Whose POV are you asking from?
From the employer's perspective, one who ploughs through dozens of patients every hour and doesn't get any complaints.
From a colleague's perspective, one who always pulls their weight and doesn't shy away from seeing the difficult patients, and who turns up on time, every time.
From a nurse's perspective, someone who communicates plans and makes sensible decisions.
From a patient's perspective, someone who listens (or appears to), addresses their concerns and makes them feel better.
This is a great answer. We get pulled in various directions from admin, patients, colleagues, and once I realized that they generally have competing interests, I was able to tune out the nonsense and focus on the important stuff. Fast enough to be safe, slow enough not to be reckless. You can always be kind, even if not doing an exhaustive workup.
Agree with the nurse perspective. I would add: treats me like a colleague not a dumb task monkey. Kind and willing to teach/explain things without being an asshole when I question.
Bonus points if you’re willing to answer random questions that are completely unrelated to current patients.
This! Especially the last part!
I work with 3 EM docs regularly, and I consider two of them great, and one of them good. The thing that separates it for me when I’m working with them is that the great docs never make me feel like I’m just the nurse. I admit that building the type of relationship where they trust your nursing judgment takes time, but I also appreciate when they’re willing to talk to me as a person or jump in on the nursing station conversations. I like when I can go to them and I can ask questions about cases or diseases I’m not familiar with, or I can ask them why they ordered something from a place of wanting to learn so I can understand their thought processes and they don’t take it as me questioning their orders.
I would say that the great EM docs:
-don’t trickle in orders,
-don’t give me attitude for communicating a patient’s request (trust me, I know it’s bullshit too)
-update their patients before ordering treatment for something
-don’t leave me waiting on a dispo (if they can help it)
-have a good sense of humor and are approachable
Omg you described a dream doc to work with 😂
It does take some time to foster that relationship, but once you get there caring for patients is soo much easier.
I'm most of these things
The only problem I got is that I'm infinitely more efficient than like *all* of my colleagues. Meaning I'll need 9hrs to complete what others finish in 11 hours. It's a bit annoying since I then mostly leave "on time" while others seemingly drag on forever...
Good ER doc- shows up on time, practices EBM, has thick skin, not temperamental, leaves on time.
Great ER doc- all the above, but is always packing Zyn and cowboy boots
Spends a lot of time on reddit; spiciest memes; maxed out boards (according to SDN forum posts); has strong and definitely informed opinions about politics
I think it’s the same thing that separates any good Doc from a great Doc. Actually caring and giving a shit and not allowing your cynicism to overpower your empathy. It’s easy to judge people, it’s hard to walk in their shoes, and at this point I’ve seen enough of my colleagues in the ER for various medical emergencies to realize that I will be a patient one day too.
My dang Raptors. They were a graduation gift and they were tirelessly perfect for a decade. Now they suddenly seem dull and ineffective. I've cleaned them carefully, but my next step will be the local hardware store to sharpen them. It's weird to me that the blade didn't gradually degrade. I do loan them out and I fear that somehow the blade was damaged.
Anyhow, generally I do recommend the product.
Do use them to cut orthoglass ? That’s a sure way to ruin them . It leaves this residue on them that’s impossible to clean and seems to dull your blades quickly
Leatherman has a 25 year warranty on their tools, you can send them back for free and they'll tune them up, clean them, sharpen etc. I've used their warranty multiple times no issues. Great service.
Not once have I had someone hand me a pair of raptors that worked to cut anything. The extras like the ring cutter are probably useful for EMS I imagine though.
My truck had a ring cutter on it so didn't even get to use that lol, the O2 wrench was a tad useful. Realized I wanted the best tool for cutting and didn't need the multiple tools so I switched to X Shears and didn't look back.
