Wednesday, April 11, 2007

Charity Doc Taking a Breather

A fellow ER doc has had enough (at least for a while). Click on the above title to read about our friend at Fingers and Tubes in Every Orifice and the nit-picky, incessant crap that has forced him to take a break from medicine. We have covered the same ground here but it can't be said enough: America's doctors are fed up, and, while the general public may not care or shed a tear, it takes at least 7 years to train one. In all the talk about the health care crisis we are usually only mentioned as part of the problem. Fine, many of us will simply remove ourselves from the equation and then we will see how much worse a 'crisis' can get.


  1. I guess since we're ranting, I'll add mine.

    Ummm, nurses get "fed up", too. Each day, I fight the battles of "the system" with the hopes that God, in His infinite wisdom, will help things make sense for me.

    In fact, when I hear stories such as Charity Doc's, it hurts my heart, it discourages me, and it further "enables" my already high-level career frustration. In fact, I'm seeing so much anger in doctors these days that I think it's getting contagious.

    Today my patient's local, primary doctor refused to sign my patient's hospital discharge orders (from a "big city" hospital where the patient had gone for an ORIF/rehab after a fall)---orders which allow us road nurses to resume the home health care for the patient upon that patient's return to Podunk.

    The doc refused to sign the orders due to a temper fit. (A "conniption" fit in local lingo...)

    (Around here, a patient's local primary doc routinely signs such orders when patients come home from "big city" hospitals in order to allow the patients to resume their road nurse home care.)

    I thought maybe he'd had a "moral fit" and didn't want to be responsible for the Lovenox or something. But noooooooo, his office nurse explained that he'd gotten mad and wouldn't sign the orders simply because the assisted-living facility where the patient resided had "forgotten to tell him that the patient broke her hip and went to a "big city" to have an ORIF/rehab."

    Okay, their bad. My bad, too, for not anticipating the laziness of the ALF and ensuring the doc knew.

    But this guy got mad, threw a conniption, and returned the unsigned orders to me with a post-it saying: "Nobody let me know she broke her hip. Therefore, let the big city hsopital doc sign 'em".

    Thanks a lot, doc. Now I have to go through gymnastics to call a big city doc and beg him to help a hick nurse get her stupid orders signed.

    My point is this: what is this "system" coming to? Everybody's getting mad, everybody's taking measures to ensure their anger is heard, everybody is expressing anger right and left.....

    Anger, anger, anger. It doesn't solve anything. Only the patients will suffer over all this anger.

    I'm getting tired. I'm tired of the battles. I'm tired of hearing discouraging things. I am tired of hearing anger. I'm tired of the fall-out from anger.

    Galveston is looking better all the time....

  2. take heart good nurse! it may have to break before it's fixed and we may not be part of the fix. there are probably many fixes that would improve things but the one that will ABSOLUTELY NOT WORK is one that involves 'free health care' for all. if this is what happens then the health care will be worth exactly what free stuff is worth, squat. simple economics.

  3. True. Anger is no solution. But here's the rub (WS, circa 1600): by being a passive voice in health care politics in the name of 'compassion', docs have sidelined themselves from the debate. When you stand up and say ,"it doesn't matter how I'm treated, it's my duty to take care of the patient", it is deemed noble - and, in fact, it IS noble. But guess what - the public, government and everyone else sees this as weakness. It is an invitation to be shit on, and we are seeing this happen right now. 911doc's economic analysis is right - free shit is exactly worthless. Face it: humans respond to appropriate incentives; the incentives in the current system encourage abuse; docs take it in the ass because the bleeding hearts take the 'noble' line.
    Wake up.

  4. The system has to go towards social, free for all, everyone suffers medicine.

    Prisoners are getting great medicine; organ transplants and complete cancer therapy are the norm. Homeless people get health care. Lower middle class gets punished by use of health care.

