Here’s the link to my January EM News column on the symbiosis between emergency medicine and hospital medicine. Text follows.
This is just a note to say that we, in emergency medicine, appreciate you. Like all of us, you are stuck in an endless loop of unending residency. Don’t worry, it isn’t an episode of The Twilight Zone. It’s just your life. No, it’s our life!
As specialty after specialty withdraws from the practice of medicine, you, and all of us, are left holding the bag. We’re the college wing-man, sitting at the table with the hot girl’s weird friend. That is, the rest of medicine skimmed off as many normal, paying customers as possible, and the rest of them were granted graciously to us.
We feel your pain. Heck, we adminster your pain. But not because we have any options really. Every neighborhood clinic that has a slightly sick patient sends them to the ER. Each and every nurse’s aid or home-health worker who notices a blip in blood pressure, a faint murmur or something black or red in a body fluid sends their charges our way. Every family medicine office or urgent care that feels beyond their capacity, or is approaching closing time, tells the patient to go to the ER. Sometimes they call, sometimes they don’t. But ‘go to the ER’ is one instruction that they always follow.
So, when they arrive at our door, some of them are actually sick! The nerve! At that point, either their physicians have astutely chosen to surrender hospital privileges in exchange for more money and time off, or they don’t have a physician at all. And so, when the work-up is done and it becomes clear that discharge is no longer an option, we ring you brave lads and lassies.
We recognize the empty souls behind your tired eyes as you admit the 105 year old dementia patient with, yep, weakness. Your tenth admit for weakness in 12 hours. We know that the average age of all your admissions is somewhere around 85. We hear your souls die a little when we say, ‘the family wants to put him in a nursing home and says he’s more confused than normal.’ It’s sad to hear you sobbing to yourselves over the phone, wondering why you didn’t study just a little harder and become an opthalmologist.
But we know it hurts in other ways. It hurts when you have those days. Those days when you have all the same patient. Eight chest pain work-ups. Six Xanax overdoses. Nine TIA’s. Seven syncopes. And a partridge in a pear tree. The thing is, we see them before you do, and we understand. We just realized, early in our career, that two hours of anything was more than enough. You have them for days. Bless your hearts!
We also feel for you when it comes down to the patient dumping contest. You know, the ancient hip fracture with 26 meds whom the orthopedist says, ‘have the hospitalist admit them, we’ll consult.’ The GI bleed, of whom the gastroenterologist says, ‘have the hospitalist admit her, we’ll consult.’ The nosebleed on Coumadin dodged by ENT and gifted to your capable hands. The post-op cellulitis, the post-partum pneumonia, the vague abdominal pain. ‘Have the hospitalist admit them.’ The very words must haunt your nightmares, as assorted specialties leave the annoying work, the admission orders, sliding scales, pain meds, dispositions, social planning and midnight phone-calls…to you!
Sure, we have our differences. I have nothing to offer the patient who refuses to go home, and you can’t admit them or you’ll be hauled off to Medicare prison and water-boarded by government functionaries. We have our tiffs. But the thing is, we’re BFFs. We’re soul-mates. We’re ‘brothers by another mother.’
Medicine keeps getting harder. And fewer and fewer folks are doing it. America has no idea that the weight of it all is falling upon the shoulders of the emergency physicians and hospitalists who lurks inside the trauma rooms and inpatient floors, the fast-tracks and ICU’s of their community and university hospitals. The pasty-pale, coffee-sucking, junk-food eating Spartans of health-care, who will bear the full Persian assault of health-care reform when there aren’t enough primary care doctors to manage an AARP convention, much less all of America.
So let’s stick together, shall we? In point of fact, we might need to form an organization, a common political advocacy group. If nothing else, a fraternity. Tau Iota Lambda Mu…Take it like a man.
Bottom line, hospitalists, we respect you and we need you. So don’t get mad when we call you. Just think of it as a little note from someone who, for assorted reasons, understands you. Someone who ‘gets you.’ And someone who has already endured the same patient and has simply run out of ideas. And has to go home at the end of the shift…
Hospitalists, we heart you! We’ll have your coffee waiting. The hematologist says that the grandma in Room 8 has ITP. Call him if you need him.