Tuesday, April 01, 2008
In the spirit of April Fool's Day we are, just for today, going to do the following in our ER...
1. We will see all comers regardless of their ability to pay, and regardless of whether they are drunk, high, lying, in the country illegally, have just murdered someone, or are coughing up blood after having smoked four packs a day for 50 years and have never seen a doctor before.
2. We will pull out all stops for all patients and do the absolute best medicine anywhere in the world for all patients mentioned in #1 and collect what we can from people with nothing to do with any of the patients in #1.
3. We will smile and respond 'yes ma'am' and 'yes sir' to patients and their families when they call us "asshole" or similar epithets and hit us, spit on us, and threaten our lives.
4. We will comply with all regulations and laws promulgated by the federal government to do all of the above without any funding to back up said rules, and with full exposure to liability for medical negligence for any of the patients mentioned in #1.
5. We will strive to comply with all JCHAO regulations, my favorite of which forbids us to eat at our work space (ostensibly to protect the health of the patient), but allows patients to eat in their rooms in the ER and upstairs.
6. We will surrender our power, gained by detailed expert knowledge and training, to people with clipboards who work 9 to 5 and haven't seen a patient in their lives, or, if they have, are no longer involved in patient care.
7. We will approach the art of medicine by applying a strict business model, striving for customer satisfaction with our patients, and look quizzically at each other since we have no idea how much particular tests or procedures cost, and have no expectation of being paid by any particular patient.
8. We will 'go paperless' and put dotting the "i"s and crossing the "t"s on the computer ahead of getting stuff done in a timely fashion for our patients.
9. We will dump more and more work on fewer and fewer providers (nurses, doctors, techs, and paramedics), and buff out that bottom line for our masters with clipboards and 9 to 5 jobs and zero clinical experience etc...
10. We will look the other way as our EMS system is abused by people calling 911 who "can't get a ride" to the ER or have that pesky 4am insomnia which is very uncomfortable for them.
11. We will happily put our helicopter crews at risk by flying at night and around dangerous obstructions to rescue the folks who plow their cars, drunk, into other cars, into crowds of people, or into bridge abutments, and cry a little each time a crew is lost.
12. We will see the same patient for the same complaint for the thirtieth time this year and spend thousands of dollars of other people's money looking for an imaginary diagnosis because the patient simply wants narcotics.
13. We will groan as clipboard people create new forms to supplement old forms and new requirements to supplement old requirements.
14. We will meekly comply as clipboard people and entitled patients demand quicker throughput in the ER while doing all of the above.
15. We will listen sympathetically to patients who are doctor shopping and tell us, "no one has ever done anything for me" while trying to make sense of their 500 page charts.
16. We will attend required meetings at 7am after working all night where freshly showered and manicured clipboard people in suits tell us that we need to work harder, faster, and better for less money.
17. We will look at the salaries of hospital administrators, often equal to or greater than ours, and put a grim smile on our faces while swallowing very hard.
18. We will wonder how an undergraduate degree cum laude from a top university, a doctor of medicine degree from a top-ten medical school, and a top-ten residency in our specialty of choice is worth less than an undergraduate degree in business from the State College of Northern Bumfoodle (with distinction).
19. We will attempt to resuscitate 96 year-old, severely demented nursing home patients because their family, not having seen them in 8 years, rushed to the hospital when they heard that 'dad was sick', and are demanding that we do 'everything'. We will crack the old man's ribs doing CPR, and wince with every 'snap', suck vomitus out of his oropharynx while we intubate him under chemical paralysis, and push tons of drugs into his veins in hopes that we get him back to his normal state of nothingness (with the family staring daggers at us).
20. We will walk into patient's rooms and smile at them while we wait for them to finish their cell phone conversation and order their super-expensive pregnancy test (that costs $5 at the drug store). We will then send their bill to the taxpayer.
21. We will break the spirit of brilliant and motivated medical students and residents as they shoulder the burden of 100 hour work weeks, an almost universal sense of patient entitlement, and we will pay the residents less than minimum wage.
22. We will give depositions to attorney's representing patients whom we may have harmed in some way and fret about our licenses and family and sleep and whether we really hurt or killed someone.
23. We will work shifting schedules that are akin to flying to Europe to work a few days and flying back here to work for a few days. Then we will take a few days "off", then repeat.
24. We will wonder why we chose to do this.
25. We will tell our kids not to go into medicine.
26. We will search for an exit and despair at our silver-plated handcuffs.
27. We will pay down our medical school debt way into our forties and then think about getting a nice house or car.
28. We will watch "House, MD" and laugh hysterically at that farce while knowing that people think that's what we do.
29. We will work a ten hour shift and realize, right at the end, that we are really hungry and need to pee really badly.
30. We will smile and feel good when that one patient in ten, thanks us for helping them.
31. We will consider going back to school to get a more valuable but much easier "advanced degree" so that we can get out of medicine and maybe retire at sixty.
32. We will pronounce a baby dead after trying everything we know and cry with the parents and cry later too. Sometimes the parents will be drunk..
33. Come to think of it, we'll just do this every day... I was mistaken, it's Groundhog Day.
Posted by 911DOC at Tuesday, April 01, 2008