Sunday, June 29, 2008

Reasons I'm Leaving Emergency Medicine (number 9)

Dr. Deborah Peel was not the name of the female attending I'm fixin' to tell you about, but I like the name so I'll use it. This story goes back, again, to my residency training.

I believe my Deb has a lot in common with the real Dr. Peel... an overblown sense of her own importance, a barely buried contempt for masculinity, and a boatload of guilt and remorse from sources unknown (but which, probably, have to do with the ever-dawning realization that the career she chose over family will not be all it was supposed to be).

Deb got drunk one night at a conference all us senior residents attended. It was 3 in the morning and my wife was with me at a little pizza joint. We were all drinking beer and having a blast. We had just come from one of the last drug-company boondoggles I will ever see, with open bar and super food and music at a very posh venue. We had a blast (ever since that drug company function I have only prescribed their medicine... for everything).

There were about six of us around that table when Dr. Deb said to me, one drunk to another, "You know 911, you need to treat your wife better" (my wife was sitting right there and heard the whole thing).

"Huh?" with quizzical look and waiting for the punch line.

"You walk around like you're some kinda big-shot and you don't deserve to have your wife and you are not a bigshot and everyone thinks you're an asshole," said Dr. Deb.

This was not a punchline. I was stunned. I left with my wife and we went to the hotel where she tried, unsuccessfully, to convince me that I was a good husband and a good doctor and that Dr. Deb had been drunk and crazy to say what she had said. For the record I only beat my wife when she deserves it and only with my non-bowling hand... I usually remove the all my rings too. I later learned that Dr. Deb spent the rest of the night trying to seduce a fellow resident who was 12 years her junior. Classy.

I was so upset by this that I went to the program director and asked if the rest of the attendings felt about me as Dr. Deb did. "No", he assured me. He then wrote her statement off for reasons having to do with her life outside medicine (pending divorce, screwing one of the nurses etc...), and they did, in fact, graduate me on time and with honors.

No matter, I couldn't get over it and avoided most contact with the bosses after that. 8 months to go in residency and I shut my mouth and tried to let it die.

Dr. Deb offered an apology of sorts at the graduation party she had at her house. The apology was in the form of a joint... I declined.

52 comments:

  1. One can only hope Dr. Peel's nipples fall off during the throes of passion.

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  2. 911 - What a stupid bitch she was/is. For what it's worth, the times I have had the pleasure of being around you and your wife/family, you have impressed me. You are a thoughtful, kind-hearted, funny, incredibly intelligent human being. You can take care of me and my family anytime. Hugs! Wife O' Cat

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  3. i was hoping someone would use that word because in this case it fits. pedimom, you are the best... you just made my night.

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  4. That is a horrible thing to say. Also how is your relationship with your wife anyones business? In polite society it is not appropriate table conversation. My Mother would say that she was probably jealous of your relationship and therefore was acting out. My Mom spent most of the 70's and 80's reading self help books.

    ANd if I was residing in your brain, I would say "Wow, what a F-ing Douche bag!!!!

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  5. .
    "He then wrote her statement off for reasons having to do with her life outside medicine"

    A true professional does not let personal problems influence behavior in a work-related environment.
    I do believe that what goes around eventually comes around. It will catch up with her. What an idiot...

    You are such a considerate person. I mean, not all men would think of removing their rings first. I am sure your wife knows how lucky she is. :-)

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  6. If you want to keep that bowling hand safe, keep the pimp hand strong...

    pedimom / catwife: are we talking about the same person? maybe you have a closed head injury suffered concurrently with the ankle break ;)

    911: i hope you said something offensive about female genitals and had a drink thrown in your face. dude, is this fucking cunt related to our associate dean of students? they sound like the same fucking miserable slag-whore.

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  7. You had me until you turned down the joint. Attendings probably had the good stuff, not that Mexican schwag.

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  8. related? only in worldview. 'cat, it probably was fine northern california sinsemilla. she had a patent on it, mixture of kentucky bluegrass, featherbed bents, and n cali sins. the great thing about it is you can play 18 holes on it and then come home and get stoned to the bejeesus belt smoking it. cannonball coming... it's a bit harsh.

