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» Can’t we all just get along?

Can’t we all just get along?

Today I was lucky enough to have have a short daytime shift that was steady but not overly busy. It was actually quite perfect. Only one test had been inexplicably delayed by hours, and the patients were pleasant with medical complaints that made sense. I only had one patient with a small case of verbal diarrhea, and he was a sweet older man who was just trying to be helpful. The good mood I started my shift with was actually lasting into the afternoon. Then I had a wet blanket thrown on me–from a fellow doctor no less.

His tone was disrespectful, and the unspoken punctuation to his statements was, “stupid ER doc”. True I had made contact with the gastroenterologist before all studies were back, but the fact was I did not need his help then, but I knew the patient would in a day or two. Furthermore, it typically takes a couple of hours to reach some of these guys so I figured we better start early. I wanted to make sure GI services would be available if the patient was admitted, but this doc just didn’t get it.

This year hundreds of GI Bleeders had been transferred because we lack 24/7 GI coverage. This is the case in many California hospitals. Specialists, such as GI, maintain hospital staff privileges where they perform lucrative elective procedures for insured patients, but avoid on-call obligations. If a hospital tries to pressure them into taking call, many take their business elsewhere which costs the hospital money in lost revenue. Most hospitals give in considering sparse GI coverage is better than no GI coverage at all.

It’s hard to blame the GI docs for this maneuvering. If they do take call, EMTALA laws leave them vulnerable to transfers from any hospital lacking a GI doctor and seeking their services. They can get slammed with uninsured alcoholic patients bleeding into their guts from all over town while colleagues sleep peacefully in their beds after refusing to take GI call at these other hospitals. Some docs take “secret call” and will care for any patient in their affiliate hospital, but are not actually on-call, and therefore not obligated to help any other facility seeking GI services.

Of course family members and patients have no idea that this is all happening behind the scenes, and perhaps the GI doc I spoke with today thinks I am equally clueless. I wonder if he has any idea what we in the ED sometimes go through to provide proper services and not lead patients down a dead end street with a hospital admission going nowhere. He certainly must be unaware of the poison his bad attitude infuses into the entire hospital system. Immediately after my conversation with him, I felt my smile sag a bit. It’s hard to go the extra mile for patients when doctors like him constantly push back, and rarely take the time to understand why I would call him before the labs were all back. I can assure him it is not because I am a “stupid ER Doc”.

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