Ask the ER Doctor

I’ve been considering starting this thread for some time now. I figured now was as good a time as any.

I am a physician who is board certified in Emergency Medicine. I practice with a large group of physicians who cover 4 emergency departments.

This thread is not for medical advice about a specific problem you may or ‘a friend’ may be having, but I’ll try my best to answer any other questions you may have about my field and my work environment.

Do any of the TV medical shows even remotely come close to what happens in a real ER?

How many times in your career have you uttered the words “GSW to the chest”?

What is the most interesting emergency case you’ve had come through the ER?

Have you ever had to treat a friend or family member in the ER?

When do you find time to dive?


Someone in the medical field once told me that of all the TV shows, Scrubs was the most accurate when it came to portraying life in a hospital. Do you agree?

What is the weirdest thing you’ve ever encountered? Have you ever had to call the cops to report an abusive parent, and if so, how do you keep from punching said abusive parent in the head?

And how do you deal with telling someone that despite your best efforts, their loved one has died?

You hear about the incredibly long shifts some recent grads have to pull in the ER (isn’t that who and where?), long to the point of potentially bordering on sleep deprivation and possibly causing someone to not be able to think as clearly as needed in such a critical environment. Have you ever noticed this to be the case? If so, is the problem widespread?

Also, there’s some concern now that the efficency of many ERs is being compromised by the excess of non-emergengy treatment requests by those without insurance or permanent legal status. Again, any observations of real emergency care being delayed because of this?

Thanks, USCDiver, for starting this!

One time, during college, I had a temp job for a data company doing inventory in a local hospital. My work colleague and I were in the ER one day counting tables, chairs, IV racks, etc. Then they brought in this little baby boy. They put him in what looked like a baby-shaped tub and strapped him in, face up. We were told they were doing a circumcision. We were like, in the ER?

What was up with that?

Surprisingly, ER was fairly accurate as far as the medical treatments of the patients (at least early on, I stopped watching around 2002). The main difference is that we don’t see that many critically ill patients or dramatic injuries. A majority of our day is spent dealing with day-to-day routine sick people.


I get asked that first question a LOT. It’s hard to say what would be the most interesting. For me traumas are very rarely interesting. There has been so much research and standardization of the ER treatment of trauma. Everything is based on accepted algorithms such that there is very little independent thought needed. Bear in mind also that my job is to stabilize the patient until a trauma surgeon, neurosurgeon, orthopedist, etc can definitively fix whatever is injured. For me, the more interesting patients are the ones with unusual or severe medical problems, but I see so many patients it is hard to say who has been the most interesting. Also the ones that might be interesting to me medically might seem boring to a lay person.

I have on occasion treated a friend (or friend’s family member). Usually for something minor, like a laceration. I’ve never treated one of my own family members.

Why are ER co-pays so high? My regular physician’s co-pay is $15, yet if I go to the ER, it’s $150.

Haha, thankfully I don’t! when I was a diver, I was of the springboard variety as opposed to the SCUBA kind. Once I finished college, that part of my life was over.

Actually, yes with regards to residency training. Residency is a completely different animal than private practice. For instance, on Scubs, the characters were Internal Medicine or Surgery residents. They spend a majority of their time with patients in the hospital setting. When they graduate, they often transition into a clinic setting and may never go back to the hospital again.

Loa Loa

Occasionally. I’m usually pretty good at getting them to calm down. I don’t have to punch them because I have better weapons at my disposal, such as haloperidol and lorazepam.

This is, unfortunately, something I have to do one a routine basis. Probably several times a month. I don’t mince words or use euphemisms. I come right out and say, “your family member has died”. After that I try to convey what we did and what we think happened, but I suspect the family doesn’t really hear much else I say.

The long hours typically are limited to residency training and involve overnight call. There have been recent regulations imposed by the USGME (US Graduate Medical Education) who oversee all accredited residency programs. Residents are not allowed to work more than 30 hours straight in the hospital (think, arriving at 6am and leaving the following day at noon). But that also includes overnight call where you may not be directly involved in patient care for several hours at a time. In the ER things are different. ER residents are not allowed to work more than 12hours in a shift and must have one day off in seven. Across all residencies, no one is allowed to work more than 80hours a week averaged over a 4 week period. This has improved a lot of the problems that were occurring, especially with surgeons who might be on call all night and have a full day in the OR the following day. It has never been much of a problem in the ER since we are essentially doing shift work. We come in, punch the clock, see patients for 8, 10 or 12 hours and go home.

