Wednesday, May 26, 2010

Entitled or Amnestic?

It sure SEEMS like the entitlement mentality holds sway over a greater proportion of our population today than it did when I was in college. It SEEMS like the numbers back this up. It SEEMS like in just ten years that the percentage of patients I see in the ER who speak to me like a bastard child has increased. Am I right? I mean, I'm starting to sound like my dad so I'm a little less than convinced. Perhaps I am amnestic, forgetting the trials of our past, like Jimmy Carter for instance. Comments?


  1. I think you're right. A couple years ago my mother fell and shattered her wrist and I remember going to the ER with her a couple times after her surgery when her hand was swelling so much inside her cast that she couldn't stand the pain (it probably didn't help that she refused to take more than half an oxycontin at a time since it made her vomit). As much pain as she was in, she sat there quietly and patiently, even as all the morons around us whined and complained. It was ridiculous how many people were there, for supposed emergencies, even though their kids were sitting there coloring, or they were talking on their phones, etc. I find it hard to believe you can be a 10/10 on the pain scale if you can bitch to your friend on your phone and crack jokes about how loud the drunk guy in the next bed is. And yet when the doctor finally did arrive, they'd yammer on about how they were in "soooooo much pain" and "how dare you make me wait more than 10 minutes!"

    My personal favorite was "If I went to _________ Hospital [in the next city over] I would have already been seen." WTF? Then GO there. Doesn't make any sense.

    I could never do EM, I don't have the patience. Plus I like to be able to think things out for the most part rather than going into action at the drop of a hat, if need be. I really commend you all for what you do... even if most of the time it isn't an emergency.

  2. Hell yes. People are getting extremely entitled. They want us to be primary care/surgeons/specialists all at once. They want to be fixed right then and there with the answer to their 20 years of complaints. They want to strong narcs (those 10s, not those 5/500s). They want a meal tray. And they want it all now.

    And they know they get to fill out a fucking patient satisfaction sheet. They see the damn advertisement in the waiting room. They cuss us out like we are their bitch. If they dont get what they want, they complain, and administration comes down on our ass b/c these trolls, non paying patients affect their press ganey scores.

    I say fuck this shit, fuck Press Ganey, and fuck JCHAO. When are we going to form a doctors union?

    -ER Doc

  3. Another reason to get out now and not look back. The practice of medicine is not what it used to be. It is one thing to deal with the day to day stressors but another to deal with the way in which people disrespect Docs.
    The public has more regard for the winners of singing shows.

  4. I don't see patients who insult me or use profanity, unless theyre drunk, or really sick or hurt, cause its the law, and I always use this fake East European accent when I moonlight, 1;cause its fun, its sorta like your acting in a movie, and 2; if I ever go to court, it'll hurt their credibility when the "Foreign Talkin" defendant doctor sounds like Ernest T Bass's idiot inbred half brother, which is another voice I do really well.
    What happened to Cecille??


  5. Can we really form a union? I would love to see a situation where we have rights - and - is that the best way?

    I am all ears... there are days I really hate the job, despite the job security.

  6. Be still. Be still you whiny doctor-bitch and treat my cold. You are amnesic, not only for forgetting the trials of those before you, but forgetting my trials of me, who stands before you now.

    I had to wait nearly six minutes for the ambulance and another five to see the triage nurse. How dare you treat that gunshot victim while I wait here in the hall, I arrived first.

    I have half a mind to text the state and report you, my state medical card guarantees me medical care, making me wait is wrong.

    Who is Jimmy Carter anyways? And what is he getting that I am not?

    Thanks for the post. I think it's just that we are becoming a culture that is less polite and more demanding. I blame it on Bush.

  7. It's not just you, 911DOC. The entitlement mentality is getting worse by the day. And it's not just in doctor's offices or the ER. They expect to get what they want when they want it. And not to pay for it, either. Any kind of job dealing with the public feels the wrath of these people.

  8. I'm not sure how to clearly word what I mean here but I'm hoping you understand this.

    I think all the whiny demanding rude people are making it very difficult for the rational good people. I am kind of quiet, don't want to be a bother, etc. Because of this sometimes I feel like I get screwed because the loud person gets the attention/better treatment. When I had surgery last July, my roommate was a horrible bitch. And often people seemed to go out of their way just to make her quiet/happy. I just wonder if sometimes trying to shut the loud people up actually reinforces their behaviour because they get results faster and learn that it works.

    This doesn't seem to apply to you, just in general I think in life we (the collective we, not you or me) have pretty much reinforced this kind of behaviour and by doing so, have made it something that is not as much out of the ordinary. It's actually something I have noticed when people tell me my kids are so good and why can't their kids be more like mine. Well...start following up your words with actions, make things have consequences and they might be.

    I sure wish there was some way to let you treat patients without having to try to parent them as well. I can't believe no one appreciates the incredible gift of your knowledge and skills you are sharing with them. Maybe the ER needs a mean mom to put everyone in their place? I just think it sucks that no one seems to have any manners/respect anymore. And in about a second I am going to have to start yelling at kids to keep off my lawn or something with how old this all makes me sound.

  9. Just took a self defense course sponsored by learn to protect my self from irate patients or of the verbal examples was continual racial slurs by a patient and the solution...drum roll...get someone of the same race to care for them. chin ----> floor. The last is so non negotiable in my mind that I'm still reeling.
    Now get your damn self over here and take care of this 10 of 10 hangnail pain.

