ER/IM Residents Suck

In my years of practice I've never met dumber residents. They suck at ER and they suck at IM. Please pick one to suck at!

In the ER they order chronic workups and forget to treat the acute issues. When they are upstairs in the ICU or floors, they treat evrything as if it is an acute issue. They have cute lil recipes for everything. Hypertensive? Esmolol drip.

Make up your minds! Suck at one or the other.

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Central Line? Nah!

Why is it that patients that need a central line never get one. But the ones that don't need one always get it?

Can someone from the ER explain this.

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You feel big because you are!

I'm tired of big people wondering why they feel so huge. It's because you are so huge! When you weigh 450 pounds, that bizarre unexplained feeling of being big.... is actually reality. You really are big!

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Yes, your knees hurt because you are fat

I remember many years ago when a patient who weighed 380 pounds, walked and asked me "My knees really hurt, do you think it's my weight?"

"Yes. I do"

"That's what I've been thinking, I know it's my weight."

"Well, even if you lose a few pounds, you will feel better. I highly recommend it."

We need to always talk to patients about weight loss and smoking cessation. EVERY VISIT! THEY NEED IT! AND IT WORKS!!!!!!!!!!!!!!!

Of course, we can always replace knees. But come on people, why get to this stage? Just lose some weight!

"I'm the ER Attending"

Nothing irks me more than when the ER attending gets on the phone and says, with an air of authority and condescension, "I'm the ER attending."

Well, if you are the ER attending shouldn't you know better?

A few years ago the ER called me telling me that my patient is having a STEMI (big heart attack) and that they are going to call the interventionalist on call and activate the cath lab. Fine.

The resident is talking to me and telling me the patient's story, and it really sounded more like a pneumonia case than a heart attack case. I asked the resident to tell me about the EKG and they began describing it, "Some ST elevations in the inferior leads..."

Then the ER attending got on the phone and quickly said, "The machine is reading it as an Acute MI."

"Wait, who's this?"

"This is the ER attending. And the machine is reading it as an acute MI."

"Well, I was talking to your resident, and it sounds more like pneumonia."

"I am the ER attending and it's reading it as an acute MI."

"Ok, sir. Thanks"

If you are the ER attending you should have something more intelligent to say than restating what a dumb EKG machine thinks it is. Just because the machine thinks it's an AMI, doesn't mean you have to keep saying that. Machines are wrong nearly all the time. The sensitivity is not that high. Especially in acute MI.

Stop telling people you are an attending, but that you can't read an EKG. It's not very flattering. If you are an attending you should be able to use your own brain. Don't be a dumb ass!

Otherwise, why do we have doctors? Nurses and EKG techs (heck, even janitors) can read back what the machine says. Why do we need doctors? Just fire all the doctors and let the janitors run the show.

As the federal government tightens and the economics of medicine tighten, we can't afford stupidity. We have to be smarter than the machines and morons that they are hiring to replace us and save costs. If a physician actually knew how to read an EKG or chest xray, maybe you could save the nearly $50,000 it costs to activate the cath lab and have an interventionalist come in and perform an unnecessary, and potentially harmful procedure, on an unsuspecting patient who just needs some antibiotics.

"I'm the Angry Internist!"