A Few Things...

Actual Patient Conversation

"Hello, I'm Dr. Panda. What brings you folks in to the Emergency Department."

"I think my baby has an ear infection."

"What does your pediatrician think about it?"

"I didn't call."

"Why not?"

"I only call the pediatrician for important things."


And Another...

"Excuse me, do you know when that jackass doctor is going to get around to see me?"

"I'm the Jackass Doctor. We're really busy today and I will get to you as soon as I possibly can."

"I've been here for two hours."

"Sorry, I've had some really sick patients today."

"Man..I could have just gone to Wal Mart and got some cold medicine."


One More...

(Very Pleasant Gentleman in a Hall Bed)

"You know what, I can see that you're really busy today. I'm really not that sick. I think I'll just go home and call my doctor in the morning."

Bear With Me

Sure, my first post on this blog was something of a diatribe, laden with cliches and an exercise in dead horse flagellation. That there was nothing original in the whole article has been established definitively by many of my critics. I beg your indulgence. I have not written much over the last year and I'm a little rusty. In my defense, I have well over 700 pages of content on my old blog and if you think it's easy coming up with something original to say in every article I invite you to try it.

On the other hand, some things just need to be repeated again and again, particularly anecdotal evidence to support the general consensus that American Medicine is an insane Goat Rodeo organized and directed by the rodeo clowns who ensure that it is as difficult and expensive to deliver care as it can possibly be. The paperwork burden alone is phenomenal and grows every year defying any kind of reason or common sense except the inexorable logic of a rapidly expanding state and federal bureaucracy that exists to perpetuate and amplify this kind of thing in the circle jerk that we know as public service.

I am also amazed that, in exchange for the right to comment on American Goat Rodeodery, I must provide intricate solutions to its problems. In fact, the solutions are as obvious as they are difficult to implement and there is no amount of policy wonkery or 2000-page Health Care Bills That Nobody Read that will change the basic facts that we are ridiculously over-doctored, over-litigated, over-regulated, and over entitled. Or that most of the money spent on medical care is wasted and buys services that are at best horrifically redundant but mostly just unnecessary. Medical care, something that most people don't need much of most of the time has become the bloated tail wagging the corpulent national dog and is both the cause of our economic decline and the blunt instrument to be used by government to extend its influence into every aspect of your life. We have gone insane in this country harboring as we do a pathological fear that somebody, somewhere, somehow might be expected to pay for his own routine medical care.

Why, it might cut into his cigarette money.

It is this insanity that serves as a permanent obstacle to common sense things like meaningful medical malpractice reforms, ending the practice of futile care, holding people accountable for lifestyle decisions, and making it just a little more difficult for a 25-year-old methadone addict to collect disability.

Medical School Debt

I never said my debt was unmanageable. I just commented that the month between the end of residency and my first real paycheck was a difficult one. I'm actually paid pretty well, a lot more than I thought I would be making, and on that point I have no complaints. I imagine the economic outlook for Emergency Physicians will continue to improve as the wonder that is Obamacare unfolds on an unsuspecting public who will have trouble finding primary care doctors who are still in business. Hell, Emergency Departments are already swamped. I see between thirty and forty patients in a twelve hour shift and while not all of them are minor complaints, the vast majority are and when you take out the patients who are lazy, stupid, and irresponsible, a good portion of those are people who simply could not get a timely appointment with their own doctor.

I'm a special case in regard to debt anyway as I was a non-traditional medical student and resident. Generally, if you follow the normal path into medicine (college to medical school to residency to practice) your debt is very reasonable compared to your income and you would be stupid to ask the government to pay your way, thereby ensuring they have a first dibs on your ass at all times. The hardships of medical school debt, for most doctors, is something of a myth.