Catching Up

dar-today-61

I’ve notice among my fellow residency bloggers, that there tends to be significant posting drop off sometime during the second year, and I’ve really tried to not let that happen, but indeed it has.  Maybe it’s that not every single thing is all shiny and new anymore, maybe it’s that I like to think about things other than work when not at work, maybe it’s this or that, who knows.

Regardless, time has been chugging along. Hard to believe that I’m more than half way done with residency at this point.  This year up to this point, has been pretty great, I have to admit.  I feel that I can walk into most any room and have a pretty good idea of what to do. I don’t claim to know it all, by any stretch, in fact, I have a pretty good idea of how high the mountain of knowledge is, still looming above me. But, I feel like it this point, I know how to find the information that I don’t know, if that makes sense.  And this has been something I’ve been actively working on, trying to find answers to new problems, problems I may have never have had to consider before, without just asking my attending.   I do this intentionally, knowing that when this is all said and done, I’ll probably end up taking a single coverage job is some small ED somewhere, somewhere that might not have a lot of backup readily available.

I’ve seen the way I approach patients change as well, over the past 1.5 years, and over this 2nd year especially. I no longer get frustrated by drug seekers, sickle cellers, gastroparesis and what not.  I’ve realized that getting mad, playing bad cop with them, doesn’t actually do anything to fix their problems or relieve their burden on you. Given the wide variety of places they have us work as resident, I’ve seen how many different institutions and doctors have dealt with these types of patients, and are using these as models to develop a strategy that I feel good about personally, while striking a balance between treating the patient and feeding an addiction. “Nasty” patients, still do get under my skin, they still make me mad and frustrated,  but I think that’s a good thing quiet frankly. I’d be more worried if these type of people didn’t upset me from time to time.

And yes, I still loathe nosebleeders. I don’t think that’s ever going to change.

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on February 17, 2013, in Emergency Medicine. Bookmark the permalink. 3 Comments.

  1. Glad you are back!!!! Keep your chin up:)

  2. How did you get over the drug seeker frustration? As a medical student I think I would love all aspects of EM, except for people like that.

    • Mostly by not fighting every battle with every seeking patient. First time I see them, I’ll give them what they “need”. But tell them that if they come back, they better bring something with them that shows they have followed up, gotten some sort of care, something other than just coming to he ED for their pain meds. I document this discussion in the chart, and make sure they have very clear instructions on how to get follow up care. If they come back a week later, with nothing that says they are doing their part, then I’m far less inclined to give them additional narcotics. But if they make some sort of effort, are holding up their end, then I’m much more willing to play ball, and work with the patient, and their care team, to give them what they need to feel better.

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