Is notifying patients of an extended wait time a violation of some sort?

[Angry Birds]

---

Members don't see this ad.

Is notifying [my entitled] patients of an extended wait time a violation of some sort? (This would be the nurse or secretary letting them know...)

Is this kosher or not?

 

[Zebra Hunter]

I would imagine some lawyer could construe this as an EMTALA violation by deterring individuals away from care. Why even risk it?

 

[Jlaw]

Is notifying [my entitled] patients of an extended wait time a violation of some sort? (This would be the nurse or secretary letting them know...)

Is this kosher or not?

Not sure if there are any laws against this but some admins would argue that telling people that might cause them to leave and go home with an unstable condition. I rotated at a hospital where you weren't even allowed to ask for insurance or billing information before the patient had seen a doctor because admin was worried people without insurance would leave, end up dying, and the hospital would get sued.

Other hospitals I've been at get insurance info at triage and some even post wait times in the waiting room and online, so its highly variably from facility to facility.

 

[TooMuchResearch]

If you can advertise wait times on a billboard, you can advertise them in person.

 

[Vandalia]

It is the right thing to do, .... so it is obviously a violation.

 

[WilcoWorld]

Vandalia's post is the best this forum's seen in awhile.

That being said, I do this with some frequency. If I start a shift and the wait is 4 hours, I go out to the waiting room and ask for everyone's attention, then I say something like,

"Hi. I'm Dr. Wilcoworld, and I see that some of you have been waiting for over four hours to be seen. Please accept my apology. We are doing everything we can to see you all and get you the care you deserve as quickly as possible, but because the hospital is full we have to discharge a patient for every patient we can bring back. Thank you for your patience while we continue to work to get you seen as quickly as possible."

The patients actually really appreciate the acknowledgement (most of them, anyway). When I first did it I was worried that the admins would get cross, but they actually thanked me for it, probably because the triage nurses said it took some heat off of them from the waiting room.

 

[Angry Birds]

I would imagine some lawyer could construe this as an EMTALA violation by deterring individuals away from care. Why even risk it?

To deter individuals away from care.

 

[filhodeinferno]

To deter individuals away from care.

I don't mind it when patients self-triage themselves right out of the department.

 

[RustedFox]

This is highly variable between practice environments, but shouldn't be.

OldJob: 10-minute door-to-doc time! YOU are responsible for seeing all of these patients SAFELY and within the standard of care. Charting?! You can do that on your own time; and it will not be paid. Should the 10-minute door-to-doc time EVER be breached, then frantic phone calls will go out to every credentialed provider in the area to come in and help. If they cannot come in and help; then they will be subject to scrutiny, and will be threatened with multiple nonspecific actions. Furthermore, at the beginning, in the middle, and at the end of every shift... we will discuss every metric with you... and it will be painfully obvious that this is all beyond your control. Nevermind that; we'll make you feel bad about it anyways... and your paycheck will suffer. If you do agree to help; you used to be given a small bonus; but not anymore - you will come in and accept that all of your metric-based bonuses (which are already ruined by our poor staffing decisions - as all the metrics are already F*cked) will already be denied.

NewJob: We would like it for every patient to be seen in 30 minutes; but we understand that given the resources, this is not possible. Hell; its not even realistic for every patient to be seen in less than the time that it takes to deliver a pizza... and we're not talking about screwing up a pepperoni-and-mushroom pie, here. You will not be penalized because we are boarding eleveteen patients in the ER and your triage nurse cannot adequately direct a patient who demands a "smoke break" and twelve phone calls before she decides to HAVE an emergency (but not before checking in!) to come back to the primary patient-care space.

I had no idea how bad OldJob was.

 

[Apollyon]

When I do it, I REPEATEDLY tell the waiting room that "everyone WILL be seen", but that it might be a bit, but we know they're there.

 

[deleted109597]

I don't mind it when patients self-triage themselves right out of the department.

I don't either, when they aren't actually having emergencies.
Unfortunately, sometimes they are. And even my "damn them all" personality actually has a problem with patients who leave and then go on to die, even if I can't/won't get sued for it. What we need is a way to discourage the actual non-emergencies while not removing the true emergencies from the pile. And I don't know if there's a way to do it.

 

[filhodeinferno]

I don't either, when they aren't actually having emergencies.
Unfortunately, sometimes they are. And even my "damn them all" personality actually has a problem with patients who leave and then go on to die, even if I can't/won't get sued for it. What we need is a way to discourage the actual non-emergencies while not removing the true emergencies from the pile. And I don't know if there's a way to do it.