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  9. Maybe not related, but the similarities with, well, let's call her "Dean Peel", are scary. Like, as in, secretly despising you for several years and wanting you thrown out of residency / med school if possible... maybe this is a story for another day.

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  10. obtw lynn,
    enjoying your book. readers, lynn price has written a good book. it's worth a buy and a read. she is only paying me 1$ per referral so it's not like i'm getting rich or anything. and based on the crap i have read and not finished lately (shockwave by clive cussler, and some atrocious POS just like it this is a keeper). just click on her link and you can read about the book. it's not all hippy or anything and is an especially good read for romantic comedy fans with an interest in medicine and alternative medicine.

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  11. are you referring to the woman named after a person from a specific country?

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  12. lynn price has written a good book.
    Aw, 911, you have me blushing here. And what would my character, Kim, think of that? She'd probably kick me in the ovaries (if I had any) and tell me to widen the doorways for my fat head. Seriously, dood, thank you. Coming from a doc, I'm really touched. Or is that tetched?

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  13. Lynn,

    Must your books be read in the order they were written or does it not matter
    Thanks,

    911,
    Which one are you reading now?

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  14. donovan's paradigm. kim donovan md, totally hot.

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  15. Hey 9-11 I can gather Deb probably wasn't a hottie, but was she even potentially do-able? Because I think she wanted some of your one eyed Georgia Trouser Snake. The XX residents at my program were mostly affirmative action graduates who went around getting offended by various things like used condoms in the call room.

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  16. she was potentially do-able if you like handsome men. she definitely had a huge chip on her shoulder. i think women make great doctors but i do think there is a subset who put off the family decision till they are halfway through residency and then want desperately to get married and have kids. the more 'modern' they are the less likely they are to plan for this ahead of time and choose a specialty based on this. how many happy female surgeons do you know? how many men would not be intimidated by being a working-stiff married to a hotshot surgeon? it would scare me to death and make my penis shrink down to 8 inches.

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  17. Yuck! It's obvious, she just wanted you. In some weird demented way.

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  18. I put off the family thing for awhile until I ran into that defective condo- umm beautiful girl who caught me in her web. I'd love to be that guy, running the Mercedes to Jiffy Lube, the Poodles to the Doggy Spa etc.

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  19. I know of one female general surgeon who is married to a very nice man who does not seem to be put off by her success. SHe is my Sister in law. And her kids are all really great kids who are well behaved. My brother in law stays home to be MR. Mom and get them to all the stuff kids do these days. For them it works out well. Next time I see him, I will ask him if his penis has shrunk.

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  20. 911 she had the hots for you. Very obvious. Why else would a woman try to put a wedge between you and your wife.

    What a bitch indeed!

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  21. Lynn,

    Must your books be read in the order they were written or does it not matter

    Amy65-c, there is only 1 book out right now - the one 911 is reading. The second one is in the works.

    Really sorry for the hijack, 911...

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  22. Good story - but.....why is this a reason you are leaving emergency medicine?

    After all - this occured before you officially entered it & you seemed to have weathered that storm, both maritially & professionally.

    Are you still so upset over this encounter you must run from it in real life as well as in your memories?

    Seems to be more going on there than is being said?????

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  23. etotheipi - yes, pedimom/wo'cat would be the same idiot who drank too much wine at your rehearsal dinner and fractured foot. Man, I was hoping that had slipped from your memory. What a fun weekend, though (minus the fracture and a cussing Cat who had to handle all luggage and a wheelchair w/me in it at the airport- he swore he'd never take me anywhere again!)Thankfully, he lets me out of my cage on occasion.

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  24. Hey a question for an anonymous doc. Please.

    I think I just broke my pinkie toe. Holy crap my pain is a 10 out of 10 and I need to go weep and wail and gnash my teeth at my local EMR. Just kidding.

    Ok seriously though, I don't need to do anything but take tylenol right? I caught it on a suit case. It's not deformed. It's the first pinkie toe joint that hurts, the most distal joint. Nothing to be done I'm sure, but whine right? Should I stop exercising until it's better?

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  25. Buddy tape the last two toes, ice, and motrin ( or dilauded if you have some) Will heal in 3 or so wks if toe be broke.

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  26. Sweet! Going to make myself a dilaudid on the rocks!

    Thanks Cat!

