Sunday, January 2, 2011

Why Work In the ER?

A commenter posted this question on an ER Doctor's blog:

Question for ERP, and anyone else here who works in the ER. I’m not in a medical field. I’ve been reading this blog for a while now and wonder what it is about ER work that allows drs and nurses to keep doing it. From the blogs I read, it sounds like at least 80% of the people in the ER are abusing the system and a lot of them are drug seekers. What do the drs and nurses who stay in that type of work get out of it that makes it tolerable or enjoyable? Is it the life or death situations where you can really make a difference, or are there too few of those to outweigh the negatives? Is it the few patients who are reasonable and appreciative?

It's a really good question! Let me start trying to answer it by posing a negative question. What can wear away at the ER practitioner? What makes them want to up and quit?

The drunks and druggies definitely can cause a person to toss in the towel, especially if you keep seeing the same ones over and over. I think that is what got to at least one of my colleagues.

Bureaucratic bullshit getting in the way of patient care frustrates most ER people.

The stupidity factor can definitely be a drag. When you see someone who was just in the ER or at their doctor's office a few days ago for the same complaint, and they haven't filled their script or they've only taken it for a day or two, it can make you want to put your head on your keyboard.

Not having appropriate resources, or finding that others are making your life harder than it should be can take the joy out of ER work. Floors that obfuscate so they can delay taking an admission and on-call people (especially psych!) who never call and/or come in are examples.

Feeling unsafe is a big reason why some leave the ER. Psych patients and intoxicated patients can be violent. Some ERs leave their staffs out on an island, without enough physical reenforcements or authority to neutralize and/or remove physically threatening patients.
Some places leave their staff on a different kind of island. Expectations pile up and seldom is heard an encouraging word. It can be that feeling that if you ever make a mistake you will be left hanging out to dry, without anyone standing up for you. An atmosphere that punishes rather than teaches, evaluates and problem solves after things go awry for whatever reason is a difficult atmosphere to work in.

The space between patient autonomy and correct treatment can be frustrating. It can happen with any patient who is refusing treatment, but is most highlighted with psych patients. The most frustrating thing is trying to prevent someone who has expressed suicidal ideation but has not been legally put on a hold from leaving the ER, equipped only with non-touching means of physical restraint and verbal persuasion. You have no legal right to keep them from leaving, yet if they leave and hurt or kill themselves the family--and the lawyers--will be on your doorstep.

Wow, after making that list, who would want to work in emergency medicine?!

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