We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my locums work and heard from others on various forums, lots of EDs don’t have a secretary at all.
I’ve puzzled over this. Perched at my desk trying to decide what to do with my patients, doing my best to keep them from leaving with dangerous illnesses or being discharged into eternity, I have dealt with lots of paper.
I filled out referral forms and fax cover sheets. I entered orders, and re-entered orders. And sometimes did it again when I found out that the first two were for things listed in the system that we didn’t have. I have tried to contact a social worker and a radiologist for clarification. I have called the lab to find out why my hemoglobin was taking so long.
While caring for the sick and injured, I have dialed transfer centers many times, and often been on hold as I was transferred from specialist to specialist to clerk to the wrong specialist to the lab and back.
I have held back my desire to have dinner or even go to the restroom because I didn’t want to miss a call. Like most of you, I’m fairly well chained to a computer, and thanks to the apparent national shortage of secretaries (no doubt driven to extinction by climate change), I’m also chained to the phone.
I’d prefer to be examining the sick, talking to patients, looking things up, or even resting my brain so I can make good decisions (oh, the horror of a physician thinking instead of billing!), but here’s the truth: I am actually a clerk. We EPs are an army of conscripted clerks with professional degrees for whom documentation, compliance schemes, and billing are more important than the activities documented.
Just as toxic, I have seen good, highly skilled nurses who struggle to find the time to provide bedside care. Patient care is supplanted by their other roles, which are to page specialists, page admitting doctors, page out-of-town physicians, fill out forms, document interventions for billing and quality measures, harass psychiatric facilities for beds, deal with out-of-town admissions coordinators, and take orders from physicians who can’t quite get the computerized order entry thing and refuse to try. (That’s a thing I have been told I can’t refuse to do. Seems fair, yes?)
We can do it. We do it every day. But we shouldn’t be doing it. Departments are constantly overwhelmed by complex, critical patients and swarming with others who belong in urgent care clinics, and we need every bit of physical and neurological space to be thorough and fast.
Why do we do it? My suspicion is that it saves costs. There’s no lack of potential secretaries (department coordinators, whatever you want to call them). There are young men and women who plan to go into nursing, medicine, or PA school or who just want a job and don’t mind the chaos. But why pay for a secretary when your nurses and physicians will do the job anyway, not only from a sense of duty but from a sense of expediency. You’ve heard the saying, right? “If you want to get something done, ask a busy person.” So we do like always and suck it up. We’re exhausted and distracted, and we suffer constant interruptions, but, by golly, nobody has to waste money on unnecessary staff!
Full disclosure: My current hospital administration is doing a trial of a unit secretary in our ED because we asked for it. Kudos to them! But too many emergency departments have none, and their struggle is real.
Here’s a question to ponder for those of you without a secretary: Does your CEO have a secretary? How about the CFO? How about the director of nursing, VP of marketing, the residency staff? Do they make their own calls during board meetings? Do they sit on hold while complicated financial matters are being discussed? Do they type up all their own memos and documents just to save money? Do they do any of it while someone is dying in the next room? Doubtful.
I’d love to know why it’s OK for medical staff tasked with easing suffering and saving lives to be encumbered by paperwork and phone calls on top of the toxic requirements of modern EMRs. I suspect the answer is as simple as this: “It’s different.” How unfortunate for everyone.
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