The Joust: A Semi-Controlled Rant

I know I am merely a simple car-crash physician. I know I don't have the mental capacity to do something really tough like, say, radiology, but occasionally even a blind squirrel finds a nut.

Emergency Medicine is still a relatively young specialty. In smaller towns that aren't affiliated with a large multi-specialty hospital the ED is still considered the denizen of losers and burn-outs. As more and more board-certified ED physicians take root in the smaller towns however the battle with the consultants often heats up.

In large University hospitals the turf wars of the ED versus the rest of the services were fought and settled at least ten years ago. At my current hospital, however, the battle rages.

We have consultants complaining that we keep patients in the ED too long and the next day the same guys complain we haven't done enough in the ED. We have people complaining about lack of referral patients and people complaining about too many.

The thing that these physicians understand (but forget at three in the morning) is that they aren't really mad at us. We are not the problem. In fact, we are a safety-net and stop-gap because if we didn't exist THEY would have to be in the hospital a lot more. Turns out we physicians are all mad at the following people...

1. The federal government for ever poking it's nose into health care. Medicare, Medicaid, EMTALA, and unfunded mandates. It all adds up to a sense of entitlement- a sense amongst the voting public that health care is a basic human right and they shouldn't have to pay for it. In an ideal world I don't disagree. I MIGHT even agree that some basic level of care SHOULD be a basic right for American citizens. It is most certainly not, however, a right for whoever happens to have made a series of poor choices about how to live their lives, or has just arrived in country after climbing some fence or fording some river or hopping-off some boat. The burden of providing this "right" for the above pitiful flotsam and jetsam of humanity right now is placed directly on physicians, insurance companies, and people responsible enough to have jobs, pay taxes, and insure themselves against illness. It's wrong. It's not American. It is a recipe for disaster.

2. Hospital Administrators. The "business people of medicine", only medicine can hardly be described as a business (see my previous post http://docsontheweb.blogspot.com/2006/04/customer-or-patient.html). So these empty suits control the purse strings of the hospital, have a business degree from Branchwater State Tech, keep a regular schedule, and make savvy behind the scenes business decisions that impact the physicians in every conceivable way (usually by adding another form to fill out to either admit, treat, or discharge the patient). They draw large salaries, belong to rotary, have weekends off, and never have to tell a family that their mommy died or make split-second decisions about life or death. Somehow, I work for these people.

3. Lawyers. I love my attorney but I hate the ambulance chasers (and they are out there and there are a lot of them). I also hate their willing accomplices who will sue and doc any time in hopes of winning the medical lottery.

4. Insurance companies for continually cutting reimbursement to physicians for reasons mostly having to do with number 1 and presenting said changes to us like they are doing us a favor. Hey guys, your cost shifting game is not hard to see through. Piss on you. Grow some balls.

5. Physicians for putting up with it all and not drawing a line in the sand.

6. Patients, especially my 'frequent fliers', for not giving a damn about themselves or anybody else, and expecting me to fix it in an hour