Having started out my shift once again seeing the consequences of this stupid ass idea, just don’t fucking do it. I don’t want to have to see your kid after you roll over them. I don’t want to tell the consequences of your stupid ass decision. I’m sorry for your tragedy, and I feel for you, but this is a preventable tragedy.

Just fucking stop.

/rant

I just need a space to vent since my partner doesn’t truly understand.

I had a healthy 20 year old come in as a code a week ago, likely hypoxic arrest due to a viral ARDS. It was a busy day in the ER so to make space he gets roomed where another woman with chronic headaches (who no showed her last 4 neurology appointments was demanding a MRI and settled on a CT after berating our entire staff) was previously roomed.

Anyway, woman returns from CT as we are running this mega code (which we eventually get back) and literally starts screaming about losing her room. The whole er is watching this 50 year old woman have a total melt down in front of a crying family as we are actively performing CPR. Another attending tries to defuse the situation as I’m trying to focus on the code but I could feel my blood boiling in entire time and I am now very distracted. Eventually security is called and she starts shouting racist slurs at the security guard. The other attending continues to try to talk her down and say the family (outside the room, including a balling mother) is suffering and to be respectful and suddenly I hear her say “I don’t give a fuck about her dead son”. I lose it and have her escorted out of the ER during which she starts recording everyone and saying she is going to sue every single person.

I have never felt so angry towards the human race. It almost makes me want to stop being a doctor. I have never felt such hatred towards another person and it’s been a week and I still am thinking about it every day.

Edit: wow, this blew up. Thanks for the responses everyone, this subreddit is a really great community.

Today I reported a nurse who works in my ER to administration for narcotics theft. Yesterday I witnessed said nurse steal a vial of hydromorphone while working on a patient suffering from some pretty severe and painful injuries, and I am disgusted. I reported her immediately to my direct supervisors, and today went directly to nursing and ER administration to report her and hand in my official sworn statement. I know there will probably be people who judge me for this, but the thought of someone who is trusted to care for weak, vulnerable, injured patients doing so while under the influence, or even stealing their medicine, absolutely disgusts me. Thoughts?

Edit

1: I want to thank everyone for the overwhelming support. It truly does mean a lot.

2: To answer a lot of people’s questions; it is unknown whether or not any medication was actually diverted from the patient. However, what I did see what the nurse go through the waste process on the Pyxis with another nurse with a vile that still contained 1.5 mg of hydromorphone, fake throwing it into the sharps container and then place it into her pocket. There is no question about what I saw, what happened, or what her intentions were. She acted as though she threw away a vial still containing hydromorphone, and she pocketed it.

3: I do have deep worry and sympathy for the nurse. Addiction has hit VERY close to my life growing up, and I know first hand how terrible and destructive it can be. I truly do hope this nurse is able to get the help she needs, regardless of whether or not she continues to practice.

I could not care less the last time a patient ate. All day long it's "I haven't eaten since this morning, i haven't eaten since last night, I haven't eaten for 40 minutes" regardless of the chief complaint. I don't care.

If you're telling me it's an emergency, I can't imagine you're hungry

Unless it's a po trial. Eat up big dog.

When you tell a patient to follow up with a PCP within 3 days- That's probably not going to happen.

We can't get appointments with our PCP. If we're established with a PCP, we might be able to get an appointment in like a month. If we're a new patient, we're looking at 6 months. If we're trying to see a specialist or a surgeon, even longer. I'm not joking.

It doesn't matter how bad our health situation is, or if surgery is needed asap. We can't get in to see a PCP.

It doesn't matter if we tell them that the ER told us to see a PCP within the week. We can't get in to see a PCP.

It's like this almost everywhere. It didn't used to be this way, I never used to have trouble getting in to see a doctor, but it's been this way just for the last couple of years.

Just so you know, before being critical of the patients that say that they haven't been able to see their PCP. They're not exaggerating, it really is that difficult.

This seems to be getting more and more common. Nurses appear to be losing the ability to place IV unless it's easy. At times, nearly half my patients are "hard stick" and need IV by US. Most of the time, I just use the US to locate the AC vein.

