Friday, March 23, 2007

Welcome Path Guy

Welcome to you, path guy. I look forward to your scintillating banter and misanthropic diatribes. But you don't have a monopoly on patient hate. Oh, don't get me wrong, I still shed a tear once in a while for the truly tragic case or children who are sick through no fault of their own. But as for the 50 pack year smoker, who believe it or not is having trouble breathing, the chest pain crack head, and the drug seeking tooth ache who is nursing that one last nasty tooth, the hate runs deep.

That is why my new product is going to make me wealthy beyond my dreams. It is a spray that one puts on before having to encounter these patients or their nagging families--Soul Blocker(trademarked). It contains a yet settled on proprietary list of ingredients, including but not limited to yohimbine, squirrel testicle, thyme, tree sap from old growth timber, and whale blubber. It will come in several SPF's (soul protection factors) depending on how vile the creature is you are having to encounter, and leaves you immune to their rants. ER doctors around the world will now be able to leave their shift tired, but not without their soul.

I will let you know when the final product is available. There have been a few setbacks in the initial tests, including erections lasting longer than 4 hours, uncontrollable flatulence, and sticking to everything you touch, but I am sure these can be worked out.


  1. Please leave in the uncontrollable flatulence side effect. That might make them leave quicker.


  2. I'm going to say something very unpopular here (and I'm truly not trying to be rude) so please stop reading if you don't want to hear it. (But it was prompted by your remark about "patient hate--which I will admit disturbed me somewhat and makes me very frightened to EVER go to an ER and face a doctor who may be harboring "hate" for whatever health sin I've comitted, especially since I do have a cell phone and a large TV--but no insurance---kill me now...)

    I'd like to know what YOU do to preserve your own health---and also what you do that is detrimental to your health. Thus my questions: Do you eat fattening foods with cholesterol? Do you get enough sleep? Do you exercise at all? Do you drink alcohol or smoke? Do you speed when you drive? Do you eat Twinkies? How much do you weigh? Have you always done every single thing your doctor advised? What is your blood pressure? What does your lipid panel look like?

    Just sayin...

  3. Who cares what any individual does with his or her life? Just don't bother me with it. Want to smoke yourself to death? Fine. Just don't bother me with your expectorated lung. Want to eat yourself to death? Fine. Just don't bother me with your uncontrolled DM. Want to f*ck yourself to death? Fine. Just don't come in wailing about your PID.

    One doesn't have to be a misanthrope to be utterly reviled by such individuals; Particularly when they're taking your blood, sweat and tears for nothing. And acting perfectly entitled to it to boot.

    Let me know when your start commercially producing this stuff. I'll buy stock in the company.

  4. Ditto to NAD. What I do to preserve my own health? Mostly I plan ways of getting out of medicine. Otherwise I'm a happy, healthy, athletic guy who carries full health insurance for me and my family and is saving for my kids college educations and my retirement. Am I supposed to do more than this? If so, how much? Also, at what point do my patients bear a measure of responsibility for their own health? Just sayin'...

  5. OK, maybe hate was a strong word. How about distaste or utter disgust. It is hard to hate someone you don't care to get to know well enough to hate. By the way I exercise 5-6 days a week (weights, boxing) , have a BP of 120/80 and have a normal lipid profile. Again, I would mind if my ER doc hated me if he did everything in his power to heal me or keep me alive, and I would expect him to hate me if I smoked, drank, drugged, or ate myself to the point where self induced disease brought me into his ED every f**king week, especially when he was just catching his breath at 3:00 f**king a.m. after a hell of a night.

  6. I meant to say I WOULDN'T mind if my ED doc hated me if he treated me appropriately and or saved my life. The hand holding days went out with the ambulance chasing attorneys and the lack of respect shown to medical personel. With the constant threat of lawsuits, there is an inherent adversarial relationship these days between doctor and patient, especially in the ED.