I wonder how often this happens.

 

[Angry Birds]

This is highly variable between practice environments, but shouldn't be.

OldJob: 10-minute door-to-doc time! YOU are responsible for seeing all of these patients SAFELY and within the standard of care. Charting?! You can do that on your own time; and it will not be paid. Should the 10-minute door-to-doc time EVER be breached, then frantic phone calls will go out to every credentialed provider in the area to come in and help. If they cannot come in and help; then they will be subject to scrutiny, and will be threatened with multiple nonspecific actions. Furthermore, at the beginning, in the middle, and at the end of every shift... we will discuss every metric with you... and it will be painfully obvious that this is all beyond your control. Nevermind that; we'll make you feel bad about it anyways... and your paycheck will suffer. If you do agree to help; you used to be given a small bonus; but not anymore - you will come in and accept that all of your metric-based bonuses (which are already ruined by our poor staffing decisions - as all the metrics are already F*cked) will already be denied.

NewJob: We would like it for every patient to be seen in 30 minutes; but we understand that given the resources, this is not possible. Hell; its not even realistic for every patient to be seen in less than the time that it takes to deliver a pizza... and we're not talking about screwing up a pepperoni-and-mushroom pie, here. You will not be penalized because we are boarding eleveteen patients in the ER and your triage nurse cannot adequately direct a patient who demands a "smoke break" and twelve phone calls before she decides to HAVE an emergency (but not before checking in!) to come back to the primary patient-care space.

I had no idea how bad OldJob was.

Frankly, I'm annoyed by this no-wait/no-waiting room idea. I have to wait to see my primary care doctor, even though I have a scheduled appointment.

We're spoiling patients. We're spoiling them rotten.

Having said that, I recognize that my burn out levels are again very high. They had lowered significantly since finishing residency, but they are back up due to doing 24 hour shifts... Hopefully they will lower again when I switch to 8's in a few short months.

 

[RustedFox]

Frankly, I'm annoyed by this no-wait/no-waiting room idea. I have to wait to see my primary care doctor, even though I have a scheduled appointment.

We're spoiling patients. We're spoiling them rotten.

Having said that, I recognize that my burn out levels are again very high. They had lowered significantly since finishing residency, but they are back up due to doing 24 hour shifts... Hopefully they will lower again when I switch to 8's in a few short months.

Combine that with my one job site, where its a wealthy, entitled, retired crowd with some young well-to-dos mixed in, and you have a recipe for me wanting to punch most of my patients in the face so that they actually HAVE something to complain about.

 

[deleted109597]

I wonder how often this happens.

We know it's not zero, but nobody knows how much higher it is than that.
I see about one patient a month that leaves one of our sites and presents at another with a potentially life threatening issue. Temper that with a 2-3 LWOBS rate and 5-10 LAMS rate and you can see it's likely much lower than 1%

 

[MSmentor018]

Frankly, I'm annoyed by this no-wait/no-waiting room idea. I have to wait to see my primary care doctor, even though I have a scheduled appointment.

We're spoiling patients. We're spoiling them rotten.

Having said that, I recognize that my burn out levels are again very high. They had lowered significantly since finishing residency, but they are back up due to doing 24 hour shifts... Hopefully they will lower again when I switch to 8's in a few short months.

I feel the same about long waits and people leaving that shouldn't....and I don't believe there's a whole lot to do about it. I truly believe this is expectations, not really the medical emergency itself. if they were sitting in a room, registered, (co-pay for those with actual insurance) but still wait, would they leave?less likely. is the answer building more rooms to trap them in? dobut it. back in the day, you checked in/triage by RN, level 5 finger lac, went and got registered/insurance....etc. then waited hours. I am not saying doc to door time is a bad idea b/c at least you, not the RN, have laid eyes on the pt but the implementation of it is getting out of control. now we've changed to the toyota model of the lean process, then now the hotel model. quick doc to door time then toss them behind a wall in a chair. viola! an empty waiting room but an overloaded tracker board. problem's not fixed. just rearrange the deck chairs on a sinking ship. what's next, hotwire.com model? type in your complaint and 1 hospital of equal rating will be randomly chosen for you

I am always curious about what makes them leave vs why they came in the first place especially a complaint that is either really non emergent or chronic (it's my end stage fibromyalgia acting up). when i get the chance to see a pt b/c they've complained and decided to leave I usually apologize for the wait, I don't give excuses, let them vent a little but I also ask them "at home how long do you wait for the cable guy or the ups man? 4hrs? 6 hrs? isn't your health worth the same patience?" if your not worth the same as a box, maybe it's natural selection.

