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

Dear Director,
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?
Left Out

Dear Director,
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 nursing business?
F.B., MD

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

Dear Director,
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?
A Clinician
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.
Dear Director,
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
Dear Director, 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
Dear Director, My chairman has started handing out data about each individual’s productivity. I have received a lot of grief from her because I see 1.5 patients per hour while our group average is 2.0 pts/hr. I told her that I see less because I’m seeing all the sickies while others cherry pick the easy cases. I’ve been told I need to pick it up but I don’t want to compromise my care of these sick people. What should I do?
Doing All the Heavy Lifting

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