Rob Orman is back again for another fun week where we continue his "grab bag" interview. I need to make a quick warning that there is some language in this podcast so if you are easily offended please be warned now. However, language is very brief and minimal at best. This interview was done in a lot of fun and we hope you find it entertaining, too. Remember to check out last week's podcast with Rob on how to manage the upset patient.
We start our conversation with something that can be a real challenge for PAs and NPs: how and when to ask a collaborating physician a question. This sounds like something that should be no big deal, right? But, when you start practicing in a busy department, it is not as easy as one might think. In fact, this could be one of the hardest and most time consuming things to do in a given shift. Both providers have a full patient load and they have their own goals. Now, when one needs to do something that requires the other, it becomes a challenging game where we want to keep everyone happy. We tackled this difficult question with Rob Orman and he had some great thoughts on how to accomplish this in a way that keeps everyone happy and feeling successful. Our discussion goes into this in more detail but essentially monitor the environment prior to approaching the physician you want to ask a question. If they appear to be task saturated, try and find another time to go if possible. Another option is to stand off to the side but still be noticeable. This can often allow the physician to complete their task prior to any disruption. The physician will appreciate this and will better be able to give their full attention to the question or request. This can be used not only for PAs and NPs but also other staff and is very useful with students. The Dunning-Kruger effect was mentioned in the sense that this is a common issue with new graduates whether they are physicians, PAs, or NPs. The important point is to recognize your own incompetence and have others around you who will not only monitor you but guide you through that time. The St. Emlyn's group discusses this when discussing overconfidence in the ED. Our other main question from the podcast regards transfers. Now, we have talked about transfers of care before but more in regards to EMS both in Podcast #16 (EMS to ED transfers) and Podcast #17 (ED to EMS transfers). If you are not familiar with these two podcasts featuring Geoff Horning, go back to them as they are definitely worth your time. In this podcast though, we asked Rob what we should discuss with the provider that we are transferring care to when we are sending our patients to a higher level center. 
Remember that almost everyone will be receiving patients from someone else when they work in the ED even if they are not in a tertiary setting. Think about the family practice or urgent care providers who are having to to send you patients to your community ED. Be magnanimous, or as Bill and Ted would say, "Be excellent to each other."
We also briefly discussed with Rob Orman about having consults where a PA or NP answers the phone. This should not be any different than talking on the phone with a physician. Remember, if they feel that an immediate consult with the collaborating physician is appropriate, they will do so. Also, their collaborating physician trusted them with this responsibility and so should you. The more information you give the better this will be for all those taking care of the patient. All of this and more is discussed thoroughly in the podcast so make sure to listen to it all. Also make sure to check out Rob's blog and podcast, ER Cast. Apologies for any audio issues. This was edited at a time that was difficult to hear some of the background noises. Hopefully, this was not too much of a distraction but if it was please accept our apologies. Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook. Remember to look us up on Libsyn and on iTunes. If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page. We hope to talk to everyone again soon. Until next time, continue to provide total care everywhere. 
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