 

[MSmentor018]

Combine that with my one job site, where its a wealthy, entitled, retired crowd with some young well-to-dos mixed in, and you have a recipe for me wanting to punch most of my patients in the face so that they actually HAVE something to complain about.

do we work at the same hospital??

 

[styphon]

Combine that with my one job site, where its a wealthy, entitled, retired crowd with some young well-to-dos mixed in, and you have a recipe for me wanting to punch most of my patients in the face so that they actually HAVE something to complain about.

I find this group of patients the worse, which is why I stick to Indian health services/Inner city sites. I love discussing diagnoses that the patient dislikes then having them respond "Do you know who my FATHER(mother, uncle, etc) IS???" Like that somehow factors into diagnosis.

 

[Angry Birds]

We know it's not zero, but nobody knows how much higher it is than that.
I see about one patient a month that leaves one of our sites and presents at another with a potentially life threatening issue. Temper that with a 2-3 LWOBS rate and 5-10 LAMS rate and you can see it's likely much lower than 1%

I think they eventually get where they need to be, and get taken care of. Yeah, maybe the added delay will give them a slightly worse prognosis, but then why weren't they patient enough to wait? It's in the friggin' name patient to be patient.

By the way, I know I'm totally in the wrong here. My rational mind tells me so. It's just that I can't help but get annoyed at the lack of patience in patients. F*** you, sit down and wait. If not, get the f*** out, and yeah come back if you get f***in worse.

And we wouldn't be missing these sick patients if not for the piles of "I'm scheduling my emergency" types.

Again, I know I'm in the wrong. These are just primal feelings that are coming out.

 

[RustedFox]

I think they eventually get where they need to be, and get taken care of. Yeah, maybe the added delay will give them a slightly worse prognosis, but then why weren't they patient enough to wait? It's in the friggin' name patient to be patient.

By the way, I know I'm totally in the wrong here. My rational mind tells me so. It's just that I can't help but get annoyed at the lack of patience in patients. F*** you, sit down and wait. If not, get the f*** out, and yeah come back if you get f***in worse.

And we wouldn't be missing these sick patients if not for the piles of "I'm scheduling my emergency" types.

Again, I know I'm in the wrong. These are just primal feelings that are coming out.

 

[RustedFox]

do we work at the same hospital??

Florida blows my mind, man. I gotta say: I love our senior citizens, and have a deep respect for them. I spent an elective month during my PGY-3 year with the geriatrics fellows doing ECF stuff.

These seniors, though - man. They think that the entire world is retired, nobody should be in a hurry, and that everyone under 50 is there to be a servant.

I was a touch late getting to work the other week, so I had to pick it up a little bit... doing 45 or 50 in a 35 mph zone. Not reckless, but I needed to get there. Grandma catches me at the light, and shouts at me from her car: "What's your hurry!?! You need to slow down!!"

I replied with: "I have to get to work. Do you remember work? Or has it been too long?"

I realized that I then shouted down a senior citizen, and felt bad about it. But come on Granny... don't forget that you're not the only one on the road.

My seniors at the job site (above)? They really do treat the hospital like its a hotel, and act all indignant when you won't wait on them hand and foot.

 

[deleted109597]

I think they eventually get where they need to be, and get taken care of. Yeah, maybe the added delay will give them a slightly worse prognosis, but then why weren't they patient enough to wait? It's in the friggin' name patient to be patient.

Usually. But just like they're terrible at knowing if their minor issue is an emergency, sometimes they think their emergency is a minor issue.

 

[MSmentor018]

These seniors, though - man. They think that the entire world is retired, nobody should be in a hurry, and that everyone under 50 is there to be a servant.

I was a touch late getting to work the other week, so I had to pick it up a little bit... doing 45 or 50 in a 35 mph zone. Not reckless, but I needed to get there. Grandma catches me at the light, and shouts at me from her car: "What's your hurry!?! You need to slow down!!"

I replied with: "I have to get to work. Do you remember work? Or has it been too long?"