    Hey ya'll Texans out there, does anyone know about living in San Antonio? Safe places to live there?

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  27. dear anon,
    good question. refer to post on reason ten and same question asked there. dr peel ends up not being an outlier but a common personality in medicine. one of the reasons i went into medicine was that i thought, when i was a child, that the best group of folks were doctors. it certainly WAS true when i was growing up... then i went to law school and found out that in a class of over two hundred that i found very few folks to like. medical school was different. i had a fantastic class of great people, maybe three or four of whom were very up front about wanting to make as much money as possible. the faculty, with rare exception, were the embodiment of the ideal physician. BUT, from residency onward, i have been perpetually disappointed. that is not to say there aren't fantastic doctors who are also fantastic people, but i seem to have a knack for finding the bad apples, or, more likely, because i'm outspoken, the bad apples seem to find me. more to follow.
    cheers.

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  28. I had the same question my dear friend. There are assholes in every profession. I was hoping our colleagues were not one of the reasons for you wanting to leave ER medicine.

    Question: Do you think the quality of people entering medicine has changed or could the challenges of practicing medicine today be contributing the attitudes you are seeing?

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  29. lofty,
    i don't know whether the quality of those going to medical school is decreasing. it would seem logical that medical school would now be unattractive to many folks who are independent thinkers and desirous of a career outside bureaucratic dominance. i think you would have a better insight than me here. i DO think that surgical and medical subspecialties are not filling their fellowships and i think the reason is obvious. i maintain that the REAL crisis in medicine in five years is not going to be a primary care crisis, but a surgical crisis.

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  30. lofty,
    i don't know whether the quality of those going to medical school is decreasing. it would seem logical that medical school would now be unattractive to many folks who are independent thinkers and desirous of a career outside bureaucratic dominance. i think you would have a better insight than me here. i DO think that surgical and medical subspecialties are not filling their fellowships and i think the reason is obvious. i maintain that the REAL crisis in medicine in five years is not going to be a primary care crisis, but a surgical crisis.

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  31. I haven't heard of an impending shortage of internal medicine specialists or surgeons. Certainly, lower-paying medicine specialties like endocrinology are having a difficult time finding anyone to spend 2 more years training with no more income than most primary care doctors. Most endos you will meet out of training over the next decade will be foreign born and trained.

    We graduate 25 internal medicine residents a year and less than 5 go into primary care. They are going where the money is...GI, cardiology, pulmonary critical care, or hospital medicine where they do shift work essentially.

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  32. lofty,
    in the last match vascular surg filled 75% and 25% of those were foreign trained. CT surg filled 60%

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  33. I stand mistaken.

    Primary care crisis.

    Surgery crisis.

    Endocrine crisis.

    Let's hope you don't show up needing your pituitary gland removed urgently in the next decade! Ha!

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  34. I went back over those comments from reason #10 since you pointed out your reasoning was the same.

    Forgive me, I'm trying to follow. It seemed as though that rant went back & forth "the old way was better", "no this way is better", no "a compromise is better".

    Now, the discussion turns toward younger physicians coming in compared to when you entered, which appears irrelevant in this situation since your good drunk Dr. Peel was your colleague & of "your era" so to speak.

    But, a few of your comments seem to stand out. First, you went to law school and didn't find many to like, although you were in a large class - oddly, you never made a comment on the work you were exposed to or might have done within law - just the people.

    Now, you enjoyed your medical class, but not your residency class. One could wonder it might have been the smaller class, although the smaller number of people in residency were more objectionable. One could wonder that medicial school in & of itself is a rare course of education which combines didactic work & clinical work in a setting you won't get anywhere else (coming from my experience & that of my offspring who is just about to finish).

    So - now one wonders & you do yourself since you pointed out perhaps you just attract bad apples. Rather than attract bad apples, perhaps you don't find satisfaction in the "stagnation" which comes with spending decades in any one career. I don't mean stagnation in the sense that nothing ever changes, but each of us must go in day in and day out, night in and night out. You see the rare thing you've not seen before on occasion, but for the most part, you've been trained well & can sort out most all medical problems presented even when not presented just the same. But - it is still emergency medicine - not trust law, nor trying to write new computer program, nor trying to market a new style of snowblower....or any other jobs thousands of others have which don't change tremendously once you've become good at it and been at it long enough.