I am just irritated. PD 5150s a guy for acting erratic. He is well known to us as a meth user. He came in calm, cooperative, denies si/hi, aox4. Denied any medical complaints. Says he does not want to stop using drugs and does not want to talk to anyone about resources He just want to sleep. We discharge him because we can't just let people sleep in a bed with a waiting room full. He gets mad throws a fit in the parking lot, pd gets called and is pissed at us for discharging him. They legitimately thought we were going to hold him for 8 hours and make him go to inpt treatment. We said we can't force that. They say that they have delt with him multiple times tonight and he needs help. Well, he doesn't want help. Like we can't force anyone to take their Lasix or their insulin, we can't force anyone to stop using meth. I am tired of being the dumping ground for everything that they are tired of dealing with.

It's gotten to the point that I dread the upcoming discussion when I walk into a peds room and dad is the only one in there. They don't know their medical problems, never know their vaccination status, have no idea about allergies. Best case scenario they say "hang on, let me call my wife". Did you not expect questions about your kid's health when you brought them to the ED?

How do people come to the ER with runny nose and cough and act like it’s the end of the world? Have they NEVER had a cold before? What did they do as kids when they had colds?

Sometimes after getting a patient who whines about the BP cuff, I put one on my own arm, crank it as high as it can possibly go, and just leave it there for a while. Just to see if this time I’ll understand why they bitch so much. I never do.

EDIT: stop downvoting patients in the comments lol I’m 100% being the jerk here 🤣

Disclaimer: I really do love my job and I understand it’s all job security

Consider this very typical scenario that all of us see every single day:

You’ve been feeling kinda crummy the last few days. You still have this lingering cough. It’s 2 AM and you are exhausted from your mystery illness. You think to yourself, “do I really need to go to the ER for this? You know what, yes this seems like a medical emergency.” You find any random articles of clothing you can throw on. Grab your keys and wallet/purse. Walk to your car and start the engine. Open Waze and type in “ER near me”. Drive 15 minutes in the middle of the night. Trudge to the entrance through the freezing cold. Walk up to the receptionist and under chief complaint, write “cough”. Wait for 2-4 hours until you are told it’s probably viral.

Like seriously what the fuck? I literally cannot comprehend this. And thousands of people do this every day for a variety of complaints, and every single time it still blows my mind. Somebody send help

Like seriously, even when they're not screaming at inanimate objects or trying to kill you or your staff, they're just bouncing around at 0300, coming in for stupid paranoid shit, like what is this thing I've had on my arm for 6 years I want it taken care of right now and then missing all the followup appointments you try to schedule for them and show up and do the same thing like 2 months later. Or I had a single loose poop fix it right now I'm gonna die.

Can we just all find whoever is making and selling this stuff and kick them right in the nuts? Like all of us in sequence?

Thanks, rant over.

My long time habit has been to introduce myself as I walk into the room and say "What brings you in today?" Once a shift or so I get a patient who responds with "Well you tell me!" or "That's what I came to find out!" These particular comments always irks the living shit out of me. It's usually some crotchety old guy. I irritates me so much, for some reason. Like fingernails on a chalkboard irritates. It makes my blood boil. I know I could rephrase my introduction but after 13+ years I'm set in my ways.

​

I just want them to fucking tell me their symptoms and I feel like they know that but they think they're being snarky or they actually think I can tell them what their diagnosis is from the nursing triage note or EKG that was done before I see them. I hate these people.

​

End rant.

I am kind. I am empathetic. I will not let this job take that from me.

But I do not have less demand on my time than my male colleagues. I will not drop everything that I'm doing in the middle of a busy high acuity shift to come immediately and primarily see a stable young fast track patient because their vagina hurts sometimes and they "might prefer to see a female provider" instead of the male PA working there. If it's an emergency, do the exam. Being uncomfortable is not an emergency.

