Letter to the Editor
I fully understand Dr. Edwin Leap's complaint, but his suggested solution is the wrong one. (“‘Pull Till Fill’ Pits Nurses against Physicians,” EMN 2018;40:1; http://bit.ly/2P0Hji6.) The main problem is the distractions. I don't think he would mind having patients wait to be seen in treatment rooms if they didn't cause him to be interrupted, cause breaks in his concentration, or disrupt his efficiency.
Let them be pulled till full. Let them wait in treatment rooms. Let their initial needs be cared for by standing orders initiated by the nursing staff. But don't have their requests for blankets, water, “how much longer it will be,” or even just the sight of family members standing in doorways distract the physician from the work that only the physician can do.
I don't know if Dr. Leap has worked long enough to remember when each inpatient unit had a physician dictation room, which was a dedicated quiet room for physicians to think about the patients they had just evaluated, create a differential, produce a plan of action, and document it free from distractions. What makes the architects of today's EDs and we physicians, who are still responsible for the same work as in the past, feel we can do our job as effectively in the center of a patient care area bursting with chaos?
Let the patients be pulled till full, but give us back an area as free from distractions as possible, where we can do the thinking and planning for which medical school, residencies, and CME has trained us.
Robert Baron, MD