  7. Like I said, I knew my comments would be unpopular, but I had to ask. I sincerely wondered why intelligent people who knew ahead of time what type of sickness/maladies would comprise the population of our country's patients would bother to go into medicine at all--especially ER medicine.

    And I guess it also surprised me because all the courageous and heroic ER doctors I worked with in my ER days did not "hate" their patients.

    Maybe I'm just naive or something. I will admit that it hurt my soul to have my balloon busted---which occurred when I read the term "patient hate". That was one of the rudest awakenings I've experienced in awhile because I had no idea that so many doctors (who I hold an idealized view of) despise their patients so much.

    Incidentally, I work my ass off in a job which does not provide health insurance. I go to the same doctor most of my patients go to, and I pay cash for his services. Sadly, I will some day be forced to return to the "big city" in order to find a job with health insurance.

    Anyway, party on, dudes...

  8. I wont attempt to speak for my colleagues but I think I may clarify a bit from my perspective.

    As schrodinger's cat said he does not hate all his patients and "hate" may be a strong word. ETOTHEIPI says much the same. I think what sucks our souls are the parade (and it's a huge parade) of uninsured patients that do NOT have an emergency medical condition, OR, if they do, are largely to blame for their condtition, who, without so much as a "please" or "thank you" start right in with the "I deserve this", "I want that", "Give me this", "I'll sue you", and "No one here has ever done anything for me" tirade. They are without insight, without a sense of personal responsibility, and make up about 10% of our patients (feels like 90%).

    One other thing, you might not believe this but there is another parade, right next to the first, of people who dearly wish they or their child were sick, but they are not. Their litany of maladies is a mile long and usually includes fibromyalgia and chronic fatigue syndrome. Say what you will about those problems but they are not emergency medical conditions.

    Schrodinger's Cat and I trained to take care of emergency conditions... you know, heart attacks, car crashes, broken legs, meningitis and the like. It's what we're good at. We most certainly did not expect that a large majority of our time in the ED would be occupied with the 3am family plan with the sniffles who didn't bother to see their primary care physician because they would have had to pay him or because it was inconvenient for them or because they get free food when they come to the ED or whatever. We are not trained in social work but here we are.

    We may be the only docs on the web saying that we have animosity towards many of our patients, but this is a common sentiment amongst ED physicians. And oh, by the way, if you were one of my patients and you were not sick you would never know I felt this way about you. That's why we write, keeps us from taking it out on the parades mentioned above.

  9. 911doc: Okay, I can see where you're coming from, and I appreciate the clarification. And I certainly know of the frustration you speak of:

    On my last night of ER work, the nursing shortage meant that I was the sole nurse to help a dying 4-year old in status epilepticus as we awaited the helicopter. Desperate, as the paramedics had not been able to get a line into him, I actually had to physically lay down on the child to hold him still enough for me to (one-handedly) get an IV into him.

    While I was doing that, his Medicaid mother was on the phone ordering delivery pizza--giving them directions to the ER.

  10. How about some of that for the non-medical professional, but has people in their world who smoke/eat themselves to death and take no responsibility whatsoever.

    I don't want to deal with it either, and no one pays me.

  11. pizza with their child in status? then you understand. enjoy your posts please post anytime.

  12. dear C,
    i'm not sure i understand you. all of us have people in our lives like this. the difference here is that i am obligated by federal law to see these patients and lose money on them. as far as i know, with the exception that people who pay taxes end up paying for these folks, there is no other profession, be it law, retail, or whatever, that is under a similar obligation. family and friends, well, we do what we can.

