Wednesday, March 30, 2011

World Gone Mad

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.


  1. Great to hear from you again Panda (Melanoleuca). I am an engineer who has always been fascinated by medicine and wondered if I ever could have been a Dr. Your old blog really shed some light on that profession, although you also take some criticism in the blogosphere for being too cynical. Sorry to hear that medicine had something to do with your divorce. Working too hard is brutal on relationships. I just came off a spell of working 4 weekends in a row, a couple 80 hour weeks, and I have no clue how people keep up that pace for years. Then again I am not as young as I used to be and have a lot more competing issues that require my time.

    Hopefully you will keep posting again.


  2. Thank you, thank you for this post and for this blog for a much-needed injection of truth. I could not agree more with the diagnosis of the overfed, greedy and entitled. At this point, the only phrases I hear are customer satisfaction, Shep scores, and pain scale (translate: have I supplied enough narcotics yet to overdose a small mammal?) These are sprinkled liberally along with various other options that allow the patient to assume no responsibility whatsoever for their own medical health care. I had one patient actually bristle at the thought of having to buy his own pill box (why on earth should HE have to buy it when clearly the taxpayer should pick up the tab?) He then went on to tell me about the brand new motorcyle that he just bought and great news! his 25 yr old daughter just got SSI disablity so they're really rolling in the dough now....It's stuff like this that makes me shake my head and wonder how long it will take to sink this once-great country.

  3. I love you panda!!

  4. Hurt to read, but not sure how much I can argue against it. Great to see you posting, Panda.

  5. Panda, Hate to be a Buzz Kill, umm actually thats not really true, I LOVE being the bearer of bad fact in Med School, DURING THE REAGAN ADMINISTRATION(get it?, I'm Old)I used to be the Med Student who'd play with the terminal cancer kids...
    and tell them there wasn't a God/Allah/Jehovah, except for the Atheist kids, who'd I regale with tails of an angry God/Allah/Jehovah
    and docs said the same thing in 1985, that one day we'd live in a world with a Black Muslim President, $4/gallon Gas, and where DO's and FMGs got treated like they were real Doctors..
    OK, they were right, but they left out the part about 70 inch HD Plasmas, 24-7 3D Internet Porn, and Honda Civics with 300HP...
    So put on a Happy Face/smell the coffee/lighten up Lawrence, lifes too short to complain, except
    and I don't mean they speak English "as a Second Language" I mean the ones where you can say "What the Fuck do you want?, (Insert Racial Epithet of choice) and they'll just smile or even worse, scowl and say "You No Speak Farsi/Arabic/Irdu/Japanese/Chinese/Korean/Russian/Vietnamese/Korean?"

    WHAT ABOUT THAT DR PANDA(Which is about the gayest nickname ever, OK, its not as bad as Bu-fu-ing-Homo, but its the same Ball Park)


  6. What psychotic rant was that by Frank? English - do you speak it?

  7. welcome home panda,
    so here's my question. i can't argue with you on this at all... you have summed up why three boarded ER docs on this blog don't work there anymore, but for someone like my self with a fighting spirit, is there a way to fight it? what do we do? do we have it in us as a group? i don't think we do.

  8. Panda Bear,

    Sounds about the same in the ER where I work. The physicians I work for have the same issues. I overheard one doc speaking to another. He said someone once told him, only after I accepted that I was working at free clinic and only 10% of the people really absolutely needed his help, days got a lot better.

  9. Universal healthcare would go a long way to alleviating the stress on American ERs. It would, at any rate, eliminate those customers who have foregone primary care because they couldn't afford it or didn't have access to it. Why not just open 24-hour pain management clinics -- just to get *those people* out of the ER? Here, everyone is expected to have a PCP and when a patient with a PCP shows up in an emergency with a non-emergent complaint, the PCP is charged a fee. Sure it penalizes the doctor who may not be responsible for that patient's actions -- but it also forces the doctor to explain what is emergent and what is NOT. People are stupid and it seems to take years for them to figure out you don't go to the ER for a sprain when there's an urgent care next door...and chances are you can wait till morning and see your doctor anyway.

    So what are you all doing to make it better?

  10. dear CannedAm,
    god be praised you are back! you are so special. if you were military you would be in the very special forces and would fly in a shortened C130.... and you thought we didn't have one! it is SO amazing what you have accomplished. you are an inspiration to the specially-abled everywhere. *tears*

  11. So happy to see I was missed. I love how you always drive home my points and highlight the things that really could make this world a much better place.

    Seriously, though -- I know you've got better things to do than figure out what the hell would make things better...I mean, bitching about how bad things are takes up a fair chunk of your spare time, which I realize is scant enough.

    I have this crazy belief...and I know it's crazy because I've read enough of the posts here and found no supporting evidence...that you good folks who chose a helping profession for your careers would have a capacity for empathy.

    I really cannot wrap my brain around whatever cruel, twisted, idealism it is that you've bought into that you can see a hard working individual who barely makes ends meet and has no insurance just doesn't deserve medical care. I don't understand how you can think that that individual is less human, less deserving than the rich kid down the street whose parents set him up with a great junior executive position with excellent benefits. I mean that lady she works her ass off, man! She holds a couple jobs and the insurance that the one job she holds does offer tells her she's gotta come up with $1,000 OOP before they kick in anything and 50% of the bill is hers. What twisted kind of ideology is it that tells you she just isn't working hard enough, isn't deserving of the same care that rich dude who got set up in his cushy position can access quickly, easily, and with not even a dent to his wallet. I mean she needs necessary surgery but it's going to be a few months before she has that $1,000 scraped together...I guess she just isn't good enough, hmm? She just didn't work hard enough, just didn't apply herself enough, just picked wrong. It's not like our society isn't set up so that every single person has an equal footing, right? I mean, come on, you know damned well that Johnny from the projects got the same quality preschooling via headstart that Xavier did in the 'burbs. Johnny and Xavier both had excellent educations, and opportunities --- wooo boy! Look at all the opportunities they both equally have available to them. I mean, surely when Johnny was out collecting pop bottles to have enough money to attend the school field trip he came across a few business owners who could help him out later in life....amirite? You know it.

    Where exactly is it that you store your humanity, anyway?

  12. oh my dear God I know who you are... you are that book-smart girl from college who married rich and has a huge guilt complex for never doing jack shit to help the helpless. and, to those of us in the trenches, taking care of 'johnny from the projects' you have derision, because.... well, i'm not sure why.... because we aren't smiling about johnny now being our boss? you are a communist, actually, worse than that, you don't know you are a communist. you have nothing but contempt for those from the other side of the tracks, we, however, think that only the individual can better themselves... that the government can't do it... and that a 'system' can't do it. by the way, good luck with that terrible problem you have meeting the newly imposed garbage limits in niagra county... we are going back to see patients... hey, have they had a real housewives of niagra county yet? you would be great!

  13. Panda, if you ever want to guest post on my blog, you're always welcome.

  14. panda, your old blog has been taken over by spammers...