I’ve been recruited to be the medical director/chairman for a 40,000
visit ED. My concern is that the hospital wants me to work 12-14
eight-hour shifts a month in addition to the administrative
responsibilities, and there is no plan for an associate director. Is
this too much?
I’m a medical director and have one doc who I’m under pressure by
administration to fire. Although he’s a good clinician who saves lives,
at least once a week he gets complaints from patients, nurses, non ED
attendings, etc…What can I do?
I just finished my first year as an attending and while I feel like I’ve
made progress since residency ended, I am not the “master” physician I
thought I would be. Will I always feel this way or will I eventually be a
true expert in my field?
No Master Yet
I’ve been a dedicated part-timer for years, but now I’m not getting my
shifts. Why is that, and what can I do about it?
I think my nurse manager is ineffective and has lost the support of the
ED staff. She doesn’t report to me. How involved should I get in the
Dear Dr. Silverman,
I recently admitted a patient with pneumonia which was causing some altered mental status. When the house staff came down to evaluate the patient, they lowered the guard rail down, then walked away. The patient fell and broke a hip. I told the house staff they would need to deal with the family, but they wanted me to do it because the patient was in the ED. It’s not my fault the patient fell, and I didn’t want to talk to the family as it could increase my risk of getting sued. What do I do?
Trying to avoid the suit
Our hospital has started enforcing a policy saying that every doctor has to participate in a hospital committee. I get paid by the patient, not to go sit at meetings. Why should I do that?
Length-of-stay (LOS) is quickly becoming a key metric of focus for our EDs. This is even truer with the inclusion of LOS into CMS’s core measures list. The importance of understanding LOS cannot be overstated, given that it is instrumental in determining the number of ED beds you need. This treatise is simply an overview of a little known law called “Little’s Law” and how to use it to gain new insights into managing your ED.
My VPMA just returned for a workshop on LEAN and wants me to use it to “fix the ED’s” problems. I’m not sure what LEAN is but I’m happy to try new things to improve our flow. Should I go along with it?
Willing to try anything
As I was performing a procedure recently, the nurse who was assisting me would not give the medication I ordered, saying it was outside her scope of practice. This was a life-or-death moment and I didn’t have time for that. After a brief argument, I kicked her out of the room. I’m now getting a lot of grief for that. Doesn’t the end result of saving the life matter more than me hurting someone’s feelings?
No Time for Hurt Feelings