIBE what is dictated. I don't dictate it. AND, it's not my responsibility for the final draft. It's the PHYSICIAN'S responsibility as he or she signs on the dotted line.

Finally, about the India aspect? Yes, a lot of Indians do transcribe. And you know what? It is sent DIRECTLY back to the Good ole U.S. of A. to an editor to correct. Therefore, essentially 2 people are being paid for doing the same job.

Saving money? I think not. Try again.

Voice recognition? Same scenario. It travels through the back-end system and directly to an MT, i.e., "flagman" for "phlegmon." If VR was SO great, it would have been utilized a LONG time ago with 100% accuracy. But is it? NO.

AND? At least I can sign my name to a post, and you can't or won't.

Cowards

Surfie said...

"Personally, I find those canned ER dictations utterly worthless when trying to figure out what happened. Three pages of utter shit to glean out the two or three dictated sentances that actually explain what is going on. "

Finally, the insurance companies could give a flying shit about what you can "glean from 2 or 3 sentances (sic)." They want to know the level of care provided, and the only way to re-imburse accurately is by "gleaning" the information from the "legal medical record," i.e. the SIGNED TRANSCRIBED DOCUMENT.

I am SO SICK of MTs being taken for granted. One, just one, of you try to sit down and transcribe an ESL (English as a Second Language) dictate an echo, CABG, heart transplant, lap chole, TURP, endocrine consult, dialysis session, a 3-month pediatric preemie discharge summary, bronchoscopy, Cimino fistula, balloon angioplasty of multiple lower extremity arteries, and a long-winded bunionectomy in ONE DAY.

Then, you come back and tell me how "easy" an Indian or VR transcriptionist/system can replace us.

Seriously...try. Then tell me how easy and replaceable MTs are.

medrecgal said...

Amen to your hatred for the people just trying to do exhaustive H & P's & jamming boatloads of info into an HPI to try and inflate their reimbursement! I've just started in a career in HIM and this kind of thing is at times patently obvious. At the other extreme are the people who don't give you nearly enough information to figure out just exactly what the hell they did for the patient... which can be equally frustrating. There needs to be a better system that's driven less by money and more by actual patient needs. Ain't happening, I know, but one can dream!

Anonymous said...

Surfie:

re:"Like reading "canned dication," try transcribing it like a monkey on a keyboard day after day. Most, if not ALL doctors dictate a "canned" job."

Hello, I am not a transcriptionist you are. Accept the negatives of your job or find another...period.


If all a doc is dictating is "canned" then just how does this help the patient? Again remember them, the ones who are we doing all of theis stuff for (and to)? See the problem is you just dictate, you don't actually have to read and understand what happened. The new process of saying "insert normal X and Y" is it may "capture dollars", but it makes reading the dictation and actually UNDERSTANDING what happened difficult. Personally, I find ER dictations infamously worthless for this very reason. Most the time I am of the opinion that the dictation is for the lawyers and medicare. The actual doctor reading the document is an afterthought. The other problem is you the transcriber don't have to actually understand and act on the dictation...I do. So in reality you don't understand the issue.

PS: If you think the name "surfie" on the internet gives you some level of accountability then you clearly don't have what clue what is real accountability.

emergencyem said...

Awesome post.

Anonymous said...

What an interesting post, from the beginning to the very last part! I'm not in the medical profession but I could relate to so much of what you said, very much including your last comments. Thank you.

Anonymous said...

I enjoyed reading your post. But what I liked the most is how you handled some of the not-so-nice comments made by some people. Your diplomatic manner reveals the kindness of your heart. Glad to have you in the emergency medicine field.

Anonymous said...

There is a double standard regarding healthcare for male
patients. Privacy for male
patients is not respected.
I've had a number of unpleasant
experiences with female nurses
and 2 were of unprofessional
behavior. There is much proof
on the internet as well regarding
female nurses being perverts and
unprofessional. Complain to the
ceo and the state board of nursing.
I have a tremendous hate and
distrust for female nurses.

sweepstakes said...
This comment has been removed by a blog administrator.
world said...

You actually sound like a married man who thinks it's okay to disrespect his wife by allowing other women to cross boundaries at work.

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echoinavacuum said...

"The guys tend to be immature, socially inept, sexist, arrogant, pompous little dick-heads. Racing their fast cars, and staying late to avoid going home to their wives and families. Rushing thru patients for bragging rights: "I saw 26 patients on my 8 hour shift yesterday dude..." They balance their personal/professional lives very poorly, and rarely have anything to talk about that matters (outside of medicine)."

Very judgmental and bigoted comment. Who are you to say what really "matters"? If an ED doc enjoys motorsports, rock climbing, martial arts, impressionist paintings whatever and talks about it with a passion, that's their business and it matters to that person. If you enjoy it, then by all means do it. I love driving my car, hearing the revs and shifting while passing. It's one of my "happy places". You're the last person I'd ever want to be.

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