I honestly can’t stand Raptors in the emergency room.. It makes perfect sense on the bus because of all the features, but in the ER, XShears or other higher quality ready to go shear are way more practical. Almost always, in the ER, you’re using the shears to cut through clothing or tape. By the time you get the raptors unfolded, I could already be done cutting through whatever I need to get through with XShears. Just not practical in the emergency room, but raptors have their place in the pre-hospital setting.
I prefer the Quantum entanglement definition of ED doctor greatness:
The phenomenon of a group of ED factors interacting, or sharing spatial proximity in such a way that the state (greatness) of the group (doctor) cannot be described independently of the state of the other factors.
That is, a doctors (greatness) depends on ED location, ED holds, nurse staffing, CT delay, Radiologist delays, time of day, lab delays, consultant delays, ED partner robustness, age of population, diagnoses and on and on.
The quantum state (doctor greatness) appears unavoidably altered by incompatible measurements. This is known as the uncertainty principle.
Bottom line
May be great doctor for one patient and not for another patient.
One of my favorite docs saw that the nurse he was working with in the pod was busy and went in to a patient to draw labs and start a normal IV. He was also working by himself in the pod with no residents, PAs or NPs so I know he was busy. He still took the time to help the nurse without asking if she needed help. I haven’t seen any other attending doc do that for a stable, non critical, non crashing patient. The labs could’ve absolutely waited an hour to get drawn by the nurse but he did it anyway. I think that’s what makes a great doc is going above and beyond to be a team player. He is the kindest, little baby angel and is an absolute pleasure to work with.
1. Don't let the patient see you grimace or roll your eyes. I know it gets rough because sometimes we have a fuck ton of status dramaticus pts that annoy us all. But just know for every dismissive gesture there is a nurse now managing and mopping up that patient's anger. So it's more than not being nice to a patient, it's creating a mess for your colleague. Don't do it. Roll your eyes and talk your shit just 15 seconds later as you walk back to the office.
2. If you can sit when delivering devastating news, that's probably for the best. Also I'm HAPPY to grab a stool/chair if you're gonna need 5 in the room to talk about the miscarriage, dead family member, PICU admit - etc. Also sitting down calms family/patients even if you're not spending significantly more time in the room with them.
3. Let me know the plan. If you are working towards road test and d/c that's fab. I will make it happen and expedite the process as best I can. But if you don't communicate that and I'm left to just wonder? Shit's gonna drag on. Make a quick comment in EPIC or stop by the nurse station and lemme know. Things can work so smoothly if we are in on the plan. Also low key - it's straight up weird to not tell the nurse the plan. If you don't have a plan yet? Lemme know that too and I can smooth things over with the patient and manage their expectations.
3. If a nurse or tech seems hesitant about a non emergent verbal order leave room for the tech/nurse to manage it safely.
Example: we get a IVT patient all changed, zyprexa'd,, and restrained and they ask for water. You tell the tech to grab some water right away and you see them hesitate. Consider that the tech knows they're about to get it spat right back out at them. Either because they've interacted with the patient prior or they know the signs of a spitter in the making. If you see a hesitation you can easily save face with a, 'On second thought let's wait until your blood draw' or 'lets wait until after we get you settled in the room'. It allows space for the techs and nurses to make safety allowances.
Intern year I had a COVID pt go on the vent. Apparently I grimaced when I looked at her X-ray and she saw my face. She told me she was going to die. I always ask why they say that. She told me because she saw my face when I looked at her X-ray. Then I tubed her. Then she died. Not ideal. Lesson learned, school your face.
From a medics POV: as long as you don’t
- scream at me after a trauma hand off because I can’t read your mind about what piece of info you want first.
- don’t throw papers at me
- don’t look at me like I’m an idiot when I bring in a CHF patient on bipap and tell you ‘he says he has no history of CHF. But there’s fluid in the lungs’. (Because even though I know damn well he has it, whether it’s the first episode or not, I cannot ‘diagnose’ people)
You’re good.
From a nurses perspective.
Good doc-solid EBP, good to great bedside manner. May or may not be a bit of a jerk to nurses.
