Reasons I'm Leaving Emergency Medicine (number 2)

This is a turd.

In medicine today this is what's known as a beautiful turd, a really nice turd, or not a turd at all, but something that only resembles a turd to the untrained eye. What this really is, according to those in charge today, is an opportunity to partner.

See, while I see this as a turd, this observation is not welcome. In fact, it may impact our Press-Gainey scores or our core measures, and this is unhealthy for the group and for the contract. The cynical amongst you might say, at this point, that those seeing this as a golden poo are merely motivated by money but no! They are motivated by a collectivist wisdom which is but a foretaste of humanity's next step up the ladder of evolution.

I admit that my feeble brain is not able to see this, so I am going to go hang out with other non-Mensans and other non-leaders.

To me, medicine today is a turd because we call patients 'customers', try to do better 'customer service' with all comers, most of whom do not meet the traditional definition of 'customer' (ie someone who pays for their services), worship at the feet of a terrible unfunded mandate called EMTALA, and also worship at the feet of a bunch of worthless committee hacks called TOFKAJCAHO (the organization formerly known as JCAHO).

We also shuffle money from the folks who actually gave more than a second's thought to their health to those who have made, and continue to make, poor decisions. In other words, there are tons of doctors and hospital CEOs and legislators who fancy themselves as modern-day Robin Hoods. They are not, they are the Sheriffs of Nottingham, but then again who am I to say, I think the thing at the top of this post is a turd

EMTALA has killed the best medical system in the world, and why? Because some douchebag legislators thought that it would buy them votes (and they were right). I also know how to fix our mess, but, since I major in plain-talk, I will never be elected nor will anyone who says this and here it is.

Everyone in the country should pay for their own medical care even if only for a small portion of it. Buy insurance or not, your choice. Get catastrophic coverage only and establish an HSA. Finance your care. Can't get insurance? There's no one to blame but the authors of EMTALA.

If you walk out of the hospital or out of the ER two hours after calling an ambulance AND you really have no money, no problem, we can arrange for a few hours of community service at the local free clinic. If "the government" wants to mandate that no one be turned away from the ER then let them pay for the care we are legally obligated to give or at least let us deduct it from our gargantuan income taxes.

Emergently ill patients should get our best and that's exactly what they get. They should then pay for what they received in whatever way they can. Insurance rates? Down immediately. ER waits? Gone. Bullshit EMS calls? Gone. Doctor retention and satisfaction? Up (and quickly). My job? Immediately better because I am not constantly presenting the golden turd to my consultants. In other words I'm for the good old American notion of personal responsibility. Hard in the short run, the only sane way to do things in the long run.

Pictured above is a turd. It can not be polished and there's no way to pick it up by the clean end.