    You found emergency medicine, perhaps partly to keep that constant toss up of patients, changes in acuity and exposure to all sorts of medical and surgical issues.

    However, you don't seem happy and you hold on to these apparent "slights" or bruises to your ego from long ago. No one can tell you other than you that at some point, you let some things just go and if you don't they'll wear you down from inside. Dr Peel is probably practicing somewhere & she might even be happy. Would that make you unhappy to know that?

    I'm as old as Old Fart and I'm wondering if its you - not the system, not the new physicians, not the patients, not the administrators or insurers.... Medicine is and always has been a career of change. How we handle things clinically changes and the cirucumstances under which we practice changes - it always has - sometimes for better & sometimes for worse. But, the one thing you can count on is - change.

    Perhaps it IS just you and being unhappy with where you are with life. Not unusual & certainly not unreasonable to want to change what you do for a living to find happiness. People change jobs, towns, spouses all the time for just that reason. Absolutely nothing wrong in that!

    But - Dr Peel was not the reason. Sadly, you've held onto this story. On first read, it was oddly funny. Now its just sad - and not for Dr. Peel.

    Best of luck in finding that elusive thing that has no pulse, can't be seen on imaging or in lab work. But, when you don't have it, you & everyone around you knows you're no longer happy. When you are, there doesn't seem to be any one reason why. Odd....

    Out of curiousity - does Mrs. 911 remember much of this story? I'm also waiting to see reasons 1-8. They'll give more insight perhaps.

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  35. at last dr peel comments on my blog!

    thanks anonymous, for the monday morning quarterbacking and dime store psychoanalysis.

    believe it or not the first thing that occured to me was that I was the problem. i may be.

    also, i think that if you continue to follow the series that the higher numbered reasons will be more to your liking and more indicative of issues that plague the whole of medicine and modern society.

    angry? yes. bitter? yes. quitting? yes. giving up? no.

    mrs 911 may choose to put her recollection of the events mentioned here. i will ask her to.

    as far as law goes here's the short version as i lost the long version in a mysterious blogger glitch...

    i chose law as an 'out' from medicine which i saw, at the time, as being too much for me to handle. ultimately the desire (my 'calling' to medicine if you will) overcame my rational choice but there's more...

    in law i met, not people in pursuit of the eternal, but people willing to think very uncritically and pore monotonously over the latest judicial hijaking of our legal system by activist judges.

    my summer clerkships, which i approached with the attitude of 'well, law school may suck, but now i'll figure out what the practice is all about' were worse than law school.

    the under the table power-plays and back-assward reasoning all done in pursuit of the billable hour were repellant to me. it also became obvious fairly quickly that the partnership track, at least with the large firm i was with, was replete with land mines and not for plain spoken folks like myself with a short fuse.

    enter medicine. a touch of the eternal, a touch of God, the ability to be the one who holds the line and make a real difference, now, with objective and changing, but not nonsensically changing, truths.

    from day one in medical school i was with my kinda folks. as opposed to a few friends in law school i made friends, within the first few weeks, who are still some of the best people i've ever met. you may have read some postings from some of them.

    enter emergency medicine. right up my alley. what's important now? what's the right thing right now? i'm good at that. peds to geriatrics to psych to OBGYN i'm the guy that can take care of you for the first few hours.

    lives saved? many. lives lost. many. bad news delivered? a lot. good news delivered? a lot. important? i think so. the most important thing i can do? probably. a calling? yes. a career? unfortunately for me, and, i like to think, my patients, no.

    to get back to the point of this post, the reason it is not going to end up being a career, is that dr peel and dr spanz are legion. they are already in positions of power and their clones are multiplying.

    doctors surrendered their territory to a bunch of non-clinicians the minute they said 'yes' to medicare/medicaid and fee for service was buried.

    no, i am not arguing for a return to fee for service, but i am arguing for a return to health care as a privelege and not a right. a system where you pay what you can, not nothing, for your care. a system where (shudder) decisions affecting patient care are made by (shudder) me, or another physician practicing in the ER.

    the decisions that directly impact patient care and outcome today are made by clipboard carrying putzes who go to bed at 9 every night and come in bright and cheery every day to tell me how to do my job better.