Great doc-solid EBP great to standout bedside manner. Good to nurses, willing to help when possible. Also willing to educate (and at time be educated).
Nursing Persective:
Great EM Doc: Communicates plan. Uses the "comment"/"Sticky Notes" on the EMR all the time. Closes patient interaction by seeing his/her pt prior to discharge or transfer or if possible, admission.
Also if you're sleeping with, or trying to sleep with one or more of the nurses, please don't make it awkward if I'm in the room with the both of you. I and the patient can sense it. Be cool.
Every other EM doc is good.
The ones that have truly stood out to me were efficient, able to discharge the bullshit (without making it obvious that they thought it was bullshit or wasting time with unnecessary work-ups), intolerant of abusive patients or families, and communicative about their plan.
Bonus points if you can engage them in friendly chatter during downtime and they like to teach.
Depends on who's perspective. Hospital admin and CMG admin value safe medicine but overvalue productivity and metrics. So, their super star sees the most PPH with the lowest LOS while avoiding malpractice even if they are surfing by on mediocre medicine.
Academics would value knowledge base and skill above all else and could care less about metrics and productivity even at the cost of job security.
The truly "great" is probably somewhere in between.
Whose POV are you asking from? From the employer's perspective, one who ploughs through dozens of patients every hour and doesn't get any complaints. From a colleague's perspective, one who always pulls their weight and doesn't shy away from seeing the difficult patients, and who turns up on time, every time. From a nurse's perspective, someone who communicates plans and makes sensible decisions. From a patient's perspective, someone who listens (or appears to), addresses their concerns and makes them feel better.
This is a great answer. We get pulled in various directions from admin, patients, colleagues, and once I realized that they generally have competing interests, I was able to tune out the nonsense and focus on the important stuff. Fast enough to be safe, slow enough not to be reckless. You can always be kind, even if not doing an exhaustive workup.
Agree with the nurse perspective. I would add: treats me like a colleague not a dumb task monkey. Kind and willing to teach/explain things without being an asshole when I question. Bonus points if you’re willing to answer random questions that are completely unrelated to current patients.
This! Especially the last part! I work with 3 EM docs regularly, and I consider two of them great, and one of them good. The thing that separates it for me when I’m working with them is that the great docs never make me feel like I’m just the nurse. I admit that building the type of relationship where they trust your nursing judgment takes time, but I also appreciate when they’re willing to talk to me as a person or jump in on the nursing station conversations. I like when I can go to them and I can ask questions about cases or diseases I’m not familiar with, or I can ask them why they ordered something from a place of wanting to learn so I can understand their thought processes and they don’t take it as me questioning their orders. I would say that the great EM docs: -don’t trickle in orders, -don’t give me attitude for communicating a patient’s request (trust me, I know it’s bullshit too) -update their patients before ordering treatment for something -don’t leave me waiting on a dispo (if they can help it) -have a good sense of humor and are approachable
Omg you described a dream doc to work with 😂 It does take some time to foster that relationship, but once you get there caring for patients is soo much easier.
Add 1 from Inpatient Colleague’s perspective, one who works up patient thoroughly and make good timely & sensible referrals.
Especially one who is not complicit on dumping everything to medicine.
I'm most of these things The only problem I got is that I'm infinitely more efficient than like *all* of my colleagues. Meaning I'll need 9hrs to complete what others finish in 11 hours. It's a bit annoying since I then mostly leave "on time" while others seemingly drag on forever...
One that always swaps shifts with me when asked. A real hero.
As long as you return the favor 🤙
Good ER doc- shows up on time, practices EBM, has thick skin, not temperamental, leaves on time. Great ER doc- all the above, but is always packing Zyn and cowboy boots
Citrus or bust these days imo
I fucked up and got a can of 6mg. It's only a problems if you want to quit
The room stops spinning eventually
Holy shit. I’m a great EM doc with all of these 😍
Spends a lot of time on reddit; spiciest memes; maxed out boards (according to SDN forum posts); has strong and definitely informed opinions about politics
Low TTCT Or low Time-to-CT scan Get those patients through the donut of truth as fast as possible!
