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apolitical message from a doctor

RLWSNOOK

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The following is written from an emergency room doctor. Before you judge doctors and before you make up your mind on what you think we should do with healthcare please read this. A lot can be learned from others perspectives.


I am an emergency physician with an apolitical message in this rather politically charged, polarized time in our country. I have worked for some time in this profession, and have noticed a disturbing trend about which I must speak out — the growing number of emergency department scenarios in which the selfishness and entitlement of those without real emergencies drown out the quiet suffering of those in real need.

This morning a middle-aged woman came into the emergency room in cardiac arrest. ACLS was performed to keep her alive. Other patients were in the ED before she even arrived, certainly with what they felt were emergencies, but treatments for these individuals were placed on hold as this event took precedence. After 75 minutes of continual heroic measures and life-saving interventions, with her grief-stricken husband crying, holding her hand for the last time, and stroking her face, she died.

This was no movie, no reality TV show. This was as real as it gets. Real life and real death. Family huddled around the bed to say their goodbyes and wished they or we could have done more.

I walked to my office, emotionally drained and exhausted, and from across the emergency department another patient, upset that she had to wait, spoke out brashly in tones that carried to every room in the department. “I know someone's dying and all, but I am in real pain here.”

What most of America don't know is the emergency department staff are graded with a nationally based report card by hospital administration. A survey is sent only to those who are discharged from the ED, not to those who actually needed admission to the hospital for an emergency or to those, like this new widower, whose loved one passed. This survey is a customer service tool used to see if people like coming to our ED and asks whether we did a good job. The ED staff know this survey is skewed because of the population to which it is sent, and certainly it is not the only tool hospital administrators use to evaluate us. That is another topic for another time.

But you must understand, the real emergencies are rarely graded or surveyed; they only go to those vast hoards of folks who were sent home, many of whom did not get their narcotic medication refilled, like Ms. “I'm-in-real-pain-here” who screamed her needs for all to hear, just within earshot of a new widower.

Mitt Romney recently was secretly taped speaking to his party base about the 47 percent of the nation that feels entitled to health care, to homes, to handouts, and to ever-present help from the government. If this lady represents that 47 percent, I have a few things to say.

The widower and his wife were also in need of care and financial aid. They came to the hospital for emergency care and received it. He was gracious about it, even when the scenario ended in a way he did not want. He and his family were thankful for the care. They will not be asked how they felt the care was, but screamer lady will be. It is doubtful that screamer lady would have been happy short a lifetime supply of narcotics, free ambulance rides, meals, and immediate gratification of all perceived needs. In fact, she and her friend raided the refrigerator for food and beverages without asking permission of staff or being cleared for eating or drinking prior to her labs and tests returning.

This widower and his family behaved in a way that acknowledged that there were others in the ED. They realized a limited but adequate number of doctors and staff were available. They were calm in the face of a real emergency, but never acted as though the world should stop for them, even though it ended tragically. They knew how to play fair even though their real emergency was not fair.

We live in a society that David McCullough Jr. describes as rewarding mediocrity because everything fairness and equality. Everyone is special, so nobody is. Everyone should get a prize for participating. And even though Johnny didn't win, we're going to give him a trophy for trying because he is special, too. Competition is bad because there is a winner and loser, and that's not fair. This fundamentally wrong notion breeds false equality and ultimately false fairness and entitlement. We do no one a favor by preaching this. We are lazy parents if we can't find a constructive way to celebrate the winner and help our children be happy for him. Instead, we have chosen an easier road: to make all things fair and equal. If nothing can rise above, be more important, or be first, then all must be mediocre. If all must be fair and equal, all will assume the position of being just as important and just as entitled as everyone else despite the real emergency or the real need.

The government mandates I evaluate and treat everyone who steps foot in our emergency department, regardless of the ability to pay or the acuity of the complaint. The government has passed health care legislation that makes it so everyone must have insurance. Now everyone is equal, everyone is the same — the broken physically, the broken emotionally, the broken spiritually, the broken psychologically, and even the broken culturally. Many have primary care doctors, but they storm the ED at 2 a.m. with the Burger King entitlement of having it their way rather than waiting for their own doctor to see them the following day. They will demand to be treated equally regardless of the acuity of their emergency. And you know what? They will probably get it because we don't want a bad report card from the feel-goods upstairs intent on establishing great PR or the lawyers who will use government mandates to take away your pain and make the other guy pay.

