An Honest Question

For those of you both in and out of medicine I have an honest question. Does your job make you miserable? I mean miserable to the point of sleep loss, depression, anxiety, sheer frustration, and surender?

I once again am faced with the following facts. After three overnight shifts, all of which dragged on two hours past the 7am quit time because of disposition dificulties. I then went home and tried to sleep but couldn't, my brain was on overdrive and the adrenaline was peaked and I was way past anger and just at sheer surrender.

Over the course of the last 5 days I have caught up on my sleep and got back on a day schedule. The night after my last overnight, at about 7pm, I hit the rack and DID sleep, for 17 hours straight. Then, over the last few days I have done some yardwork and spent time with family and friends.

Today, the fifth day after my most recent shift, I feel relaxed and at ease. College football starts tomorrow, God's in his heaven, and all's right with the world.

But on Saturday I go back in for four 6am shifts in a row. I know I'll be back at the dark place pretty soon, so, once again, I ask, is it like this for all of you too? Honestly, I'm not looking for sympathy and I'm not trying to be a tough-guy or anything, I'm just looking for some perspective. Thanks for your help.

New Medical Equipment

As I said before, I was trained in the art of medicine many decades ago. We were taught to use a stethoscope, percuss chests and abdomens, plunge faces into ice water to stop SVT and many tools and cures rarely seen today. I do think that some of the newer tools available to us today are wonderful. Tonight we used one of those tools in my ED..

This is one that has some degree of controversy, but I still love it. It is particularily useful in those "Haldol" allergic patients. It's result is predictable, immediate, and very satisfying to to deploy. Some of you may have seen it. The Tazer!

What an elegant tool! It immediately calms the "upset", the "intoxicated", or just the down right obnoxious! And is so much fun to watch!

I hope all of you get to use this tool sometime..Time for some shuteye!

Two Firsts, One Night Shift

First first. My father is a smart man. However, he gave me bad advice in high school. He told me not to take a language in 7th grade and to concentrate on other subjects. I don't recall what they were. Then, in eighth grade he told me to take Latin. I did, for a year. "Marcus Iulium pulsat". "Roma in Italia est". That's it.

Then, in ninth grade he advised that I take French as it is the "language of diplomacy". Great choice. So now I have to learn Spanish and while French and Spanish are structurally very similar there is really not much crossover. I'm told that Italian and Spanish are VERY similar but that's no help either.

So tonight I took care of a French speaker and damned if I didn't understand almost everything he said. Problem, I answered him in franish. Merde!

Second first. I had to call the South African consulate (not really South Africa but it will serve for the purpose of HIPPA) regarding one of their citizens who got beat all to hell tonight by some local thug gang-bangers. In front of me he tried to die and he had, by CT scan, an intra-cranial bleed from the beating. I intubated him stat and flew him to the trauma center. We had no contact number for his family but I did have his passport. I then googled for the South African consulate and, after 10 minutes on hold, spoke with a nice gal who took all the information down and will work on family contact and provide him, if he lives, with assistance during his recovery. The Emergency Department, for all its faults, is rarely boring.

Oldfart

Thanks for the welcome. I'm the night doc tonight and we're a little busy, but saw the response and thought I'd better say hello..I'm just an old ED doc..Back in days when we had just invented CT scans for heads and used something called Penicillin. But I am EM trained..Back from the days when you only did 2 years of EM after 1 or more years of "something else", so that should date me appropriately..And to clear something up. The young lady is asking for a "little" more of me!!

Cheers! More later

Welcome "Oldfart"

I have the pleasure of introducing to you, dear readers, yet another emergency physician. He will contribute on a regular basis to M.D.O.D. and will bring a unique perspective to the discussion. I happen to know Oldfart personally and I must say that while, by reputation, he has a vanishingly small penis, his insight will still be valuable. He is a bit long in the tooth compared to the rest of us here and has watched the large ship of American medicine go from cruising proudly out of port to listing in the eye of the storm (and is bailing like hell with the rest of us now). Since all I've ever done is bail his perspective will be interesting. Welcome, Oldfart.

"Allergic to Haldol"

If I read on the triage sheet that you are "allergic to haldol" I will duck and dodge and try not to see you. If someone has given you haldol you are either schizophrenic, in which case you need it or something like it and it's really too bad you are allergic to it, OR, you are a freak, and one time when you were completely bat-shit crazy in the E.D. six people held you down and you got a nice intramuscular injection of this neuroleptic drug. You didn't like it because it made you shut the fuck up and feel unpleasant hence you tell people you are allergic to it. No worries though, I've got more up my sleeve if you freak-out again. Lot's more, but I'm not saying what so you can't tell me you are "allergic" to it. Haldol, if you are crazy it makes you sane, if you are sane it makes you crazy. Beautiful.