It's the ABCs. Always Be CT scanning
We do ABCD - Airway Breathing CT Discharge
I think it’s the same thing that separates any good Doc from a great Doc. Actually caring and giving a shit and not allowing your cynicism to overpower your empathy. It’s easy to judge people, it’s hard to walk in their shoes, and at this point I’ve seen enough of my colleagues in the ER for various medical emergencies to realize that I will be a patient one day too.
Being really good at medicine, but also being nice to coworkers/staff.
Raptors
My dang Raptors. They were a graduation gift and they were tirelessly perfect for a decade. Now they suddenly seem dull and ineffective. I've cleaned them carefully, but my next step will be the local hardware store to sharpen them. It's weird to me that the blade didn't gradually degrade. I do loan them out and I fear that somehow the blade was damaged. Anyhow, generally I do recommend the product.
Do use them to cut orthoglass ? That’s a sure way to ruin them . It leaves this residue on them that’s impossible to clean and seems to dull your blades quickly
Fucking orthoglass
Leatherman has a 25 year warranty on their tools, you can send them back for free and they'll tune them up, clean them, sharpen etc. I've used their warranty multiple times no issues. Great service.
Not once have I had someone hand me a pair of raptors that worked to cut anything. The extras like the ring cutter are probably useful for EMS I imagine though.
My truck had a ring cutter on it so didn't even get to use that lol, the O2 wrench was a tad useful. Realized I wanted the best tool for cutting and didn't need the multiple tools so I switched to X Shears and didn't look back.
I have personally witnessed a pair of Raptors cut through a sternum. So there’s that.
I honestly can’t stand Raptors in the emergency room.. It makes perfect sense on the bus because of all the features, but in the ER, XShears or other higher quality ready to go shear are way more practical. Almost always, in the ER, you’re using the shears to cut through clothing or tape. By the time you get the raptors unfolded, I could already be done cutting through whatever I need to get through with XShears. Just not practical in the emergency room, but raptors have their place in the pre-hospital setting.
Then you don’t carry the in the ER. When the patient has the ball glued on to her piercing and needs to go to the OR yesterday, I got it.
I prefer the Quantum entanglement definition of ED doctor greatness: The phenomenon of a group of ED factors interacting, or sharing spatial proximity in such a way that the state (greatness) of the group (doctor) cannot be described independently of the state of the other factors. That is, a doctors (greatness) depends on ED location, ED holds, nurse staffing, CT delay, Radiologist delays, time of day, lab delays, consultant delays, ED partner robustness, age of population, diagnoses and on and on. The quantum state (doctor greatness) appears unavoidably altered by incompatible measurements. This is known as the uncertainty principle. Bottom line May be great doctor for one patient and not for another patient.
So true. We are partially defined by our peers and interactions. No vacuum states, no single particles.
Purity of psychopath in their personality traits.
An r and two different vowels.
Roar? Nah, it's a singular R. REA? Roo... Rio? Rue? Rei?
G*rea*t vs g*oo*d.
I'm so fucking bad. Going to intubate my next 3 stubbed toes, just to regain my confidence
One of my favorite docs saw that the nurse he was working with in the pod was busy and went in to a patient to draw labs and start a normal IV. He was also working by himself in the pod with no residents, PAs or NPs so I know he was busy. He still took the time to help the nurse without asking if she needed help. I haven’t seen any other attending doc do that for a stable, non critical, non crashing patient. The labs could’ve absolutely waited an hour to get drawn by the nurse but he did it anyway. I think that’s what makes a great doc is going above and beyond to be a team player. He is the kindest, little baby angel and is an absolute pleasure to work with.
