Monday, April 13, 2009

Learned Helplessness

I am not saying that Emergency Medicine is the only medical specialty in which learned helplessness is an inevitable outcome for its practitioners... I'm sure there are many other professions and specialties where this is the rule.

If you are unfamiliar with the concept of learned helplessness it is best explained by the following experiment. Three groups of dogs were placed in cages. Two of the groups of dogs learned that by standing in a particular section of the cage that they would receive periodic painful electric shocks through the floor. They quickly learned to stand only in the other section of the cage. The third group of dogs, however, were randomly shocked whichever side of the cage they stayed in. Over time they just sat down and took the pain.

The catalog of ER and EMS abuse is impressive as it is and some of you must be asking, "Well, why don't you do something about the abuse?" Good question. The answer is that every time a reasonable solution to the crisis has been tried it has been found to be illegal by a court of law OR has brought such an outcry from victim groups that the hospitals and EMS services have basically just stopped trying to end the abuse.

A $5 copay for all ER visits or for all EMS transports has been declared illegal. Any other ideas? It's a hell of a thing to be a subject matter expert in a medical specialty and have absolutely no say in how we attempt to weed out the 'true emergencies' from the abusers. We have, literally, no say.

It doesn't help that our national colleges seem more interested in parroting the latest feel- good 'aunt Betsy' aphorisms than in advocating for their physicians who burn out, on average, ten years into their careers. Call me crazy, but if a bunch of us ER docs quit, and the specialty is already underserved across the country, it wont matter much if you are riding the ambulance in with an intracranial hemorrhage or a broken toe, you will not receive care.


  1. $5!?!?!?!?!
    Thats a pack of Cigs, a 6-pack, or five Pick-3 tickets...
    Now get your effin Shine Box!!!!!!!

  2. How to buy prescription drugs...? My doctor prescribed vicodin for a while back, my back hurts, I think it is a great help, but in my country it is difficult to find, it is paramount to have my information on it and found information about the medicine, because it provided me.

  3. it's legal in Virginia to charge inmates up to 5 bucks a day while incarcerated....go figure

  4. Have you seen the latest "Cost share" idea coming from the smart ones in DC, they are still taking public comment...we will be able to cost share up to 5.10 based on a tiered scale for patients that have been triaged and don't require ED, rather need an urgent care visit. Makes so much sense, as we can always estimate to the penny the exact cost at time of if most of these folks even have the $5.10...who is going to turn them away for $5.10. However, I'm quite sure it cost a lot more than $5.10 to write the proposal and publish the 27 pages of this genius idea!

  5. Okay, this kills me! I read your blog regularly, love it actually. But here's a real problem, a real "rant", and you get 4 comments on it, when you generally get well over 25 to mostly everything written. Could it be that most of the people reading your blog, other than your colleagues, are the ingrown toenails, the "oh no, I've been throwing up for an hour, I'm dying" sort :) The smiley face is meant to be, at the very least, sarcastic. Shite, health care is going to the dogs!

  6. thanks kate,
    i didn't think this post would get many comments because there are very few people who love or even like their work. too bad as it is true that if you do what you love you will never work a day in your life. problem for me is that i love emergency medicine, but what i do is more like emergency social work and conflict resolution sprinkled with a few sick people now and then.

    the other night i took care of, and admitted to the hospital, a woman had called the ambulance because, in her cocaine fueled psychosis, she had had an 'egg burp'. i was curious enough to ask what an 'egg burp' was and, as it turns out, it's a burp that smells like an egg. she wasted 6 hours of my time, almost got her nurse to quit, and was admitted until she cleared from her psychosis which she induced by sticking a needle in her arm and you are paying for it. so i think it's fair to say that in this endless parade of entitled misery that i actually hate most of what i do and the damnable thing about it is that is doesn't have to be this way and SHOULDN'T be this way were it not for the victory of PC, relativist thought backed with the power of the ever growing government/nanny state. thanks for the kind comments.