This was supposed to be the post where I shit all over emergency medicine

I wrote a really long, really bitter tirade about my problem with some emergency physicians. It started out as part of the 'choosing a specialty' series, but I realized that my tirade had nothing to do with actually choosing a specialty, but was just my bitterness.

My complaints were not really about ER docs in particular, but were more about doctors who don't care enough to do a decent job. Every field has its flaws. ER is not exceptional in that respect, and it would be unfair for me to single out ER. Someone could write an equally bitter tirade about internal medicine. And in fact, when I was a senior resident, I was far more harsh with my interns who were lazy or tried to pass off substandard work, to the point where I earned a reputation as a hardass.

Maybe an example would make my point better. A friend of mine in the ER, Black Cloud, he is the worst of luck. When I was a resident, he would give me the most admissions, and always the most acute. It was a nightmare every time he was on. But BC always charted accurately, ordered the appropriate tests, and communicated with me personally. I knew that even the sickest patients he called to me were receiving the best care he could provide.

Contrast this with Phoning It In. PII would do whatever it took to avoid work. Charting wasn't done. Appropriate tests not ordered. Consults not called. Cases would be dumped on other ER docs incomplete, and when I came to admit, they had no idea what was going on because PII hadn't given signout. I've had patients of PII's whom I've intubated upon walking into the room because they were seconds away from respiratory failure.

PII was a tremendous white cloud, and calls were easy, but if I had to choose between PII and BC, I'd go with BC every time. Even though the calls were tough, I knew that BC was doing everything he could to take care of his patients. And that's what loving your job is all about.

I will close with this parting shot. I got a LOT of attitude from some (certainly not all) of the ER residents when I was the on call IM resident. They would tell me that IM is cupcake, and imply that they could do my job without breaking a sweat. They would order me around like I was their servant. "You need to admit this guy in 5. The chart's over there. Pfft, I don't know his name, look at the chart! Jeez." This is a direct quote. My favorite call for admission was, "You need to admit this patient. What's wrong with him? I don't know. You're the medicine doc. You figure it out."

To those residents, I want to say that I am now (right now) forgiving you for treating me like shit, but I cannot forgive the disregard you have shown to your patients and the stain you have placed upon the profession of medicine. I was taught that we have a moral obligation to provide the best care for our patients, and I find you lacking.

To all the ER docs out there doing good work and fighting back the tide, thanks. I really do appreciate it, as much as I complain. And it makes me feel fantastic to know that when I send my patients to the ER, they are in good hands.

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