We have this kinship that the rest of the hospital does not understand. I don’t think we are cliquish about it, but others definitely feel like outsiders when they come through the double doors. They are strangers in a strange land. They wonder how we put up with the noise, the chaos, the smells, and the odd personalities we encounter. They come down and take care of their business and then scoot. No conversation about salt spreading or New Year’s cards. It’s like they are in a foreign country and don’t speak our language.

Occasionally some of the older members of the medical staff will hang around to chat. They remember the bad old days of rotating call for the ED and the hit-or-miss quality associated with that system. They’re in the club because they understand what we are about.

So maybe this is why some doctors are so surly when they come to the ED. They feel left out. Of course, getting called at 2 a.m. to admit some drunken guy will put anyone in a bad mood. Some docs, however, always seem to be in a bad mood when they come to see us. It’s like they waited in line for gas at Costco and realized that a membership card is needed to make the pump go. They feel like outsiders and therefore sense a need to express their superior status.

The need to belong is basic. I think that quietly they envy the kinship we share in the ED. Our full team camaraderie and closeness is unmatched in the hospital, and I can understand why others find it desirable.

When these folks come to the ED, they are the odd man out. Fifth wheel. Three’s a crowd. Possibly if we let the people we regularly encounter know that they are “in the club,” they would be nicer to us. Just telling them or giving them some dopey card won’t do it. This requires time and multiple positive interactions before they will come to this realization. Until then two personality traits, which we have in abundance, will be needed: patience and perseverance. Eventually they will come around and join the club.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.