The Exodus Continues

Scratch one more surgical sub-specialty at my semi-rural facility. The burden of the uninsured, the lack of a surplus of these particular surgeons in general, and on-call responsibilities have combined to drive another necessary capability out of our town. Under EMTALA we can not transfer these patients either because, while, due to our bylaws, these particular sub-specialists are not obligated to call anymore, we do technically have the service available. Therefore, accepting facilities elsewhere will be able to refuse these transfers as they can say that it is a service that we have. Well, on paper we have it, in reality we don't. The Titanic is listing and the boats are away.

Private Health Care Rescues Public

Check this out. Guess we have to crash our current system, install socialized medicine, and then come back to the start like the Aussies when people start dying.

F****NG DRUG COMPANIES!

So get this. I had an indigent patient today who recently was diagnosed with a DVT and pulmonary embolus. I admitted him to the hospital and he was treated appropriately (and his bill will be distributed amongst the more fortunate). When he was discharged Sanofi-Aventis provided him with a full course of free lovenox therapy. This great drug allows folks to be treated out of the hospital for this dangerous condition but the drug itself is so expensive that not many without insurance can afford it. It's probably $700 for ten doses. So he came back today without a therapeutic blood level of coumadin and was nearly out of his lovenox. He needed a few more days so I called those Sanofi-Aventis assholes and they quickly ponied up for more (probably out of guilt). The thing is that those jerks actually make money on this stuff! The gall! Money! Yeah, I'm sure they spent millions in research and development of the drug and countless man-hours and hundreds of tests on DEFENSELESS ANIMALS no doubt, but really, this stuff should be free. We surely can not expect a man who can barely afford his Marlboros (half a pack in shirt pocket, new pack in back pocket), and could clearly not afford a dentist, to pay for this can we? I mean we are the richest nation in the world for Allah's sake! Where is the federal government when you need it?

Good to be home (warning, not really medical)

Just got back from vacation, and I can say it's good to be back in the USA. (Although my first night shift back sucked) Went south of the border. It's amazing how long it takes in customs and immigration (thank you jack hole Islamo-fascist for trying to blow up your f**king shoes) to go and come back, when it is so easy for millions just to walk right in. Missed my connecting flight and had to entertain 2 young children in an airport for 5 hours. Now that's real terror. I'm just glad no one in my family got sick or injured. Nothing against the well meaning docs there, and I speak Spanish, but I just wouldn't want to be in the hospital or clinic there. And after being there, it makes me realize how great we have it here, with the opportunities, freedom, great medical care, etc. Sure it's not perfect, but we must be doing something right for so many to desire to come here. Out of one side of their mouths they curse the "great evil" that is the U.S., but out of the other they would love to be here and enjoy what we enjoy. Most of the America bashing left wing socialist liberal jerk offs enjoy it more than most, but have swallowed the Flavor-aid given to them by the media, Harry Reid, and Sean Penn/Alec Baldwin types and simply repeat the mantra, failing to step back, take a deep breath, and realize it is just the freedom we have here that allows them to be agonizingly blind and irritating. To them, I say if you don't like it here, go to Venezuela or Cuba or some other shithole, climb up and hug a tree, and keep quiet. Because if you think verbal or physical protest would be allowed, or even what they consider benign discourse, you would soon find out to the contrary. As for me, I say God Bless the USA.



P.S. When you do leave the country, please try to stuff Michael Moore and Rosie in your carry- on. They are too fat to check, and your would have the pay the $25 dollar overweight luggage charge.

Courage

Got called to a CODE BLUE on the floor the other day. I still run to them and as I barreled around the final hallway the nurse standing in the patient's door gave me the "wave-off" sign so I slowed down. In a whisper I asked her what was going on and she told me that the husband of the patient had decided against resuscitation for his dying wife. I poked my head quietly in the room and saw him at his wife's bedside, crying, and patting her on the head and telling her he loved her.

The patient had widely metastatic cancer and, as I turned to walk away I found myself thinking about the courage it takes to actually comply with previously discussed wishes when death arrives. This gentleman made the right decision to let her go. One day I will have to do this for one of my family members or one of them will have to do it for me. I pray for the same kind of courage when the time comes.

Monkey Girls Scoops Us Again, Thanks Law Dog

Found this link on Monkey Girl's site as "The best argument against universal health care ever." I agree.

Medgeekonomics

This article is from last weeks New York Times' Week in Review: (insert here long http address instead of a simple link which i have added for my friend... he's hopeless, he works in a cave with dead bodies... you may also click the title of the post for the NYT link,911doc)...(Yes, I'm retarded and can't figure out how to put in a link without copying the entire address. So no blog-snob comments. And f#%k off.)

This article caught my eye because it was about health care, sure, but what really pulled me in was that the editor decided to 'tease' the article on the front of the Review by headlining: "Are doctors paid too much?" The assumption you may logically make from this teaser is that the NYT, in its infinite wisdom, thinks that we are, in fact, overpaid.