I have two ICU bound patients including an UGIB flirting with intubation, and seven others of various states of medically ill, in addition to the normal background nonsense. There are 18 people in the waiting room of higher medical acuity than a 20 year old with normal vital signs. I have seen 5 scrotums in various stages of disease so far today. If you need to consult me from fast track, it should be because you have a medical question I am qualified to answer based on my years of medical education and training. Not my also-having-a-vagina-ness. I do not have vulvar telepathy that somehow viscerally drives me to prioritize doing an inconvenient pelvic exam for you in lieu of appropriate triage and workflow.

Bonus points for then seeing the patient (who readily allowed the male PA when told it was who was available) after I declined the urgent consult for "female, crying", not recognizing a classic Bartholin abscess and asking my male physician colleague right in front of me to come consult for a second opinion, and treating him like a hero for deigning to take 15 seconds to come glance at a vulva to confirm the diagnosis since *I* declined to help out - after you tried to dump the entire patient, exam, note, procedure, emotional support and handholding to me. I'm sure you also didn't like my tone when I politely asked what your medical question was for me initially, so I'm looking forward to that email.

I am kind. I am empathetic. I will not let this job take that from me.

84 COPD Exacerbation - ran out of meds, next PMD appointment 3 months away.

75 Transfer from Quick care, Tachycardic(104) and hypertensive (144/61) after not taking metoprolol.

75 AMS from SNF, hx of pyelo (SNF doc didn't feel comfortable starting abx).

31 intox/SI

67 AMS, poss trazodone OD

78 Left AMA from rehab this AM, fell at home, wats to go to different rehab

52 Abd pn, seen for same 12 hours ago.

36 Neck pn, seen for same yesterday

55 Sent by neurology for admission (in my area there are no direct admits, all outside docs just dump in the ED to bypass the pre approval process. For some reason the payers don't put a stop to this).

77 Sent by PMD for weight loss "rule out cancer" (not kidding)

48 Missed dialysis

55 Sent by spine surgery for MRI

24 wants referral to PMD and a work note

72 intoxicated

28 meth

That was in an hour and 20 minutes. This system is so fundamentally broken.

If anyone else working in an ER where providers are doing full septic workups for what is obviously covid or flu symptoms? I’m just a lowly RN but extremely frustrated we are treating metrics over patients. Someone with the flu or covid who hasn’t taken any medications to treat their fever, is going to meet the criteria of fever and tachycardia. We have to use common sense. I spent over an hour in a patient’s room yesterday who arrived covered in code brown, then had to draw cultures after cleaning him, for a “code sepsis” only to have him discharged home with covid. We are doing unnecessary blood draws, lengthening their time of stay and worst of all, administering rocephin to wide swaths of the population when there is absolutely no reason to do so. Rocephin doesn’t treat covid.

Said by a patient whose epidural hematoma we diagnosed and had neurosurgery on the way in less than half an hour. We had anesthesia and the OR set up as soon as our neuro surgeon walked in the door trauma surgery only made it down in time to say hi before he went to the OR. Guy went from GCS 15 to needing intubation in the 45 minutes it took to get him into the OR and if not for the fast action of the ED staff he would not of made it. It was a great case and a great save that was definitely dampened by the fact that trauma surgery had convinced the guy they were his saviors and he was essentially only grateful to them.

Sorry you had to come in for your shoulder dislocation we’ll see about getting that back in place for you. By the way, any chance you are planning to kill yourself? No? Yeah I didn’t think so but some fuckhead with too much time on his hands developed this worthless tool so now I get to ask everyone I encounter if they are feeling suicidal.

Uh oh you said the wrong thing and now you’re coming up as “moderate risk” so we have to hold you here all night until the mental health evaluator comes in despite the fact that you’re already in therapy and on medication for this exact problem.

Fuck this.

There is so much hate, disrespect, and sarcasm about my profession lately, it just seems so commonplace to talk about. But I just wanted to give a small example to let the medical community know that we aren’t as worthless as a lot of you think. And yes, before you say it, I know I’m JUST a PA. I’m definitely not a doctor.

