Subj : Re: Working in a (real) ER To : alt.tv.er From : Sharon Three Date : Mon Oct 03 2005 09:57:22 From Newsgroup: alt.tv.er "DawnK" wrote in message news:ny80f.14918$uD2.7061@fe05.lga... > > "Sharon Three" wrote in message > news:qg40f.58905$8q.19161@lakeread01... >> >> wrote in message >> news:1128273917.837110.276110@f14g2000cwb.googlegroups.com... >>> npardue@indiana.edu wrote: >>>> [...] >>>> But the other thing is that, in the early years, County WAS shown as >>>> being a leader. It drew top doctors -- Mark and Susan were clearly >>>> VERY capable residents. We were told time and again that the surgical >>>> program anyway was one of the top ones in the country. [...] >>>> >>>> But then suddenly, by around S9, we're told that County is a crappy >>>> place where nobody REALLY wants to work ... Pratt is thrilled to get a >>>> resident slot at Northwestern, and Luka can't understand why Gallant >>>> would choose to here. They get stuck with below-the-bottom-of-the- >>>> barrel residents like Morris and Howard because, apparently, they can't >>>> find anyone better. They have trouble finding new attendings to replace >>>> those who've left, leaving the ER horribly understaffed. >>> >>> >>> Is it possible that a hospital in a major urban area would attract >>> students eager to do serious procedures far more than it would attract >>> more experienced doctors? >> >> Students need experienced docs to teach, so any hospital that doesn't >> have experienced docs wouldn't be certified to teach students. Med >> schools have rules about this. So does the government, which doesn't pay >> for any work done by a med student, or even a resident unless an >> attending is in the room and directly supervising. >> >> Would a typical medical student be more >>> attracted to such a hospital, or is it simply that the major medical >>> schools are in such locations? >>> >> Probably both. Only hospitals as large as County have enough patients, >> as well as residents, to take students on a regular basis. In real life, >> most teaching hospitals are affiliated with a single med school and most >> med schools provide their students with a choice of maybe half a dozen >> nearby facilities where they can do their clinical rotations. First, the >> student decides where he/she would like to do the major rotations and can >> change hospitals with each one, every 4-6 weeks. Then, he/she can >> sometimes choose a subspecialty to do within that rotation. For example, >> on Surgery, I was required to do one month of General Surgery, then an >> elective month of 2 week rotations on subspecialty services. I ended up >> with Neurosurgery and Pediatric Cardiothoracic. ER wouldn't be a major >> rotation, but wouldn't have the subspecialty choices either. When I was >> choosing, I chose Mount Carmel Hospital in Columbus rather than OSU >> simply because it was in a worse part of the city and there was much more >> trauma there. A 'knife and gun club' in the vernacular. OSU's hospital >> is mainly surrounded by the campus and then some relatively middle class >> neighborhoods, not nearly as good a patient mix for a student. BTW, >> despite the rep, I didn't see even a tiny fraction of the stuff we see on >> ER every week. They compress about a month's worth of 'big cases' into a >> single eppy. >> >> Doc Sharon >> > > So, they really aren't going from big trauma to big trauma, one right > after the other. Is the majority of stuff that comes in, more of the > little stuff, like migraines or abd pain, or injuries? > > Dawn > One or two big traumas a day is the norm, even in the big places and the mass casualty type things occur once in a blue moon, probably less than once yearly. On ER, we see several huge traumas a shift with at least several mass casualties a season. 99% of what comes through the door in any ER, even in the inner city, is small stuff. Babies with runny noses and earaches, kids with sprains and needing stitches, people with chronic things that don't belong in the ER in the first place. If I had a nickel for every woman referred to me by an ER who went there because she had been having pelvic pain for months or years.... Most of the traumas are minor auto accidents with neck or back pain. There are also plenty of substance abusers looking for meds with vague complaints and 'allergies' to everything but vicodin. There are also plenty of elderly patients with pneumonia or heart failure. Big city ER's have become the primary caregiver for the uninsured and underinsured these days and most of the patients seen there (my estimate would be about 75%) either don't need to see anyone at all or would be better treated in a private physician's office but the patient can't or won't pay for that so they go to the ER where they can't be turned away even if they've been there a dozen times and never paid a dime. Doc Sharon * * * * * * * * * * * * * * * Spoiler: For example, the very last eppy last season had the porch collapse with multiple fatalities and dozens of patients shipped to County. Episode 8 this season is already another mass casualty with two planes colliding midair and crashing into an apartment building which catches fire. There are dozens, maybe hundreds of victims in this one. How often do two events like this occur in the same city less that 5 months apart?. How often does it occur in the entire country for that matter? Of course, there's an even bigger tragedy in that particular episode, it doesn't happen in the ER, but in Luka's bedroom. Doc Sharon .