The relationship between ER physicians and the hospitalists is often…let’s say complicated. The two physicians often have a completely opposite agenda. In a nutshell – ER doctor thinks that everybody coming to ER should be admitted to the Hospital. The hospitalist, in contrast, thinks that there is never a good reason for an admission.

Let’s look at things from the ER physician standpoint first. The ER doctor has to facilitate patient flow in the ER. Otherwise, the waiting room will be overflowing with people, waiting time will be long and the patients will be grumpy. You send the patients out of ER either by discharging them home, if they are not too sick, or calling the hospitalist to admit them, if there is a good reason for it. This sounds simple enough. In real life, though, there are a lot of patients falling into the grey area. The patient might not have a good indication for an admission, yet not quite ready to go home. And that’s where the problem begins – the ER doctor is not comfortable sending patient home, the hospitalist does not see a good reason for admission. The problem is made even worse by a heavy workload for both physicians.

From the hospitalist’s perspective, the patients are often admitted to the hospital for no good reason. Things are rarely straightforward and sometimes it takes time and effort to do the right thing for the patient. Talking to the patient, looking into the old medical records and communicating with the patient’s family takes time. If the ER physician is not quite sure what is wrong with the patient, calling the hospitalist IS the path of least resistance. Some ER doctors even get creative when trying to “sell” admission to the hospitalist. There is always a mysterious pneumonia that nobody can see on the chest XR, otherwise, known as ER pneumonia or NOmonia. Some patients are being admitted for obstipation or “failure to thrive”. Occasionally, the ER doctor will tell you that he has no idea what’s wrong with the patient and is just not comfortable sending the patient home.

I don’t know how many times I was told – “Just watch the patient overnight”. The thing about “watching somebody overnight” is that it often requires the same (or even more) amount of time as a regular admission. The next day, somebody will have to discharge the patient, which takes yet more time for something that could have been done on an outpatient basis.

This is a hospitalist blog and I might not be entirely fair to the ER doctors. I welcome ER physicians input into this problem. After all, why can’t we all just get along?