Were I to say something to screamer lady about her behavior, she likely would fall back on the clichéd finger-pointing canard, and say, “You're a doctor. You are well off. You don't understand. You can't relate. And you are the one responsible for the high cost of health care. It's your fault.”

As a young, married medical student, my family and I participated in Medicaid because having insurance was a requirement for my rather expensive medical school. I felt grateful, not entitled, to be able to sign up for the program. I know poverty in America because I lived it for a decade despite help from family. Government programs can help for a time. But know this, I spent my high school years working on grades and homework and at a job. I went to four years of college, working on grades and a job. I went to four years of medical school working on grades and leaning on the government for help, which I am now paying back. Then, I worked four years as a resident on call, on 12- or 36-hour shifts with just enough sleep to go back and start again. Now I work. And I work. Work and making good life decisions result in prosperity. No one — I repeat, no one — becomes prosperous on government programs. Student loans, food stamps, Medicaid, and unemployment benefits are there to help temporarily, but for heaven's sake, government aid is not a right and living your life like you are entitled to eternal government care is not right.

Anyone who wants to can go to school for 12 more years after high school and work, incur student loan debt, drive a 14-year-old car for 12 years, and study (while passing on TV, movies, parties, conversation, family life, sleep, and eating to study some more). They can then make a living that buys a nice home, clothes, insurance for family, and, hey, a new car. Anyone who can work can do this. And I'm all for government help for those who, through no fault of their own (and not their poor choices), can't work.

This woman, however, would reach into my pocket and take my hard-earned money while tapping impatiently on my watch to give her more of my immediate time and attention when others need it more, still claiming I am a cold-blooded heartless rich guy intent on robbing her of all the government assistance that is her due while simultaneously stiffing the hospital for what she considers an unconscionable medical bill. I am not cold-blooded or heartless, just tired and beat from the work I do and proud and gratified that I can do it. The same is possible for anyone here in the land of opportunity.

Are we so far gone as a society, in the name of popular progressivism, that we now don't view work as something to be valued, specifically when the work requirement is removed from the welfare bill? Are we so far gone as a nation that we vilify someone for their hard-earned wealth and elect a national leader who believes in taking that away to pay for those who would act as drains and not aquifers to the national pool of prosperity? Have we developed a national mindset that makes it normal to expect others to take care of us?

I think we develop a self-absorption that is callous in the face of anyone else's need when we rely on the government to handle our every need. No respect. No decency, no restraint, no responsibility, and no apology for it.

Frankly, our government cannot fix this, they cannot mandate a solution to this, and they cannot legislate against this. Nor should they. The solution to selfishness and entitlement can only be fixed with a mother and father (who know how to model character) teaching a child that work is hard and rewarding, that life is not fair and never will be, and that the freedoms you enjoy in this life are because someone else paid the price. Get up and get fixing.

Sincerely,

Michael E. Jacobson, DO

Source: Viewpoint: A Letter to the Country from an Emergency Physici... : Emergency Medicine News
 

Sarcogito

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Some good info in that, though it certainly wasn’t apolitical. I wasn’t aware of how ERs are rated. Certainly doesn’t seem like a good method.

Some of it is the same type of (justified) complaining you get about rude people from just about anyone who works in the service industry. There are plenty of self absorbed people out there who think their problems are worse than everyone else’s. I am sure that is an annoyance that is greatly magnified in an ER environment.

It will be interesting to see if Obamacare has any effect on ER overcrowding. After all, many of those without real emergencies showing up at the ER that Dr. Jacobson is talking about do so because that is the only way they can afford to be seen by a doctor. So like I said, it will be interesting to see how things play out.

Being an ER doc is certain a noble profession and I believe they deserve every dollar they make. I sure as hell couldn’t do it.
 

tererun

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Some good info in that, though it certainly wasn’t apolitical. I wasn’t aware of how ERs are rated. Certainly doesn’t seem like a good method.

Some of it is the same type of (justified) complaining you get about rude people from just about anyone who works in the service industry. There are plenty of self absorbed people out there who think their problems are worse than everyone else’s. I am sure that is an annoyance that is greatly magnified in an ER environment.

It will be interesting to see if Obamacare has any effect on ER overcrowding. After all, many of those without real emergencies showing up at the ER that Dr. Jacobson is talking about do so because that is the only way they can afford to be seen by a doctor. So like I said, it will be interesting to see how things play out.