  13. Bohemian road nurse - your opinion is not unpopular. There are really horrible people out there, it's true (ordering pizza when your child is in status?) but they are not the majority (10%). It's easy to be angry at them, it's harder to remain compassionate. 911Doc is right not to tell the patients how he feels, but it would be even better to find a way to let the anger go. Almost every horrible patient is a product of a horrible life... many times these people make bad decisions because they were abused or abandoned as kids, or have gone through hell and aren't strong enough to handle life with grace. Mental illness is behind a lot of it too, and that's not easily controlled. So for the sake of peace of mind, I think it's healthier to remain caring even though we are exasperated at times. We should offer strength and hope to each other as healthcare professionals - so that we can continue to behave nobley despite the pressure to do otherwise. We can bear the misery better if we remind each other of the good things... and focus on that. There still are many docs out there who feel this way. My 2 cents.

  14. dear val,
    after 12 years in the game for me i would gladly pay for the magic formula or incantation allow me to hold on to the compassion. i think schrodinger's cat is working on it but it's not commercially available yet.

  15. In the spirit of the lenten season please keep this in mind:

    "Pater, ignosce illis, non enim sciunt quod faciunt."

    "Father, forgive them for they know not what they do."

  16. dear charity doc,

    are you speaking about the docs here on this board or about the patients we are upset about or both?

    i am well aware that i am broken and flawed and need forgiveness but as humans living in a society we have rules and laws which we should heed. it seems that in the current health care debate that the one piece that no one wants to talk about, the dirty little secret if you will, is that a small percentage of patients use a huge piece of the pie and they are not paying a cent for it. everyone else is paying.

    i know this will never get anyone elected but, as you know, especially if you work in a large inner city hospital (like the one where i trained), everyone on our side is loathe to even ask for a small copay for the services of the ED.

    the trickle down effect hits all physicians, nurses, insurance companies, taxpayers, and patients with legitimate complaints who have long waits while we clear out the flotsam.

    how much responsibility does a patient have for his or her own health? the answer is certainly not "none". who will hold their feet to the fire? i have no idea.

    res ipsa loquitor

  17. Charity Doc - I get your quote. Here's another one, "The poor you will always have with you." The patients who drive us all nuts are never going to go away. There is no way to hold their feet to the fire, or make them disappear. The best we can do is shoulder the burden together, and try to improve the system so that ERs aren't overwhelmed with non-emergencies. Also, I would vote that cosmetic dermatologists take turns caring for the unsavory frequent flyers in the ED at least once/month.

  18. indeed, we will always have the poor with us. indeed we need to keep in mind that what we do for the least of God's children is more important than what we do for those of means who are thankful etc... this is not really my point. my point is that the current system under which we labor is deleterious to the health of these downtrodden BECAUSE it fosters a sense of entitlement and irresponsibility. certainly i knew that these patients would always comprise a large part of my practice but i do not think the general public has any idea, until they have to come to the ED, that they are multiplying and clogging the system specifically because of bad laws and, really, the tremendously paternalistic attitude that they are so far gone that they can't be expected to do anything for themselves. my 2 cents.

  19. You'll like Flea's most recent post:

    He totally agrees with you.



  20. In our ER, we are extremely commpassionate to anyone and everyone who comes in. With this being said, we have our "personal" moments where we must have to get it off of our chest. This usually involves alot of cursing and ranting, and is followed by a "yep-this crap is rediculous!"

  21. True to his name, Shrodinger's Cat exists in a dual state of being: healer and hater. Please keep us enlightened and updated on product testing. I am in awe of your insight into the human condition and the abitilty to withstand a perma-boner in the name of science.

  22. Why is it that angry docs are expected to keep their frustrations underground? Why not drag your anger out into the daylight where the public needs to see it?
    A Boston ER doc is doing just that. Burned out for all of the reasons listed in medical blogs everywhere, though I don't recall anyone mentioning patients' spitting as one of the more endearing behaviors.
    This ER doc is making a documentary on the treatment/abuse of today's physicians. Who among you want your opinions to be heard? Join him in this most important film. The public needs to know that 60% of physicians are mad as hell.
    Our plans for distribution have begun and we will be submitting the movie to several film festivals.
    If you want in, contact Nancy from Crash Cart Productions at