The Excuse Matrix
"That kid has a well-constructed excuse matrix" is what the instructors in my old fighter squadron would say about newbies whose first response to a question or criticism was an excuse.
The Excuse Matrix in Emergency Medicine is anchored deep in the earth with steel girders blasted into bedrock and built to withstand hurricanes and tornadoes.
I understand. Really I do. We are asked to do the impossible in the ER every day... to see more patients than our staffing and facility can handle... to transfer the lifelong alcoholic with variceal bleeding to an institution that will agree to lose tens of thousands of dollars in her futile care... to restrain our fingers, at three in the morning, from choking the life out of a mother of a cute little two year old girl who wants us to document for the court, the possible sexual abuse by the father who just walked out on her (yes, we are often used at pawns in court)...
But really, whether you are a nurse, a tech, a physician on the other end of the phone, or the gal that cleans the floors, didn't anyone teach you, EVER, that listing the excuses as to why you have not drawn the labs, given the medicine I ordered two hours ago, or got that pesky second EKG on the guy with unstable angina, is going to kill me when I pop that undiagnosed circle of Willis aneurysm? Because guess what? Even though I am 'the boss' in the ER, I can't fire any of you and you know it. Those of you that DO work hard and do care are shouldering the load for the losers. How does it feel?
Are we not in the same boat bailing with the same buckets? Ix nay on the excuses already. Here's one that I like and really the only one that is appropriate, "I'll get to it as fast as I can, sorry."
That's it. I don't care that nurse X is a slacker... we all know that he is, but when you declare the obvious it makes me think less of YOU. I KNOW doc, dammit, that you have already had ten admissions... I sent half of them to you and my partner sent the other five. I can probably tell you more about them than you know yourself, so telling me about how slammed you are makes me think less of you because, well, I'm working harder, and the minute I start making excuses is the minute I quit.
I am on the verge of making excuses, so, rather than come of like a pussy, I'm quitting. Done.