    if i thought this would change anytime soon then i would stay. but the fact is, that me pointing out the problems gets me nothing but trouble.

    example, suggesting at my last facility that we have signs in the waiting room encouraging our spanish speaking only patients to bring a translator with them got me branded 'racist'. suggesting that people actually pay something for their care is laughed out of the building while bills are inflated and people are overcharged to make up the shortfall.

    meanwhile my lobby is all atwitter about the proposed cuts in medicare funding. our livelihood, now, depends on the government, and aside from a few of here and elsewhere, we are going to smile and be grateful that the government deigns to not cut our pay.

    the time is ripe for an entrepreunurial type to open a clinic that gives great service for cash. it will end up happening anyway and the wealthy will still get great care. meanwhile, absolutely BECAUSE of EMTALA and ridiculous tinkering from legislators and groups who demand, and demand, and demand, the care for the general populus will suffer.

    so. ER? great fit for me. layers of beaurocracy with nincompoops calling the shots? terrible. i did this to be the boss in my little area. i am not. i will never be the boss in the current system even within the walls of the ER.

    the thing that drives me crazy is the thought that this is NOT the way it was forty years ago. hence my longing for 'the way it was', whether that is based on a clear view or not is, well, unclear.

    taking my ball and going to play elsewhere.

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  36. Comment from Mrs. 911

    Dear Gentle Readers (don't you just love Mrs. Manners?);

    I've tried to stay away from this battlefield blog but my presence was requested for some interesting questions by anon. So here goes...

    Yes, I do remember the night in question (at least I remember THAT part of the night, although the rest gets a little blurry). Those comments were made and she was as drunk as the rest of us.

    Does that excuse her comments? Certainly not, 911 had never "asked for it". She's lucky she's a girl, since the last person to have made a comment like that promptly got a fist in the face afterwards (another large bash, maybe 911 is an easy target for loose-tongued drunks?)

    I think that anon asks some interesting questions, but I will tell you that 911's places of employment are straight out of Orwell's 1984 with doublespeak and all.

    The administration of the "hospital" requested that employees stop sending emails because "they were tired of hearing complaints from all over the hospital".

    I've got nothing against ostriches, but perhaps the head-in-the-sand approach might not be the best way to fix an understaffed, overworked facility.

    Strangely, they've had a difficult time retaining physicians and nurses! Go figure.

    On that note, anon, I just heard about a pediatrics nurse who has been working on the floor for 30 years who just quit. She simply could not take the dangerous environment that defines our local hospital. Today the telemetry floor had 8 patients and 1 poor little nurse who was taking care of all of them.

    It would have been at that point I would have quit. Last year, our assistant CEO was heard to say, when the CCU was at critically low staff with full unit over the weekend, "Well, no one DIED, did they?" Are you kidding me?? That's pitiful and sums up the uncaring, dangerous attitude of people who don't know better.

    Thanks for the invite, 911. You are a well-endowed, handsome young thing! By the way, your wife-beater T's are clean.

    Mrs. 911

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  37. Dear Dr & Mrs. 911,

    So glad you both showed up to the party this evening (morning???).

    It shows an interesting side of both of you! Mrs. 911 - you recall the evening, but from your point of view, what does any of that evening have to do with what is occuring right now in the environment your husband works?

    Honestly - I have no judgement at all of your choices - they are difficult & have taken years to come to, I'm sure.

    I, like you, left jobs due to staffing & what I've felt were critical issues in which I felt trapped. There were days when the only way out was "not to kill someone that day by my negligence or being overworked" - I think I said that very thing when I left my last job and I announced my decision to my spouse.

    However, there are alternatives - and you seem to have found some Dr. 911. I've actually had to use services similar to what you describe when I had to take my 89yo mother to my brother's funeral. He passed away at 59 after a valiant fight with prostate cancer. He was a lawyer - but not one you describe.

    He chose to take the underdogs fight - he had a small practice with 2 others & fought for those who had little, but who had been oppressed. He did not worry about billable hours & a partner track. So - he never made tremendous amounts of money, but- he was happy.

    When he died, there were hundreds at his funeral. He was well liked by many, although an adversary to most. However, he had respect - and that itself brought him happiness.