My seniors at the job site (above)? They really do treat the hospital like its a hotel, and act all indignant when you won't wait on them hand and foot.

she was probably on the way to see you :
1. get valet parking
2. antibiotics b/c her PCP and urgent care won't and told her it's just a cold
3. want you to call the rx in
4. get the first dose now
5. drop your press ganey score b/c the blinds didn't keep enough of the sun out

 

[MSmentor018]

Usually. But just like they're terrible at knowing if their minor issue is an emergency, sometimes they think their emergency is a minor issue.

I think it's: they're terrible because they BELIEVE their minor issue is an emergency and in DENIAL when they find out their emergency is a minor issue

 

[RustedFox]

she was probably on the way to see you :
1. get valet parking
2. antibiotics b/c her PCP and urgent care won't and told her it's just a cold
3. want you to call the rx in
4. get the first dose now
5. drop your press ganey score b/c the blinds didn't keep enough of the sun out

Some of the things they say, man...

"You mean to tell me I came all the way here and you're telling me you're not going to do ANYTHING?"

"Why can't you just give me all the pills here now... This IS a HOSPITAL, isn't it?"

 

[Angry Birds]

Some of the things they say, man...

"You mean to tell me I came all the way here and you're telling me you're not going to do ANYTHING?"

This.

I wish they would reflect on this and realize that this is on them, not us.

 

[Doctor Bob]

This.

I wish they would reflect on this and realize that this is on them, not us.

"I'm sorry you incorrectly believed that I could do something that I can't. But the problem is not my inability to do it; it's your erroneous belief that I could in the first place. You don't get angry when McDonalds won't make you a pizza. I didn't go to your house and force you to come here."

 

[TeamZissou]

It is the right thing to do, .... so it is obviously a violation.

Some of the things they say, man...
"You mean to tell me I came all the way here and you're telling me you're not going to do ANYTHING?"

Highlights of last shift:
0100- pt presents with cc of abd pain x 2 years and balks in disbelief when "yes you will be getting an US and some of the same tests you've had before".
0400- pt presents from home with cc alleged assault while "minding my own business". Pt states suspects "jaw is broken", in between bites of potato chips.

 

[deleted109597]

"I'm sorry you incorrectly believed that I could do something that I can't. But the problem is not my inability to do it; it's your erroneous belief that I could in the first place. You don't get angry when McDonalds won't make you a pizza. I didn't go to your house and force you to come here."

I like to phrase it as "tell me what happens when you order a McRib at Burger King."

 

[WilcoWorld]

I like to phrase it as "tell me what happens when you order a McRib at Burger King."

Have you actually ever said that to a patient? If so, I want to buy you a beer.

 

[RustedFox]

I thought that I was the only one who used a food analogy.

I put it like this: Youre in Home Depot, and youre trying to order spaghetti.

 

[The White Coat Investor]

Frankly, I'm annoyed by this no-wait/no-waiting room idea. I have to wait to see my primary care doctor, even though I have a scheduled appointment.

We're spoiling patients. We're spoiling them rotten.

Having said that, I recognize that my burn out levels are again very high. They had lowered significantly since finishing residency, but they are back up due to doing 24 hour shifts... Hopefully they will lower again when I switch to 8's in a few short months.

Combine that with my one job site, where its a wealthy, entitled, retired crowd with some young well-to-dos mixed in, and you have a recipe for me wanting to punch most of my patients in the face so that they actually HAVE something to complain about.

This kind of attitude cracks me up. This is what happens when doctors don't own their jobs. When doctors do own their jobs, they realize that everybody in that waiting room is really $300. The last thing they want is $300 to get up and walk out of there before they can pick it up and put it in their wallet.

Imagine you owned a restaurant. And every night there was a line out the front and people were waiting 2 hours for a table. What do you do? You open a second restaurant down the street, you put some more tables on the patio, you hire some more staff etc etc etc.

Granted, medicine is a little bit of a special case, especially emergency medicine, because a certain percentage of patients aren't paying you anything and another certain percentage aren't paying you much. But there are only so many of those folks who are actually having emergencies and the rest you can burn through pretty quickly.

The real issue is you guys don't have enough doctors on for the patient load and you don't have enough beds to put the patients in and nurses to take care of them. The first issue goes away when you own the job (hire more docs.) The second two issues go away when you own the FSED.

