When I first started practicing emerency medicine, 19 years ago, transfers were one of the most miserable things I faced.  I practice in a semi-rural facility with a paucity of subspecialty backup.  Complex cardiac anomalies, multi-systems trauma, unstable neurological or neurosurgical problems, very sick pediatric and obstetric patients all had to be transferred to a regional facility.

Among my favorite stories:  ‘Why do you guys always wait till Friday afternoon to transfer this stuff?  It’s a dump!’  (Large pituitary tumor with confusion and weakness…no neurologist at our facility.)

‘What do you mean pre-eclampsia?  She has reflux.  Put her in her car and send her to me.’  (Actually had HELLP Syndrome.)

‘I’ve told you over and over to call trauma, not me. ‘  (Isolated brain injury).

My partner had this gem from an ENT, regarding a child with a large retropharyngeal abscess when we had no ENT on call.   ‘How exactly is that my problem?’

And of course, one neurosurgeon always returned calls collect.

Over the years, professionalism has risen to the fore and the facilities where I send the most patients now have transfer lines.  Furthermore, they have physicians who want to succeed financially and professionally, and who are interested in being the very best in the area.

Now, my calls are monitored by a transfer nurse or secretary, and my interactions are often with physicians I have known for years.  We respect one another.  I don’t have to worry that I’m being evaluated,  or my every decision questioned.

‘Hi there, it’s Tamasseedoc, I have a 56 year old lady with a STEMI.  (Basic info given.).

‘Great,  I’ll activate the STEMI team.  Send her on.  Standard stuff, Heparin, Plavix, Aspirin.  Thanks a lot!’

That’s how good transfers go.  That’s the benefit of a transfer line and established relationships.

And that’s the fruit of professionalism and friendship on both sides.

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