    Sadly, on the way to his funeral, my mother fell and scraped off the top layers of her leg - on warfarin & I'm in a different state...you know the rest. She WOULD NOT go to an ER because this was what she had to do, so I did what I could do with what I had available. My brother had physicians as friends (obviously - he had undergone many, many rounds of chemo - so I had access to those who could intervene and who were there and availble. But she would have none of it. Dignity brings with it its own problems).

    However, the day later, we went to an urgent care clinic and there was a very nice urgent care physician who kindly gave advice, but couldn't offer more than bandaging & mupirocin and to see her PCP when she got home (she has not!) since so much time had lapsed - very appropriate.

    So - there is a place for you. He charged $75, she paid by credit card & was reimbursed 1 month later by Medicare. Yep - you can do this - see little old ladies from out of state with scrapes, up to date tetanus & on their way home.

    But - think long and hard - is this what you want? Is this the only way out for you?

    Is there any way you can think to work within the system of emergency medicine to obtain the changes you seek and desire? If you're in a small town - no. You are sunk. And realize - if you've made enemies among the medical, nursing, pharmaceutical business within your town, you are sunk as well because they become referrals.

    I cannot comment on your hospital - I don't know it. However, I do know that within hospital administration, there will be a tremendous shakedown of borderline profitable operations. Yours may be one of them. If Mrs. 911 is correct and you are living in an area of Orwellian double speak, then - move! Why live in such a backwards area since that mindset infuses everything - healthcare, education, city funding - even what you might seek - zoning and licensing!

    Mrs. 911 - I can appreciate a hospital being flooded by employees sending complaining emails (does anywhere even allow this???) - those should all be routed via their supervisorial chief and dealt with at the administrative level. Each individual should not be able to flood an administrators email - that then becomes spam and not productive. There is a process and way to make changes & you either work within the system - or leave - just as you've both chosen to do.

    However, I must disagree Dr. 911 - I live in one of the most multicultural and multilingual states there is. We do not insist the patient bring a translator (how in heaven's name can you even expect that in an urgent situation??). The telephone company will provide translator services for free - utilize it!

    I guess I'm suggesting - this change will not solve your problems. Both of you are still upset over Dr. Peel's poor behavior at a drunken party. Both of you can get over that (yes - dime store analysis) and move on - or not. However, both of you still place "blame" on Dr Peel & her "ilk". What does a drunken resident bash have to do with anything in 2008 with regard to politics and medicine?

    Your healthcare dime, mine and the whole country's healthcare dime is now very, very scarce. When I had no choice with my mother, I was willing to take her to an Urgent Care center - but, we were the only ones there. That was very "telling" to me! I would be money there was a wait at the ER. It did occur to me to wonder how an urgent care guy could pay for the overhead of that operation....

    Do you want to see just those that have sore throats, think they're pregnant, scraped shins on warfarin? Is that your choice?

    Or - can you find it in your very educated self to find a way to work WITHIN the system? Perhaps not since Mrs. 911 supports your decision. But, you have legal knowledge and medical knowledge. From my perspective, it would be wasted doing stat strep cultures or flu clinic lines in the fall.

    Sadly, I think you might find your years of practice ahead just a bit more than boring and slight less profitable since the more advanced ED's are adding Urgent Care to their model to take the load off ED & to change billable hours to an outpt model. These will be your competition. I'd choose a hospital based Urgent Care in a heartbeat before one with a shingle with Dr. 911 - I don't know you, but I do know your hospital must abide by some rules. I also know what my recourse is when they don't! But, plenty of physicians fly under the radar - I know them well!

    Still - I appreciate both your inputs and look forward to hearing reasons 1-8. Thanks Mrs. 911.

    But - I don't appreciate the reference of me to Mrs. Peel - was that really necessary? Is that what gets you into trouble? I am old - yes, but not yet dead.

    All the best with your choices! I hope my offspring does not become this jaded, since this has been the only choice my child was ever interested in since said child first started on this journey - and it is a journey - not a destination.

    Happiness is a choice - not a given. Thats my only point. If your happiness lies in doing the urgent care model - I wish you all the best!

    Your druken Dr. Peel did not affect that. You ALLOWED her to affect that and still do - see the difference?

