Fighting with Emergency Medicine colleagues is stupid. Learn how EM doctors think and avoid the petty infighting with tips from Dr Scott Weingart, MD FCCM FUCEM DipHTFU, of the EmCrit podcast and Clinical Associate Professor and Chief, Division of Emergency Critical Care at Stony Brook Hospital, NY. We discuss heuristics, how to avoid anchoring bias, the devil of the gaps, why the elderly always get admitted, how to build relationships with the ED, and Scott’s pet peeves.
Correspondent, Dr Shreya Paresh Trivedi joins Matt, Paul, and Stuart!
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Goal: Listeners will conceptualize how emergency medicine physicians think about admissions, avoid conflict, and better collaborate between specialties.
After listening to this episode listeners will…
Disclosures: Scott reports no relevant financial disclosures.
01:10 Picks of the week
05:28 Guest bio
07:00 Getting to know our guest
12:00 Do EM and IM docs hate each other?
14:04 Where conflicts arise.
17:05 System 1 versus system 2 thinking
20:19 When the patient doesn’t match the story
23:55 Why does every 85 year old get admitted?
26:05 Transitions of care: form ED to medical ward
32:08 Is face-to-face signoff only needed for sick patients?
36:28 The devil in the gaps
41:03 Scott’s beer recommendation
42:17 BP cutoff for discharge home
43:44 Scott’s biggest pet peeve with primary care
45:04 How to make friends and collaborate with your EM colleagues
47:14 Take home points
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Scott mentioned a 2% significant illness miss rate in emergency medicine as it related to over testing... Is there a reference or study supporting this percentage?
Great listen, thanks for this podcast!
i am an ER doc. have been since 1986. first: extraordinary work, team. i shall try to follow future pods, and catch up on old. second: i think so many good points were brought up here; too often there seems to be less than a team spirit amongst the EM and IM folk, sometimes , as scott said, a fault of the team players. but sometimes, simply a different way of seeing the same patient. communication at some point is probably a very good thing, for lots of reasons. overall, i feel this pod was not only entertaining, but also clarifying. thanks, team. tom fiero
"The Devil of the Gaps: Post-test probability (PTP) of serious disease after a workup in ED: Between 10-100%, everyone happy to admit patient. Between 2-10%, IM says WTF!, but DC too risky. Between 0-2%, DC home. Low risk, but lawyers may still sue if something bad happens.Older, sicker, frail patients live in the WTF gap (PTP 2-10%). EM trained to admit these patients. Don’t fight it!" TThank youuu!
Great episode guys. I'm a huge fan of the podcast. I'm a dual trained EM/FM doc and acutely aware of the pain on both sides of the admission process. The point I try to hammer home to the residents and students I teach is that admission to the hospital is not a benign thing. From the risk of nosocomial infections to medical errors, there are risks to being an inpatient...especially for the frail elderly. I make every student/resident answer the question "What will this patient get out of an inpatient evaluation that they won't get as an outpatient?" Usually, the answer is pretty obvious, but not always. And when it's not, we have a serious discussion about the feasibility of safely sending the patient home. It is my hope that the new generation of upcoming ED docs will do a better job of understanding the risk/benefit ratio of admission vs discharge and maybe together the ED and Inpatient team can do a better job for our patients. Thanks again for the great podcast. I never miss an episode. You guys rock. AW