RustedFox apparently hates taking care of wealthy and well-to-do people. Would someone please show him where he can find a job with 40% Medicaid patients and 40% self-pay so he doesn't have to punch his patients in the face? Feel free to send your wealthy patients over to my ED. We'll hire more docs if there are too many of them.

 

[RustedFox]

This kind of attitude cracks me up. This is what happens when doctors don't own their jobs. When doctors do own their jobs, they realize that everybody in that waiting room is really $300. The last thing they want is $300 to get up and walk out of there before they can pick it up and put it in their wallet.

Imagine you owned a restaurant. And every night there was a line out the front and people were waiting 2 hours for a table. What do you do? You open a second restaurant down the street, you put some more tables on the patio, you hire some more staff etc etc etc.

Granted, medicine is a little bit of a special case, especially emergency medicine, because a certain percentage of patients aren't paying you anything and another certain percentage aren't paying you much. But there are only so many of those folks who are actually having emergencies and the rest you can burn through pretty quickly.

The real issue is you guys don't have enough doctors on for the patient load and you don't have enough beds to put the patients in and nurses to take care of them. The first issue goes away when you own the job (hire more docs.) The second two issues go away when you own the FSED.

RustedFox apparently hates taking care of wealthy and well-to-do people. Would someone please show him where he can find a job with 40% Medicaid patients and 40% self-pay so he doesn't have to punch his patients in the face? Feel free to send your wealthy patients over to my ED. We'll hire more docs if there are too many of them.

Dont be dense... its the entitlement, condescension, and the generalized hysteria in the face of little pathology that this "clientele" (lets not call them patients, thats for "poor people") displays that stirs my anger. Ive worked in a diverse array of shops... funny how its the impoverished and tbe disenfranchised that have patience, show gratitude, and understand that their complaint "can wait a bit... its not like (I'm) dying this second."

 

[The White Coat Investor]

I don't know. I see the poor act entitled about as often as the well to do. I would say most of the "Thank Yous" that I get are from the well to do.

You sound like you need a few days off. Sometimes I feel that way, but it's usually after 4-5 shifts in a row and especially on the DOMA for the month.

 

[deleted109597]

Granted, medicine is a little bit of a special case, especially emergency medicine, because a certain percentage of patients aren't paying you anything and another certain percentage aren't paying you much. But there are only so many of those folks who are actually having emergencies and the rest you can burn through pretty quickly.

And yet, the hospital systems either don't seem to care or actually don't care. Because they got theirs I guess.

 

[Janders]

I don't know. I see the poor act entitled about as often as the well to do. I would say most of the "Thank Yous" that I get are from the well to do.

You sound like you need a few days off. Sometimes I feel that way, but it's usually after 4-5 shifts in a row and especially on the DOMA for the month.

(1) Just got through with a rough string-- and have a couple more overnights this week-- so I know what it feels like the be the Captain of the USS Burnout heading flank speed towards an iceberg. Take care of yourself because no one else is.
(2) Entitled, irritating, irrational, HEALTHY patients come from rich, poor, all colors, all forms of insurance (or lack there of), all sexualities, all races, all ages. Trust me, I've seen them all. It really givens me the warm fuzzies about equality and the human condition :-D It's funny, one minute we'll be harping about the greatest generation after taking care of a nice Iwo Jiwa vet, and an hour later an old man is cursing me out for not refilling his blood pressure meds and having them delivered to his house within 20 minutes of arrival. And he can't believe we won't be paying for his taxi home! Then we'll have a 20yo puke cursing us all out for giving him narcan and ruining his high, while an hour later some 20yo kid wants to make the rounds and thank every staff member face-to-face before he's transferred for his fracture-dislocation.

As WCI points out, the silver lining to entitled rich people is at least they are likely to be insured and thus their payments will help keep the ED open and in good financial standing. But I know how frustrating it is to be deep in the weeds trying to actually save lives and have someone get cross with you for their 25 minute wait. One of the negatives to this job.

 

[Janders]

And back to the topic at hand, I wouldn't be surprised if someone said notifying patients of a specifically long wait time is against EMTALA_-- remember when some shops posted their opiate policies publicly and were told this is a potential EMTALA violation for driving away customers.

 

[Old_Mil]

Having said that, I recognize that my burn out levels are again very high. They had lowered significantly since finishing residency, but they are back up due to doing 24 hour shifts... Hopefully they will lower again when I switch to 8's in a few short months.

8s are going to feel like a vacation compared to 24s. Heck, 8s feel like a vacation compared to 12s.

