Imagine going to the emergency room at your local hospital only to be greeted by a nurse who tells you to expect a significant wait time. Her comments are not unexpected. However, what you observe when you finally enter the treatment area is surprising: two doctors walking down the hall while juggling balls.
This amusing illustration is not something you are likely to ever see in the emergency department. However, that does not mean emergency physicians (EPs) are not juggling a lot of things. Quite to the contrary, they juggle all the time. Emergency room doctors and nurses are the medical equivalent of full-time jugglers trying desperately to maintain control over every item they are juggling.
If you are not quite sure of the metaphor we are attempting to put forth here, consider the following three reasons EPs are a lot like jugglers. As you read, remember that all of this applies to both employed doctors and locum tenens EPs.
1. Multiple Treatment Algorithms
A fantastic article by Forbes contributor Sai Balasubramanian, J.D. discusses what he calls “treatment algorithms” in the context of what makes emergency medicine so complex. Treatment algorithms are the defined protocols doctors rely on to treat patients as they come in. Emergency departments deal with a fairly large number of such algorithms due to the variety of cases they see.
A patient arriving in the emergency department showing signs of a heart attack is going to take priority over another patient who came in with a lacerated finger. Both will be prioritized over a third patient who comes in with symptoms of the common cold.
As Balasubramanian points out, EPs cannot treat patients in the order they come in. Patients must be treated according to the urgency of their cases. This reality, combined with multiple treatment algorithms, has doctors shifting treatment gears almost by the minute.
2. Inadequate Resources
The reality of inadequate resources is not limited to emergency medicine. A lack of resources is a systemic problem that reaches nearly every corner of healthcare. Yet in the emergency department, the issue is exacerbated by the nature of the beast. EPs have to juggle the resources they do have in order to make sure that every patient is cared for commensurate with his or her need.
It must be understood that the emergency department is, first and foremost, a triage center. It exists to provide immediate and life-saving care to people facing life-threatening situations. A conflagration of unfortunate circumstances has led us to a place where the ER is being utilized for far too many non-emergency needs, yet that has not changed the ER’s primary function.
As such, triage remains the most important function. Doctors have to juggle the little they have to work with to ensure that the triage mission does not go unfulfilled.
3. Healthcare System Bureaucracy
Thanks to a combination of regulation and insurance company influence, the U.S. healthcare system has become a bloated beast of bureaucracy. That bureaucracy doesn’t take a backseat in the emergency department simply because triage is the main priority. Bureaucracy still exists in the emergency department, and its wheels move extremely slowly.
EPs are faced with decisions every day that pit the need for good medicine against the rules of bureaucracy. To their credit, they do a fine job of making the most of a difficult situation. Lives are saved because of it.
You may never see an EP literally juggling balls while walking down the hall. But remember that he or she is juggling all sorts of things you cannot see. It is part of the job.