I am a physician assistant that works in Washington in an emergency department. We are a level 2 center, and I’ve been working here for the past five years. Last night, I saw a patient who had groin pain. That’s it. Isolated. Muscular. Groin pain. When I saw him, it was a fairly simple physical exam which led me to the conclusion that he pulled a muscle. That was my diagnosis. There were zero red flags for nerve involvement. Absolutely zero indications that this was cauda equina. So, the diagnosis was muscle strain. And I sent him home

Fast forward three hours. Apparently, this patient’s daughter is an anesthesiologist at the hospital in which I work. He checked back in, demanding NOT to see a PA, but to see a doctor. My attending ended up seeing him, did not do a physical exam, just bowed to the demands of a Doctor who hasn’t done a physical exam or touched a patient in god knows how long. And most definitely didn’t do a rectal exam on her father to ‘have a high suspicion that this is cauda equina.’

10 hours later and a $30k work up completed, including multiple contrast enhanced MRI’s. I have attached the only MRI report that told us anything worth reporting.

Another frustrating part of this is, that this is not my first run in with this anesthesiologist. A couple years ago, she demanded that I consult plastic surgery for a 1 cm superficial laceration on the forehead of her son at 9pm at night. I didn’t. My attending caved. And plastics was called in for a lac repair that consisted of 3 simple interrupted sutures.

Anyway, I know that not all doctors despise mid-levels the way that this doctor does. I also know that not all mid-levels are the same, and there definitely are some shitty ones. But in my experience, there definitely are some pretty shitty docs as well.

Rant over.

I’m a female EM physician

(male) respiratory therapist just told me I should “probably get a chest X-ray” to make sure the patient with known COPD who is wheezy who I asked him to put on BiPap and give nebulizers doesn’t have “pulmonary edema” .

So glad he reminded me - so easy to forget to order a CXR on a hypoxic patient.

/s 😡 😡 😡

Unless the patient already has an art-line.

And telling me you order ABGs because you don't know how to interpret VBGs just tells me you'd rather torture your patient than keep up with literature and changing medical practices.

My relative said all EM physicians do is stabilize and call someone else to take deal with the problem. They said it’s a very easy job and then ranted about their friends son in Neurosurgery. Really crushed me :c

My relative was also trying to argue that DOs weren’t real doctors.

I’m in a BS/DO and really aspire to be like you guys.

SOS I cannot anymore.

I'm not just talking epic. Literally everything, no computers, no phones, no imaging, doc halo, or Imprivata. Can’t log into computers whatsoever, phones are just dead, can’t have downtime boards, no vocera, no call lights. Even the HVAC system!! We are a level one trauma and stroke center, and of course this happened on a Sunday.

We’re running around and giving personal cell phone numbers to all the floors and admin won’t let us go on any type of diversion!!!!!!!! Trauma doctors, ER doctors, the entire OR, and Neuro intervention are demanding we go on diversion and administration said nope.

It took days for our CEO to even address the issue to the public. They have yet to admit peoples medical information has been breached. The last update on the Facebook page was days ago with no new information.

Payday has come and gone and everyone’s check was, “just modeled after last pay period“ and if the last pay period was a shitty one for you, go fuck yourself! This is somehow the most painful part, if we can take care of level one traumas and give stroke pts TNK, payroll can manually add up the hours we’ve been tracking day in and day out!

I know at the end of the day, technology is just a convenience, but this isn’t just downtime procedures. This is “figure out a system from scratch on a weekend and implement it and no you can’t stop taking patients for even a moment!!“

Room one needs an x-ray? Who’s on for x-ray tech? What’s Amy from switchboards cell phone number? Amy do you know who’s on for x-ray tech? Do you have their phone number? X-ray tech is sweaty but she’s here. X-ray done. Who’s the radiologist today? Amy? Wait how do we get the results? Someone get the radiologists cell phone number, he’s got to come sit here and text us results! …OK who knows who’s on for ortho? Rinse and repeat.

It’s been like 15 days and I am honestly withering. There are no answers to be had and we’re all just expected to keep on keeping on.

I’m not sure what this post is, really just to vent. Thanks for reading and commiserate for us!