Being an ER doc is certain a noble profession and I believe they deserve every dollar they make. I sure as hell couldn’t do it.
Actually, an ER visit for simple problems is much more expensive than a doctor's visit. The thing about the ER is they do not charge you up front like most doctors do. Obamacare should save money by allowing people with small problems that can be handled with simple prescriptions to not rack up 300 dollar plus visits to the ER that they never pay. They will have to do something to re-educate people to go to the doctor because many are used to going to the ER. The ER needs a way to push people who could see a physician off to the physicians instead of munging up the ER.

This will drastically reduce ER wait times because most people in the ER don't need the ER.
 

the makeout hobo

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First of all, this is in no way an "apolitical" message, and it's disingenuous to claim it is. What I read was mostly a lot of whining about the customer service aspect of his job, and a lot of unfounded assumptions about a certain problematic customer he had come in. You get those no matter what work you do, and that's just a fact of life. What the author did here was take this customer he had a bad experience with and from there assume all sorts of nasty things about her. He then takes his straw-man patient and uses it to bitch about government handouts or something, and about how superior he feels to the poor. Wha wha wha.
 

tererun

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The following is written from an emergency room doctor. Before you judge doctors and before you make up your mind on what you think we should do with healthcare please read this. A lot can be learned from others perspectives.
(Lots of doctor stuff snipped)
The doctor doesn't seem to be familiar with the fact America has trained it's people to do these things.

First the Obnoxious customer. There is a cause for this and it is caused by customer service policy. Most customer service policies reward assholes. Yes, the louder, stupider, and more annoying you are to deal with the faster people will try to get rid of you and the more stuff they will give you to make your stupid ass STFU. People are rewarded mopst of the time for being as awful as they possibly can be as customers. I am sure the lady in the post here thought if she was nasty enough some doctor would toss her a script just to keep from having to speak to her, and in many cases this probably has worked. good for him for not doing it, but the reality is this probably works 9 times out of ten. That tenth time they bump into me and if you are going to piss me off i am going to enjoy listening to you cry and bitch.

Then there is the other problem of training. We have trained the poor in this country to go to the ER for everything. This is because the ER has to serve the. What consequences does the ER have to get paid? Oh they will send the bill to collections. These people are probably already getting tons of collection letters and have crappy credit anyway. So basically they are trained to go to the ER because it is free medicine for them. This is mainly the product of charging for medicine. People need medicine, and if the Er is the only free place for it the poor have to go there. The other choice is to be sick and die. So the insurance companies have made it so regular doctors charge first and that poor people have no choice but to go to where we all go when we need emergency help even if they do not have an emergency. There are only 2 solutions. Start covering the doctors for their unpaid visits which the greedy bastards int he insurance companies and republicans hate doing, or tell the ER to toss the sick who cannot pay into the streets and have the ambulance check your insurance form before they do anything for you. Otherwise the poor are going to go where they get served and now we have to train them to go other places where Obamacare will cover them. That is if they have Obamacare because if you have no income they won't charge you the penalty anyway, and will only toss you vouchers which we all know never covers the full cost of insurance.

really, we just need to cover basic medical care outside of the ER and make sure it is funded. There is no way you will stop the poor from clogging up your emergency care until you get them out of the emergency room for every little hangnail. They are not just going to die because they are poor. As much as the republicans would love for them to do that it is unrealistic and the real problems of the ER keep on going because we force the poor into the hospital when we could save a lot of money and just give them a visit to the doctors. Someone has to cover the expensive ER visit, and the poor will never pay the bill.

people have also got to recognize when you train people to be the worst they can be. You set up systems designed to reward people for the wrong behavior and then you wonder why you have a bunch of poor assholes in your ER? You told them to go there with your government policy and you taught them to be assholes through the customer service people the rich and cheap love to abuse. It was not the poor people who learned you can get stuff by being assholes, the rich taught them that attitude. In CS terms of worst customers it goes old hippies, teachers, doctors. Politicians would be worse than doctors but they get special lines they are so bad. God forbid you have an old hippie who works as a professor for a medical center. If there is an apple logo anywhere near that customer shoot first. I am pretty sure life in prison is far less annoying than 5 minutes with an Itard hippie professor doctor.
 
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