Overcrowding is a huge issue in ERs nationwide. Uninsured and indigent patients unfortunately have no where to go and federal laws (EMTALA) require us to evaluate every one who walks in the door. The system is constantly stretched to a breaking point on a daily basis.

HA! I’m familiar with the contraption you are describing from my rotations through Labor and Delivery and newborn nursery, but I have no idea why that thing would be in the ER. Is it possible the nursery and the ER were sharing storage space?

That is a question best asked to your insurer, but I have a few guesses. One, to discourage you from using the ER except in true emergencies when it shouldn’t matter what the cost is. The insurance company wants you to go to your primary doctor because it’s cheaper for them. We charge a lot more for your visit than the primary MD. The reason we change so much more is because 15-30% of the patients we see will not pay any part of their bill, yet we are required by law to evaluate and treat them. Our malpractice insurance is also much higher than a primary MD who works exclusively in an office setting. We are held to a higher standard with regards to missed diagnosis and we are much more likely to be sued because we do not have an established relationship with the patients.

What are the demographics of the departments that you cover? Urban, rural, densely populated, etc?

Do you get a lot of “frequent fliers”?

I hear a lot about drug-seekers in ERs. What’s the most unusual reason you’ve had (if any) for someone seeking pain medication? A doctor friend of mine once had a patient request Lortab because her “boyfriend’s business was too large and it hurt down there.” :dubious:

Believe it or not, I know what this is. How did you treat it? Did the patient keep his sight?

Do expand this answer a bit, I’m curious what the contrast might be between “interesting to a lay person” versus “professionally interesting”.

One of my best friends is a Captain in the NYC EMS, and his wife is and/or has been the head nurse at a number of NYC area ERs. I have learned never to ask them “anything interesting lately?” because they will go on until asked to stop!

Their definition of “interesting” usually centers around the weird or the dramatic. Like the big, heavy guy who came in with his ass – can I say “ass” on the Internet? Yes? Good – with a chair nailed to his ass through a pillow early one New Year’s Day. Someone broke a wooden chair at his New Year’s party, separating the seat from the frame and leaving long pointy nails exposed. So the (ir)responsible party put a pillow on top of the nails. This poor fellow pulled the chair up and sat on it, full force, driving the nails through the thin pillow deeply into his buttocks.

On some TV shows, the nurses are always injecting that stuff into crazy people’s necks. Would/Why would a real medical professional do that? Because the patient’s arms are flying around, or because the drug gets to the brain faster from the neck?

How often do you get sick from working with people with communicable diseases? How much of your time is spent on paperwork?

One urban, one community, one rural and one ‘free standing’ ER. We get a lot of variety here. We see a fair number of frequent fliers. Thankfully we cover all the ERs in this town, and we use the same computer system throughout, so we usually know when they’re shopping around. The excuses I usually hear for the drug-seekers is something along the lines of ‘I lost the prescription’, ‘my doctor is out of town and won’t be back for a month’, ‘my dog flushed my pills down the toilet’, etc.

This is one of the downsides to ER work. I have no idea what happened to the guy. The Infectious disease doctor came down to look at him. With filarial worms like that, you have to be careful with treating too aggressively, because if they have a large number of worms in their body, they can go into anaphylaxis if they all die at the same time. This guy ended up getting a titer sent to CDC in Atlanta, so I don’t know what they ended up doing for him the next week.

ER was set at the major Chicago-area trauma center (Cook County Hospital, now Stroger Hospital) so I wouldn’t be terribly surprised if they really did have a whole lot of dramatic injuries there. Probably no ER docs getting injured by their med-flight helicopter though. :smiley:

Right, the rectal foreign bodies are always a crowd pleaser. But professionally, I’m more interested in the guy with the heart attack who goes into cardiac arrest, gets shocked and then placed on our induced hypothermia protocol. Or the young woman who came in with mental status changes the family thought was due to a narcotic overdose, but who ended up having a subarachnoid hemorrhage, and then seized, got put on a breathing machine and got an emergent hole in her head (done by a neurosurgeon, not me!)

Nah, that’s a really bad idea. You’d be just as likely to inject the medicine into a muscle or trachea or esophagus. Legs and buttocks are best for intramuscular injections, occasionally a shoulder will do.

I usually get a mild cold for a few days every year. I definitely get my flu shot(s) every year, and I think that being around the stuff on such a constant basis gives me some sort of low level exposure that allows me to build up some immunity without getting too sick.

All of our charting and orders are computerized, but I’d estimate I spend about 30-50% of my day charting or reviewing labs, xrays etc. The balance of the time is spent talking to patients, consultants and my PAs.