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  38. dear anonymous,

    more tomorrow, but hey, you came here and offered advice so if you come off like dr peel to me then i call it like i see 'em!

    urgent care would bore me to tears but right now i'll take bored.

    finally and again, more tomorrow, it is precisely the turn of american society towards 'rules' or 'procedures' or 'protocol' for answers that results in the mess medicine is in right now.

    doctors are fully trained, exceptional experts in their fields. the answer, to most question in the ER and ALL questions regarding care of patients are best answered by us, not the government or clipboard people and not by protocol or process. protocol and process are for non-experts.

    i say this fully understanding the utility and necessity of laws and the rule of law, but show me greatness and great acheivement without a personality behind it... iow, something created by a bureacracy that is GREAT, and i'll take a look.

    and by the way, i agree that dr peel didn't do this to me, again, dead horse, i chose these drs as examples of a type... a type that migrates to the top of huge human factories... a type that used to be shunned in medicine and is still shunned at the hightest levels no matter what field you are talking about.

    someone, somewhere, sometime has to answer for decisions. i am ASKING to be this person in my little world. i am asking for the buck to stop with me, but the only place it does is when i'm a defendant in a malpractice action, an action made more likely by people with clipboards, people with the legislative pen, politicians, and folks who CHOOSE to ride on the backs of others.

    cheers.

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  39. Don't leave emergency medicine, 911! Check out our hospital first...Fully staffed, working equipment, specialists always reachable, good payer mix, get to leave on time, hospital-paid insurance, incentive pay for seeing more patients and not being layzee, and only a few real tools to deal with. Optional side-jobs in rural areas included. Not sure if we're hiring per se...but...

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  40. Anon, I think you missed the point. Dr. Peel isn't the reason. I believe that she is an example, an archtype. It's not that one incident that you so doggedly keep analyzing, it's a case in point.

    At least that's how I'm reading it over here in layperson land.

    Nice to hear from you Mrs. 911.

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  41. I appreciate the banter Dr.911!

    Have a chat with Dr Oldfart. If he is truly as old as I am, he can remember the early 70's - perhaps the "peak" of hospital care.

    We called the shots, we determined when the pt was ready to leave - not a social worker, an insurance monitor, a nurse case manager - NOPE - it was all US!

    We arrogantly insisted the pt be admitted the day before for a cataract removal & stayed for 3 days post op. CABG - a very new procedure took 3 pre-op days & 10=14 post op days. We admitted pts for workups which were benign or were for lonliness (holiday admissions). We insisted the hospital formulary carry every cephalosporin that came out & they came on the market about every 3rd month.

    We brought this on ourselves - yep - those of us you hold in such high esteem. We were fee for service based & if we could keep the pt one more day, do one more test - we managed a higher fee.

    Its embarrassing to think what we did then. We could not monitor ourselves, so others took over. They developed protocols and processes. Good things happened - pts stayed less, procedures became more rapid, fewer complications occurred. Bad things happened too - when complications happened, pts were at home & not monitored. Formularies became strict - I no longer had the choice of medications I wanted and could give them when I wanted - I had to follow protocol. That made me mad. But, it made these procedures and treatments cheaper (yes, less reimbursement for me), but made them better too. The change became a beast that took on a life of its own.

    But - is that beast any worse than the beast we had before? You might be too young to know that when there was a real admission which turned catastrophic & resulted in a huge medical bill - one spouse could lose the home to pay for the bill of the ill spouse. I sadly was part of the care of some of these patients & its nothing I'm proud of. Fortunately, that can no longer happen.

    We no longer have pt dumping since its against the law, but now we take all comers & for free (well on the govt - our - dime). Was dumping better than care for free? No - neither one should be an option in this country.

    I agree - medical people should be the ones who determine the medical decisions regarding patients. But - they (we) are not the best with regard to making the economic decisions. Why? We showed ourselves to be greedy b*st*rds in the 70's who were unable to control ourselves.

    Even now - our colleagues who are in the outpt specialities of cardiology & IM don't have a clue how much the drugs cost their patients. Some of my colleagues don't know what the Medicare Part D "donut hole" is. I'm close enough to that it is now become a real part of my life. Our hospitalists won't even take the time to write options for discharge for drugs that are easy - like PPIs or statins. That makes therapy wait for the mess to get sorted out & it won't get sorted out by the hospitalist!

