Chapter 1219: 【1219】The teacher is going to test her now.
The door to the consultation room banged open, and the nurse popped her head in directly asking the doctor: “Doctor Xin, 120 emergency call for deployment, an internal medicine patient. Are you going or is Doctor Dong going?”
“I have a relatively critical patient here. Could you ask Doctor Dong if he can spare a moment?” Xin Yanjun replied.
Bang, the nurse pulled the door shut and left without a further reply. This was the ER—every syllable more spoken might waste precious time.
The brief interruption left the patients and their family members in the waiting area a little confused, not having caught what had just happened before the nurse disappeared.
Only the medical professionals who’ve worked in the emergency department understand that there’s no better way to describe the ER than these four words: a living hell.
Once the patient was lying comfortably on the examination bed, he no longer crouched in pain as he had while seated earlier. Perhaps the sight of the doctor attending to him had offered him some peace of mind.
“Which department do you think he should be admitted to?” Xin Yanjun quietly asked the student next to her.
Clearly, Teacher Xin intended to test her.
This introduces a common dilemma in the ER. Symptoms like abdominal pain are among the most difficult to differentiate clinically. Certain conditions can be treated by both internal medicine and surgery. For instance, upper gastrointestinal bleeding—milder cases can be managed in internal medicine, while more severe ones requiring surgical indications need to be directed to surgery. In some exceptional situations, ICU stabilization may precede surgical intervention.
The triage nurses cannot instantly determine whether such a patient should go to internal medicine or surgery. If there’s no hematemesis or other strikingly alarming acute symptoms, they’ll typically schedule an internal medicine consultation first. The internal medicine doctor will then conduct a thorough examination and decide whether to treat the patient or refer them to surgery.
Each doctor’s judgment depends on their own expertise and clinical experience. While medical guidelines provide direction, doctors’ decisions can vary. Particularly with diseases that blur the line between internal and surgical treatment—when both can manage the condition—these individual differences in choices become even more apparent.
Such variations may arise from a doctor’s habitual patterns of thinking for specific diseases, or even from factors unrelated to the condition itself. For example, some patients may prefer surgery and will prioritize surgical departments. Others might opt for conservative treatment first, and the doctor will respect their choice by directing them to internal medicine.
If a patient lacks any preferences and both internal medicine and surgery are viable, then another factor might come into play. Each department takes turns staffing the ER according to hospital mandates, but every department has its own considerations.
Although inpatient ward night-shift doctors seem to dislike admitting ER patients, as soon as department heads start discussing bonuses, everyone quietly refrains from protesting. No one wants to turn away money—even doctors. Fewer patients mean less revenue and fewer opportunities to hone skills.
In departments fiercely competing for business with others, the directive to their ER doctors is clear: admit more patients.
Outpatient services can admit patients, and the ER is equally a source of patients. If you don’t admit them, other departments will take them all. Over time, you’ll see fewer patient inflows, leading to reduced income and fewer opportunities for skill development. When hospital management notices declining numbers against their metrics, they won’t be pleased with your reluctance to take ER cases.
Of course, doctors won’t compromise their ethics by admitting conditions that clearly fall outside their department’s scope of treatment—doing so would simply invite trouble.
The patient in front of them complained of upper abdominal pain just below the xiphoid process and reported vomiting coffee-colored material. The preliminary suspicion was upper gastrointestinal bleeding. This was absolutely not a case for the pulmonology department to handle.