Sunday, January 02, 2005

Stupid ER

So last week I go to morning report. The resident on call the day prior was, as is usual, bleary eyed and looked like shit. Not that I have to much sympathy for them though. I went through it as well, it sucked, and it was harder because we didn't have bullshit ACGME rules making us go home early post call. I made it through, they can make it through, everyone makes it through, except the ones who don't. Still, sympathy is in order for anyone who goes 24 hours straight and looks like hell the next day. The ACGME hasn't made seeing patients any easier.

So this guy sits down, pulls out his H&P forms from the night before, and starts presenting. First case, he says, is "one to get out of the way."

The ER calls him up for confusion in an old man. I'll just call the old man Mr. Geron (it's Greek for old). I can almost hear the story over the phone. The ER says, "so there's some guy here. He's brought in from his nursing home because he's altered. We don't have any more information on him."

I hear their voices because I was once the taking that call. At that point you know it's useless to ask any more questions about what they should have done: like vital signs - they will not be known, an exam will not have been done, no labs will be done, lucky to have them even sent off. Instead, the ER guy saw confusion, knows the patient will be admitted, and then calls it in. There's no futher data he needs to deal with.

So our resident goes down there, finds the guy dehydrated because he hasn't had a drink of water in his nursing home, and when the labs get back they show he's missing about 2 L of free water, and probably a few gallons of salt water.

On a related note, single cell organisms are able to regulate their salt and water to maintain life. Also: jellyfish, worms, fungus, grass. But not Mr. Geron. He needs our help.

With water Mr. Geron perks up. But he got admitted by then anyway. What a waste of time. Not mine, but I feel bad for the residents. Or rather, I would feel bad for the residents if I cared. Even with all the ACGME rules in the world, ER residents don't seem to get any smarter or care any more about the patients that roll through their doors. ER doctors: when they are even half-good they are great. When they suck, they suck.

Most suck.


Anonymous Anonymous said...

ER doctors are fucking idiots. Most should wear hazard signs.

10:15 AM  
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