    I don't, I don't have health insurance. I used to have a high deductible plan that didn't pay 20% of almost nothing. Independent insurance is immoral and drops people that need it. Kind of like hurricane insurance in Florida, if you can afford it; you don’t need it. And if you use it, it’s your only and last chance.

    And the cost of health care is absurd. Let’s outlaw all medicine and only have veterinarians. Let’em all suffer. Heck the commies killed all their doctors. What’s the difference.

  5. Uh.... okay. You lost me with your last paragraph. Please do a google search for "tin foil hat" and act accordingly.

  6. Anonymous:
    What the f*ck are you talking about? I completely lost the plot there.
    Prisoners get great health care so this is the model we should use?
    Do you REALLY think the prison health care system is a good model? Wow.
    Indepedent insurance is immoral?
    It's also immoral that I don't get free food - I need it to live dammit!
    I have an idea: let's just have a system where everyone gives what they can and everyone takes only what they need. Oh, wait, already tried that on a mass scale...hmmm. that worked out. only 50 million murdered or starved to death. Refer to your 2nd to last line.

    Maybe you were being sarcastic. I hope so. Sorry, gotta go misuse my position as a physician for personal gain. Toodles.

  7. etotheipi, one other thing re your most recent comment here. docs, by nature and for the most part, went into medicine to help people. sure, a lot less of us would have done it if we didn't see a good lifestyle are a result of our career choice, but my point is that we, as a group, are not protestors or sign carriers. we don't have time to march on the street or do sit-ins and such. i wonder if we will ever organize and strike?

  8. please include nurses and paramedics in the above post as well... BRNurse, sorry i tend to write only about docs but we couldn't do what we do without excellent nurses (and i bet you are one).

  9. My mom, an RN of 30 years, speaks of the days when "medicine was fun". As a pre-med aspiring to general practice, I am a little sad that I missed that time, but I can only hope that over time things will improve.
    I've been working in front desk and records for a rural, federally funded, low-income clinic, and your words about people using the ER because it is "free" sounds very familiar- we cannot discriminate on the ability to pay, and have some amazing social workers to boot. There are so many people we see that genuinely need the help, but there are so many that are out for all they can get. That, I think, is the main problem- how can we choose the first type from the second? How do we go about separating the homeless teenage mom from the 30-year old trying to fake a TDI claim?
    It seems broken, but we have to mess with a lot of machinery to get to the problem.

  10. dear lindsey,
    i would say two things. first, if you want to be a physician then do it. there will be a resolution to all this and we will need you.

    second, i would encourage you not to look at the problem as one which "we" can fix for "them". "we" fixing it for "them" has never worked anywhere it's been tried in any way it's been tried. i'm speaking of socailism or communism or whatever system seeks to have central control of resources with "smart people" in charge distributing goods or services to "those in need".

    having worked in the VA system and having been a military physician for many years i can tell you, aside from the basic economic argument made above, that "the government" will do a lot worse job of efficient resource distribution than even the current nearly-broken semi-private system of helath care.

    i maintain here, as i have in other posts, that a hugely critical part of the current crisis that is NEVER discussed is that people have to cease thinking of health care as a right and have to take some responsibility for themselves.

    the way things are going people believe and act as if they have no responsibility for maintaining their health, and no responsibility when it fails. they have been trained to look to "the system" or "the government" and, as a result, "the government" has promised what no one can deliver through laws like EMTALA. there is no end to the spiral and many physicians feel like it's all part of a cynical plan to bankrupt the current system so that the health care industry can be nationalized.

    i am all for a system similar to the australian one, or what i understand to be the australian one, where there is a basic health plan for all and those that choose can purchase private insurance for better access.

    in other words, i am not against a safety net in health care, i'm for it, but we can clearly not continue to provide extraordinalriy wonderful care to all in all emergency situations without regard to their citizenship or ability to pay for the services delivered.

    as an example of the above you may choose to read a post i wrote last year called at this address as a very common example of the way our current emergency and trauma system operates.

    good luck in your studies lindsey.