One of the big differences between EM and hospitalists is how we think about observing patients.

To an EM doctor, watching a patient for 24 hours in the hospital to monitor repeat vitals and recheck symptoms is perfectly valid.

To a hospitalist, this is often viewed as an unnecessary admission that should be blocked.

There’s no labs or imaging that need to be done. No medications that have to be given IV or supplemental oxygen.

“I’m not going to do anything for them!”

ER will sometimes do the initial treatment, then watch patients for hours. Just observing for worsening/decompensation.

For some reason this is widely accepted in the ER but if you try to do it under observation status in the hospital, it can create a ruckus.

Often times just watching a patient is met with disdain because “they’ll just be on observation status!”

Which is kind of the point of obs... (aside from obs being a scheme by Medicare/insurers to pay less for hospitalizations)

The medical system masks this a lot when it’s a gray area.

Example: 70yo man with cellulitis, got 1L NS and has been observed for 4 hours in ED. HR 107, BP 102/70, RR 22. Thrown up once in ER.

I could put him on PO antibiotics and he’d *probably* do fine at home.

I could put him on PO abx and ask for a day of observation to see which way he goes. But it’s a hard sell.

So instead I go for IV abx to make it seem like I’m not trying to “just” observe him. Gotta act like he needs IV abx when really what he needs is just monitoring.

I’m lucky to work at a place where I can be honest with my hospitalists. We have a great relationship.

But there’s a lot of places where you have to do a lot of used car salesmanship to get other people to take good care of a patient.