Wednesday, March 30, 2011
Time Goes On
For those of you who don't know me, my name is Panda Bear. I am an Emergency Medicine Physician and a few years ago had a medical blog called Panda Bear, MD that had a little bit of a following for the several years I devoted to it. The blog chronicled my adventures in residency and my thoughts on the crazy Goat Rodeo that you know as American Medicine. Time moved on. I finished residency, got my first job, got divorced, and have had my head down for the last two years working more shifts than I ever did as a resident if you can believe it.
Why did I stop writing? Disgust, mostly. By the time I finished residency I had my fill of the insanity and writing about it was painful and put me in a foul mood, especially since there is nothing to do for it but laugh and let the ridiculous tide of American society sweep it and the rest to whatever oblivion awaits the West. We will definitely vanish with a whimper, a society of doddering simpletons drooling our way into a squalid sunset of entitlement and greed.
I have never seen things so bad and I don't know how we're going to pull out of this one. I think we passed some tipping point, a limit beyond which there is no going back, and find ourselves in an aimless dictatorship of lawyers, bureaucrats, and a crop of some of the worst leaders I have ever seen or could imagine. We used to make things and do things in this country. Now we are a pretend nation, devoting most of our energy to to servicing the shadow state, the great Empire of the Bureaucrat.
It won't end well.
Here's an Idea
And I offer this one free of charge to any medical malpractice attorney who reads this blog.
You know how we admit a lot of people to the hospital for suspected medical conditions that never materialize? Heck, most of the chest pain patients I admit end up with a completely normal workup and are discharged home on Aspirin and some vague instructions to follow up with the cardiologist every six months. Why doesn't some enterprising lawyer sue the doctor for "Wrongful Admission." You can claim that your client suffered mental anguish waiting for his negative heart catheterization or his normal MRI. Might as well. You sue everybody and their brother for everything else.
And it will hasten the day when the system finally collapses under the weight of its own absurdity.
Emergency Medicine as a profession is rapidly becoming untenable. There is now simply no way to justify sending anyone home because apparently nobody has any follow up. I got a nasty letter from our peer review committee the other day about a patient I had seen who complained that I hadn't admitted him. Without going into the details, when I saw him in the Emergency Department for his two years of Pain That No One Could Diagnose a review of our records showed that his medical Odyssey included negative MRIs, negative CT scans, Negative lab studies, negative Studies I Had Never Heard Of, and many visits to a small platoon of specialists who could not diagnose him. On top of that he had a completely unremarkable exam when I saw him and totally normal vital signs. What's an Emergency Doctor to do?
I've also caught some flak for having my abscess and laceration patients return to the Emergency Department for follow up. Apparently the preferred practice is to have them follow up with the so called "Private Physician" or better yet, the local charity hospital where wait times for the clinics can run to months. While I'm sure many of my self pay patients could easily afford forty bucks to be seen at an urgent care for a wound recheck, many of them wont and they'll either come back to the Emergency Department anyway or let a complication fester to the point where I'll just go ahead and admit them. I do my best and try to err on the side of caution but not every simple abscess that looked like it could be drained in the Emergency Department gets better. I'd just like to see them again to make sure everything is alright. Why a routine wound check is not included in the bill is beyond me.
Not to mention the growing number of patients I am seeing with a Chief Complaint of, "My Doctor Said I Needed an MRI."
This is the growing problem...maybe we can call it Mission Creep. It seems we are becoming the de facto primary care physicians and specialty clinic for a growing number of patients who are incapable, unwilling, or unable to handle even routine medical follow up.
This, too, will not end well.
Posted by Ailuropoda at Wednesday, March 30, 2011