Home Commentary The hospitalist’s wingman

The hospitalist’s wingman

April 2013

Published in the April 2013 issue of Today’s Hospitalist

DEAR HOSPITALISTS: 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!

Specialty after specialty withdraws from the practice of medicine, and you, and all of us, are left holding the bag. We’re the college wingman, sitting at the table with the hot girl’s weird friend. The rest of medicine skimmed off as many paying customers as possible, and the rest of them were granted graciously to us.

In this together
We feel your pain. Heck, we administer your pain. But not because we really have any options. Every neighborhood clinic that has a slightly sick patient sends him to the ED. Each and every nurse’s aide 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 clinic that feels beyond their capacity or is approaching closing time tells the patient to go to the ED. Sometimes they call; sometimes they don’t. But “go to the ER” is one instruction they always follow.

Some of them are actually sick when they arrive at our door! The nerve! 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. When the workup is done and it becomes clear that discharge is no longer an option, we ring you brave lads and lassies.

Empty souls, tired eyes
We recognize the empty souls behind your tired eyes as you admit the 105-yearold dementia patient with, yep, weakness, your ninth 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 a little harder and become an opthalmologist.

But we know it hurts in other ways. It hurts when you have those days when you see the same complaint over and over. Eight chest pain workups. Six Xanax overdoses. Nine TIAs. 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 about 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 postop 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 him or you’ll be hauled off to Medicare prison and waterboarded by government functionaries. We have our tiffs. But the thing is, we’re BFFs. We’re soul mates. We’re brothers by another mother.

We heart you!
Medicine keeps getting harder. And fewer and fewer folks are doing it. America has no idea that the weight of it all is falling on the shoulders of the emergency physicians and hospitalists who lurk inside the trauma rooms and inpatient floors, the fast tracks and ICUs of their community and university hospitals. The pasty-pale, coffee-sucking, junk-food-eating Spartans of health care who will bear the full 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? We might need to form an organization, a common political advocacy group or, 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.

Reprinted with permission by Emergency Medicine News (2013; 35 [1]: 6). EMN’s iPad app is free to all physicians and health care practitioners at Em News.

Edwin Leap, MD, is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, S.C., a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of three books: “Working Knights,” “Cats Don’t Hike” and “The Practice Test,” and of his own blog.