We had a reasonably busy store once I was in residency. So busy, in truth, that we had three secretaries working concurrently — one for paging, one for order entry, and one for admissions. I haven’t been again there in a very long time, however I hope the secretarial workers has grown commensurately with the quantity and acuity of the ED. However from what I’ve seen across the nation in my locums work and heard from others on varied boards, a lot of EDs don’t have a secretary in any respect.

I’ve puzzled over this. Perched at my desk making an attempt to determine what to do with my sufferers, doing my finest to maintain them from leaving with harmful sicknesses or being discharged into eternity, I’ve handled a lot of paper.

I crammed out referral types and fax cowl sheets. I entered orders, and re-entered orders. And generally did it once more once I discovered that the primary two have been for issues listed within the system that we didn’t have. I’ve tried to contact a social employee and a radiologist for clarification. I’ve known as the lab to search out out why my hemoglobin was taking so lengthy.

Whereas caring for the sick and injured, I’ve dialed switch facilities many instances, and sometimes been on maintain as I used to be transferred from specialist to specialist to clerk to the flawed specialist to the lab and again.

I’ve held again my need to have dinner and even go to the restroom as a result of I didn’t need to miss a name. Like most of you, I’m pretty properly chained to a pc, and due to the obvious nationwide scarcity of secretaries (little doubt pushed to extinction by local weather change), I’m additionally chained to the telephone.

I’d want to be analyzing the sick, speaking to sufferers, trying issues up, and even resting my mind so I could make good choices (oh, the horror of a doctor pondering as an alternative of billing!), however right here’s the reality: I’m truly a clerk. We EPs are a military of conscripted clerks with skilled levels for whom documentation, compliance schemes, and billing are extra vital than the actions documented.

“It’s totally different”

Simply as poisonous, I’ve seen good, extremely expert nurses who battle to search out the time to offer bedside care. Affected person care is supplanted by their different roles, that are to web page specialists, web page admitting docs, web page out-of-town physicians, fill out types, doc interventions for billing and high quality measures, harass psychiatric services for beds, cope with out-of-town admissions coordinators, and take orders from physicians who can’t fairly get the computerized order entry factor and refuse to attempt. (That’s a factor I’ve been instructed I can’t refuse to do. Appears truthful, sure?)

We are able to do it. We do it every single day. However we shouldn’t be doing it. Departments are continually overwhelmed by complicated, essential sufferers and swarming with others who belong in pressing care clinics, and we’d like each little bit of bodily and neurological area to be thorough and quick.

Why can we do it? My suspicion is that it saves prices. There’s no lack of potential secretaries (division coordinators, no matter you need to name them). There are younger women and men who plan to enter nursing, medication, or PA college or who simply need a job and don’t thoughts the chaos. However why pay for a secretary when your nurses and physicians will do the job anyway, not solely from a way of obligation however from a way of expediency. You’ve heard the saying, proper? “If you wish to get one thing carried out, ask a busy particular person.” So we do like at all times and suck it up. We’re exhausted and distracted, and we endure fixed interruptions, however, by golly, no one has to waste cash on pointless workers!

Full disclosure: My present hospital administration is doing a trial of a unit secretary in our ED as a result of we requested for it. Kudos to them! However too many emergency departments have none, and their battle is actual.

Right here’s a query to ponder for these of you with out a secretary: Does your CEO have a secretary? How in regards to the CFO? How in regards to the director of nursing, VP of promoting, the residency workers? Do they make their very own calls throughout board conferences? Do they sit on maintain whereas sophisticated monetary issues are being mentioned? Do they sort up all their very own memos and paperwork simply to save cash? Do they do any of it whereas somebody is dying within the subsequent room? Uncertain.

I’d like to know why it’s OK for medical workers tasked with easing struggling and saving lives to be encumbered by paperwork and telephone calls on high of the poisonous necessities of contemporary EMRs. I think the reply is so simple as this: “It’s totally different.” How unlucky for everybody.

Edwin Leap is an emergency doctor who blogs at edwinleap.com and is the writer of the Follow Take a look at and Life in Emergistan.  This text initially appeared in Emergency Medication Information.

Picture credit score: Shutterstock.com

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