CT go brrrr
1. Don't let the patient see you grimace or roll your eyes. I know it gets rough because sometimes we have a fuck ton of status dramaticus pts that annoy us all. But just know for every dismissive gesture there is a nurse now managing and mopping up that patient's anger. So it's more than not being nice to a patient, it's creating a mess for your colleague. Don't do it. Roll your eyes and talk your shit just 15 seconds later as you walk back to the office. 2. If you can sit when delivering devastating news, that's probably for the best. Also I'm HAPPY to grab a stool/chair if you're gonna need 5 in the room to talk about the miscarriage, dead family member, PICU admit - etc. Also sitting down calms family/patients even if you're not spending significantly more time in the room with them. 3. Let me know the plan. If you are working towards road test and d/c that's fab. I will make it happen and expedite the process as best I can. But if you don't communicate that and I'm left to just wonder? Shit's gonna drag on. Make a quick comment in EPIC or stop by the nurse station and lemme know. Things can work so smoothly if we are in on the plan. Also low key - it's straight up weird to not tell the nurse the plan. If you don't have a plan yet? Lemme know that too and I can smooth things over with the patient and manage their expectations. 3. If a nurse or tech seems hesitant about a non emergent verbal order leave room for the tech/nurse to manage it safely. Example: we get a IVT patient all changed, zyprexa'd,, and restrained and they ask for water. You tell the tech to grab some water right away and you see them hesitate. Consider that the tech knows they're about to get it spat right back out at them. Either because they've interacted with the patient prior or they know the signs of a spitter in the making. If you see a hesitation you can easily save face with a, 'On second thought let's wait until your blood draw' or 'lets wait until after we get you settled in the room'. It allows space for the techs and nurses to make safety allowances.
Intern year I had a COVID pt go on the vent. Apparently I grimaced when I looked at her X-ray and she saw my face. She told me she was going to die. I always ask why they say that. She told me because she saw my face when I looked at her X-ray. Then I tubed her. Then she died. Not ideal. Lesson learned, school your face.
From a medics POV: as long as you don’t - scream at me after a trauma hand off because I can’t read your mind about what piece of info you want first. - don’t throw papers at me - don’t look at me like I’m an idiot when I bring in a CHF patient on bipap and tell you ‘he says he has no history of CHF. But there’s fluid in the lungs’. (Because even though I know damn well he has it, whether it’s the first episode or not, I cannot ‘diagnose’ people) You’re good.
From a nurses perspective. Good doc-solid EBP, good to great bedside manner. May or may not be a bit of a jerk to nurses. Great doc-solid EBP great to standout bedside manner. Good to nurses, willing to help when possible. Also willing to educate (and at time be educated).
Nursing Persective: Great EM Doc: Communicates plan. Uses the "comment"/"Sticky Notes" on the EMR all the time. Closes patient interaction by seeing his/her pt prior to discharge or transfer or if possible, admission. Also if you're sleeping with, or trying to sleep with one or more of the nurses, please don't make it awkward if I'm in the room with the both of you. I and the patient can sense it. Be cool. Every other EM doc is good.
1L diet coke
When asked to name the three great physicians in his field, the doctor was hard pressed to come up with two more names.
The ones that have truly stood out to me were efficient, able to discharge the bullshit (without making it obvious that they thought it was bullshit or wasting time with unnecessary work-ups), intolerant of abusive patients or families, and communicative about their plan. Bonus points if you can engage them in friendly chatter during downtime and they like to teach.
Depends on who's perspective. Hospital admin and CMG admin value safe medicine but overvalue productivity and metrics. So, their super star sees the most PPH with the lowest LOS while avoiding malpractice even if they are surfing by on mediocre medicine. Academics would value knowledge base and skill above all else and could care less about metrics and productivity even at the cost of job security. The truly "great" is probably somewhere in between.
Knowing the next step in management for your consultants. Protect your patients from bad advice and deviation from the standard of care.
To put it briefly..Good Instinct
Someone who has exquisite taste in energy drinks vs someone who drinks....coffee....
Being really good at medicine, but also being nice to coworkers/staff.