    We as a group of physicians are sadly inexperienced in economics and have no patience with those who are.

    You are young enough to learn to work both the medical & economic end of this healthcare system.

    Perhaps, while you suffer boredom with urgent care, you can pursue an MPH and become a real agent for change rather than one of the many voices of complaint.

    Yet one more degree to add to your wall. Perhaps you'll find that group of people more agreeable, but I think not......you seem to look for a fight. Just like you - I call 'em like I see 'em. Not a good sign when someone blows thru 2 careers unhappily.

    Yes - I'll wait for tomorrow & the next day and the next -

    Best of luck!

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  42. Ahh I relish the Dr. Peels, Spanz's etc. What would life be without Enemies? Think how boring American History would be without the British, Indians, Civil War, Spanish, Germans, Russians, North Koreans, Vietnamese, and Arabs. Don't Curse Dr. Peel, its like the Mongoose cursing the Cobra, Grasshopper.

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  43. dear anon.
    yours is the first explanation that makes sense to me as to the 'why's. i do know, that if i had been in practice then, i would have fought vocifersously against EMTALA as killing a fly with a sledgehammer, but i have no doubt that hospital stays were stretched to max the bill. now they are shrunk to pay for someone elses bill. i think the latter is much worse, but you may differ.
    cheers.

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  44. here's an appropos example from outside of medicine regarding people who don't know screwing up the people who do.

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  45. long winded anonymous: Old dude, get a screen name and join the conversation regularly! You've got moxie, grandpa... I disagree with most of what you said and I think your analysis of the post is flawed, that said, you write well and make for interesting conversation. 911's point (i think) is that the trend in medicine, due to the increasing power of administrators and gov't and the decreasing power of the MDs, ATTRACTS and PROMOTES douchebags like Dr. Peel. The man is spinning a 10 part yarn, give it time. Save the psychoanalysis for your therapist.

    911 wife: Psyched you are on board! I question your identity due to the reference to 911's dong. I've seen his penis, many, many times. Not pretty.

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  46. etotheipi,
    the only time you saw it angry was after i popped the rohypnol in your beer. and you wondered why your ass was bleeding the next day! you seemed to enjoy it though... told me not to stop and to put some 'oomph' behind it. sorry about the tear and resulting fistula.

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  47. That WAS an odd camping trip...

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  48. Anon, I do remember the 70's, at least the last part! It was a good time, but..A few of the things you mention ie hospital pre-admission days, longer stays, drug choices etc I disagree with. I do not recall thinking of keeping a pt longer to make more money, nor do I remember any colleagues doing that.(not that I doubt that it happened)It was the way of practice back then. Nobody dreamed of having a CABG and going home in 3-4 days!!My God man, we just split them from stem to stern! It took a few years to find out it was safe to do(for the most part)As well as many other practices in medicine..
    I see 911's story as, in itself, a method for ridding himself of whatever demons plague him and also give a little insight and comedy relief from our daily grind.
    Just relax and enjoy the reading. Don't try to put him on the couch, it won't work and besides he ain't worth saving!!!
    And 911, things in the mirror always look bigger than they really are...

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  49. I'm sorry but the man who came up with the "lookey-loo" post should simply NOT be allowed to leave ER medicine.

    Really, when I am having a sh*t day I meander over there and end up laughing every time.

    That is pure comedy.

    You sir are a jackass and a genius.

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  50. dear albinoblackbear,

    you just made my day. thank you.

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  51. I think of the lookey-loo post every time someone is poking their head out and staring us down at the nurse's station like I JUST didn't say where the call light was.

    Sit down, push your button. If you stare at ME, that means I have to interrupt what I'M doing and, perhaps, your loved one's desire to have the lights dimmed isn't quite as important.

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  52. lookey-loos multiply with increased ER wait times. there needs to be a guvment program or something and now that i think about it, i do believe i can get funding for a study (as the hard-core super complicated bench research is just rare in what we do outside of resusc.) to see if lookey loos impact time to discharge or bed. i bet they do have a positive impact on both these thing because they are so fucking annoying.

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