I know I will get no sympathy from the masses when it comes to money - when you make over 100,000$ per year, Joe-six-pack loses interest in your whining. You have also heard ad nauseam the arguments for why we should be well paid (years of training, high loans, importance of / life changing effects of professional decisions, bad hours, etc...). So, I want to forget all of this and ask an emotionally neutral question: as a pure economic decision are doctors, in fact, paid too much?

The way I approach this is in the context of two concepts: present value of future earnings and opportunity cost. You may now wake up.

Here's an actual example: My niece is 26 years old. She graduated from an elite university with good grades - a good comparison for your typical med student. She has been working as a consultant for 4 years. Without a graduate degree, she will likely increase her earnings to about 150,000$ / yr. within 3 years. If she works to age 60, her lifetime earnings will be about 500,000$ (appx. total earnings to age 30) + (150,000 x 30 = 4,500,000$) = 5 million dollars. This number actually approximates a discounted present value as I have assumed she will get no raise after age 30.

Here's another example: I graduated from an elite university at age 23 with good grades and decided to go to medical school. Let's assume my niece and I both had full scholarships and came out of college with no debt. I did two years of research for no money to increase my competitiveness and get into a good med school (pretty typical these days). Medical school was 4 years at a total cost of about 50,000$ / year = 200,000$. Residency was 6 years. My first year I earned 30,000$; my 6th year about 50,000$ (total ~ 240,000$). Discounting these dollars makes them about equal so here I am, age 35, at total lifetime earnings of ZERO (it's actually negative because of deferred loans but let's not go there). Let's say my salary from age 40 on is about 250,000$ (this is well above a typical primary care doc's salary and a bit above average for specialists). Let's do the math: (~1,000,000$ age 35-40) + (20 x 250,000$ age 40-60) = 6 million dollars. Of note, my salary has DECREASED in the past 5 years by 30%, so this number is likely very high when it comes to discounting to present value.

What would you choose? Go from age 23-35 with a good standard of living and by 35 have over 1 million $ in earnings or live on the edge financially to age 35 and have no earnings. Obviously an easy decision. Now if you are a primary care doc, your lifetime earnings will likely NEVER get to 5 million $. Again, an obviously easy financial decision. So, like in the above example, would a high earning specialist trade an extra 1 million in lifetime earnings for a more financially secure life while under 40? Maybe. But, guess what, this is a bad way to look at it. The consultant at age 35 probably has investments, a house with equity and other financial vehicles that have been appreciating in value over 12 years, while the doc has debt that is increasing over this time. So now, that extra million of lifetime earning discounted to the present plus the opportunity cost of 12 years of investment, roughly cancels out the extra earnings!!!

I hope this argument has been whine-free. The bottom line: for a person with the typical med-student type qualifications, upon graduation from college, medicine is likely a neutral (at best) financial decision, and likely a poor one for non-specialists.

As the New York Times asks: Do doctors make too much? As a purely economic decision, I would argue the answer is "no". Interestingly, they sort of answer their own question in a different way in the article, and I quote: "Primary care doctors and pediatricians, who rarely perform complex procedures, make less than specialists. They are attracting a declining percentage of medical students, and some states are facing a shortage of primary care doctors."

At some financial break point, which has clearly been reached in the primary care specialities, people will decide it's not worth it to go to med school. Substitute in the above quote the words "shortage of primary care doctors" with "shortage of all doctors" and you should get the idea.

A Blogger's Union?

Just when something gets to be pretty cool some idiot decides it needs to be unionized. The beauty of this form of expression is precisely that I DON'T HAVE TO FOLLOW ANY GUIDELINES AND CAN THEREFORE SAY WHATEVER I WANT (and so can you). Guess which side of the aisle wants a union?

Uhhh... There Was One?

Okay, a patient I just saw has repeated something that I hear with surprising frequency.

Me: "Ma'am, have you had a fever or chills with this illness?"
Patient: "Uhhhh.... I don't know."

Okay, this makes me think immediately that you are either Beavis or Butthead or the guy from Stripes that joins the Army to avoid the draft only to be told by SGT Hulka, "Son, there is no draft. " To which the bozo replies, "Uhh... There was one?" OMGWTF?

What Does the Sorting Hat Say?

Couldn't resist. Almost done with "The Deathly Hallows", great stuff. 'Cat? ETOTHEIPI?

The sorting hat says that I belong in Hufflepuff!

Said Hufflepuff, "I'll teach the lot, and treat them just the same."

Hufflepuff students are friendly, fair-minded, modest, and hard-working. A well-known member was Cedric Digory, who represented Hogwarts in the most recent Triwizard Tournament.

Take the most scientific Harry Potter Quiz ever created.

Get Sorted Now!

A Laugh from the EMS Side

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