Working With Multiple Attending Physicians in the Emergency Department

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Working with a large number of attending physicians can be one of the biggest difficulties of being an advanced practice provider.
Working with a large number of attending physicians can be one of the biggest difficulties of being an advanced practice provider.

The other day I was working with one of my attending physicians and we were busy dealing with a large influx of patients. I evaluated a child who had clear breath sounds and a fever. 

I treated the fever with some ibuprofen with plans to check back on the child later to see if there was any improvement in the overall appearance of the child. 

A few minutes later, the attending physician came into the station and mentioned that he had ordered a breathing treatment on the patient because he had thought he heard some wheezing.

I decided to pop back into the room to see if I could auscultate this wheeze. Again I did not hear it. Oh well, I thought, he must hear a wheeze somewhere, and I moved along to see the next patient. A few hours later, we encountered another child with a similar presentation.

I gave the child ibuprofen, but this time I added a breathing treatment because I thought there might be a slight wheeze present. I wasn't overwhelmed by what I heard and probably would not have ordered it if the attending physician had not just ordered one on the other child. However, I was trying to think like the attending physician to be one step ahead. 

A few minutes later, he sat down at the station again and asked why I ordered a breathing treatment on the patient, because he didn't hear any significant wheezing. I told him I thought I might have heard a wheeze and decided to be proactive about it. The attending physician mentioned that we could always see how the ibuprofen worked and reevaluate the breathing to see if a treatment was necessary.

I laughed to myself and thought — didn't we just have this reverse situation a few hours ago? This attending physician happens to be one of my favorites to work with because we work well together, he vocalizes his opinions, and he has a way of making work fun. 

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