I just wrapped up my last ER shift, and it's been an interesting experience. It's certainly not HGH, where we had traumas crashing through the door at all hours of the day. I saw aortic dissections (I wouldn't wish it on my worst enemy), car crashes, full body burns on a terrifyingly regular basis. The excitement is certainly everything I imagined of an ER. People running, doctors being paged overhead (I used to fantasize about being paged. Now I do everything to avoid being paged), and paramedics run a revolving door of patients.
It's not quite like that out here. The real traumas get sent straight to St. John's, so most of what I see here are really walk in clinics. I don't mind, in a lot of ways. I find the culture a lot less malignant than city hospitals. For one thing, without there being permanent residents based here, there's no expectation that we work around the clock.
I enjoyed being on call on internal back in clerkship, I really did. But was 4AM really the necessary time for me to consult on a patient with stable afib, going for surgery 5 days later? Not even a little bit. But I did. I did so many of those it wasn't funny. I literally fell asleep during one at the computer. I also did 'consults' on ICU transfers to our ward. Why these transfers happened at 2AM instead of 2PM the day before or after? Hell if I know.
Instead we as ER manage patients overnight if they're stable enough. We don't call our internists at 430AM for a stable afib. We don't page surgery stat for a query pancreatitis that isn't septic. We give antibiotics, we start fluids, and we monitor.
What I find harder to swallow is the state of this place's family medicine being reflected in the ER. I've lost count of how many patients came in for mind boggling minor complaints because they're concerned (rightfully so, anyone would be without medical knowledge) but have no family doctor. The waitlist doesn't even exist for some doctors because of how loaded down their practices are.
Patients come in for coughs because the waitlist at their doctors is 5 weeks long for an appointment. And that's how I end up doing insurance forms, viral coughs, and aches and rashes all day and night long. It's also one thing for patients to come in at 3PM and say they have a rash. I get annoyed when they show up at 3AM.
From their perspective I can see why they show up at 3AM. The ER is almost guaranteed to be empty. At least in the waiting room. We usually have a full house of overnight patients that I'm watching all night. From my perspective I'm just annoyed. I've been on all day, I'm exhausted, and in no medical logic is it appropriate to see an arm pain that someone's had for 4 months, unchanged, at that hour in the ER. It's not appropriate to be seen in the ER period. Especially not one that's been cleared by their family doctor and medically maximized in terms of management.
For those patients: please stay at home. I really won't be able to do anymore than what your family doctor has done. No I cannot send a specialist referral at 2AM in the morning. I can barely send them at all and you won't get in any faster than if I sent it versus your family doctor. Do yourself a favour and don't get out of bed at 1AM and drive in the moose infested dark roads. Stay home and see your family doc.
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