  10. thanks gang. validation from people very similar to me. it's gotta be worth something, right?

    frank, great idea. ernest t. bass. maybe i'll get me a U-ni-Form and go a courtin'. trivia, what was the patriarch of the bluegrass playin' hill family's first name?


    one of the idiot results of 'customer service' intiiatives in the ER has been to treat everyone like customers. so few of them are, so few are paying for their care, even a dime, but they get to behave worse than movie stars in the ER. hell, if i took care of a movie star i would pitch 'em a screenplay and make them as uncomfortable as the entitled make me.

  11. As a paramedic seeing the EMS problems from the beginning of a call has proven one thing, people are moochers and those who are "in the system" are conditioned to perpetuate this mentality. Politicians, good or bad, by offering these freebies has developed that attitude that any "government product" is free to use, and that medical care is a government product.

    The only good solution would be a program of primary care access where people could choose other avenues for their "free care" than via an ambulance ride to the ED. Make it easy to go to the PCP; but will PCP's be able/willing to subsidize the cost as the hospitals do now? I say not likely.

  12. dear phxg,

    there are a few problems with your plan, but i do like it. here are the problems...

    1. people know that going to an FP or internist will work, but the answers will be delayed by a day or two (send out labs... Xrays... etc...), so they come to the ER.

    2. you note a problem yourself with the willingness of PCPs to field the masses in their offices.

    3. and most importantly, just as you must incentivize the use of primary care providers, you must discourage the willy-nilly use of EMS/ER. how? a flat fee, even if it's five dollars, to ride the ambulance or get past triage in the ER. it can be payed for on a payment plan or with community service or with a bale of hay or a chicken... but everyone must feel the bite a bit or there's no stopping it.

    thanks for being in the rig,

  13. Oh it's a huge problem to overcome. Patient training and education will only go so far until there is a fundamental change to how the method of payment is made. As I see it, forcing everyone to buy insurance (ALA Obamacare) will not fix the underlying issue of the ballooning cost which was initiated by having insurance in the first place. I just don;t buy the argument that ins. cos. or hospitals will lower prices just because more people are insured.

    And like a good on the fly kinda guy, I do have solutions:
    1) Similar to the Australian model, if you visit the ER and it's determined it was not an emergency, you are charged a fee approx $500USD. It is collected through payroll taxes, so if you work, it's collected before you ever see it. This is true of fraudulent ambo rides too.

    2&3) From 1, it will drive people (in fear) away from the ED to the PCP who are being paid through the insurance plan we will all be forced to buy.

    This will force a shrinkage of EMS but an increase of "outlets" to receive medical care.

    The unfortunate side effect will be drastically fewer MDs seeing patients and many more lesser skilled technicians performing primary functions. I don;t necessarily see this as a bad thing, but at what point does a guy like me get placed at the head to run a full code in place of you who is in the hallway watching multiple rooms as the "adviser".

  14. God bless the Aussies.

    in Mexico they simply ask for a credit card or cash when the ambulance arrives. no credit card, no ride. i'm not saying i agree, i'm saying that there are solutions and there are SOLUTIONS, carumba.

    only 25% of codes work anyway so you guys would to just as good as we would. it's all voodoo.

  15. Not to digress but looks as though the medicare cuts are coming once again. Amazing how congress is able to control the lives of doctors to such a wonder there is no respect from the general public...they see we can be played like a bunch of fools...try going to a restaurant and offering to pay 21 per cent less..GOOD LUCK.

  16. people that take our services without paying for them, or have "insurance" that reimburses less than the cost of care, are not "customers." they are "shoplifters."

    what other industry do you know where shoplifters get a survey in the mail to evaluate their shoplifting experience?

    i'm doing my part to start limiting my clinical hours. i hope everyone else is doing the same (or has the financial means to).

  17. Paul,
    I shoplift, I mean, Used to shoplift stuff from CVS all the time, usually stuff I was too embarassed to buy, Condoms mostly, OK, exclusively, and they still used to send me surveys in the mail.
    So thats one.


  18. I can just imagine what such a survey would say:

    Dear Shoplifter,

    We at CVS value your input as to how we are doing as a store. Please fill out the following questions and mail it back at your leisure.

    1. How easy was it for you to shoplift?

    2. Were the condoms close enough to the door for you to make an effective escape?

    3. Was this your first time stealing condoms?

    4. Did you find your shoplifting item to be successful in its purpose?

    5. How did your partner feel about it?

    6. How likely would you be to shoplift from us again, based on your experience?

    7. Would you recommend shoplifting from us to a friend?

    8. Were employees friendly and helpful while you were shoplifting?

    Thank you for your time,

    CVS Department of Shoplifter Relations


  19. don't forget

    9. based on your fleeting glance at the pharmacist while you were stealing our products, would you say that they have an adequate grasp of the principles of pharmacology? for added fun, their pay will be influenced by your response. yay!

  20. ANON 1:28--identify yourself, dammit!! You owe me a new laptop, as a very sticky wine cooler was just sprayed all over my lappie...and btw, I almost aspirated whist laughing.!!!

    Pattie, RN
    (ER ya. but it is "IE" @ the end!)

  21. Since I mostly feel like a narcotics dealer anyways why not charge directly for the service? $2 for a lortab, $3 if you want those 10's. A shot of dilaudid or demerol might run you $10. In lieu of payment I'm happy to accept your cell-phone, redeemable once payment is made in full. Watches, gold chains or bling are also accepted. For kicks I'll throw in the full medical workup and a shot of toradol for free even if you don't purchase my wares.

    Don't like the policy? Well I've yet to find evidence that 10/10 pain directly causes death or severe injury.

  22. Hahahahaha sorry Pattie, I'm anon 1:28. Didn't mean to make you spray your drink! Whoops. :-P

  23. If I remember right, the first name of Hank Hill's dad is "Cotton".