 

[Angry Birds]

You sound like you need a few days off. Sometimes I feel that way, but it's usually after 4-5 shifts in a row and especially on the DOMA for the month.

I know for myself, I am definitely feeling this way due to burnout and pulling 24 hour shifts... which is why I'm going to leave this job for another one (8 hour shifts) in a few short months. So, I'm not disagreeing with you. It may be me, not the patients. Like I said previously, I know that I'm wrong to feel this way. But, I just do. And I guess I'm venting my frustration on an online anonymous forum.

Having said that, I'm on a five-year mission to reduce my clinical load immensely and make clinical work in the ER only a minor part of my life. I feel like being an ER doctor is like being the last man on earth during a zombie apocalypse, with zombies (i.e. patients) coming at you from every angle: you get rid of one, and another pop ups. Every time I see a new patient saunter in with their Dunkin' Donuts in hand--just as I just discharge another one--it takes its toll on me.

 

[MSmentor018]

Have you actually ever said that to a patient? If so, I want to buy you a beer.

not exactly but when they keep coming back for the same problem, and had ct, mri, admission, egd...etc done but doesn't want to do follow up b/c of costs ie: no insurance. I ask them " if you keep going to mcdonalds would you get a whopper? exactly I have a limited menu and whoppers are not here. they are in outpt land so its important to go there and explore their menu. I'll give you all the big macs I have but I don't have what you need" "

 

[The White Coat Investor]

I know for myself, I am definitely feeling this way due to burnout and pulling 24 hour shifts... which is why I'm going to leave this job for another one (8 hour shifts) in a few short months. So, I'm not disagreeing with you. It may be me, not the patients. Like I said previously, I know that I'm wrong to feel this way. But, I just do. And I guess I'm venting my frustration on an online anonymous forum.

Having said that, I'm on a five-year mission to reduce my clinical load immensely and make clinical work in the ER only a minor part of my life. I feel like being an ER doctor is like being the last man on earth during a zombie apocalypse, with zombies (i.e. patients) coming at you from every angle: you get rid of one, and another pop ups. Every time I see a new patient saunter in with their Dunkin' Donuts in hand--just as I just discharge another one--it takes its toll on me.

Yea, that's usually the case. I can relate. Trust me when I say the patients haven't changed. They're the same ones in the ED when you were a medical student and thought all this stuff was awesome. They are the same ones in your ED as a resident when you were excited to see a disease you've never seen before and do your next procedure. They're the same patients when you're working 18 twelves as when you're working 12 eights. But you're different.

Clinical work in the ED is a relatively minor part of my life. 168 hours in a week and on average throughout the entire year I spend just 28 of them a week in the ED. Starting this summer, it'll be 22. Helps a lot with burnout. I actually get burned out blogging (actually dealing with email) more often lately than I do with seeing patients in the ED. Although it's nice that I can do it at any time I want.

 

[tkim]

And back to the topic at hand, I wouldn't be surprised if someone said notifying patients of a specifically long wait time is against EMTALA_-- remember when some shops posted their opiate policies publicly and were told this is a potential EMTALA violation for driving away customers.

But there's a catch - Catch 22 - if you advertise long wait times it might be an EMTALA violation so you can't advertise your long wait times, if you advertise short wait times it's not an EMTALA violation, but more patients will then flock to your ED and increase the wait times and you will be in violation.

 

[MSmentor018]

But there's a catch - Catch 22 - if you advertise long wait times it might be an EMTALA violation so you can't advertise your long wait times, if you advertise short wait times it's not an EMTALA violation, but more patients will then flock to your ED and increase the wait times and you will be in violation.

no one likes hearing the truth.....

 

[WilcoWorld]

no one likes hearing the truth.....

If people don't like what you're saying, that's a pretty good indication that you're onto something.

 

[Old_Mil]

Doing anything in medicine is potentially a violation of something if it stands to make someone who doesn't actually practice medicine money.

 

[DocEspana]

I don't know. I see the poor act entitled about as often as the well to do. I would say most of the "Thank Yous" that I get are from the well to do.

You sound like you need a few days off. Sometimes I feel that way, but it's usually after 4-5 shifts in a row and especially on the DOMA for the month.

N=1, my program is split between true inner city and a truly privileged upper class hospital.

The inner city people are much more crude and have a higher rate of trying to malinger and opiate seek. ... but the overall community is SO MUCH more thankful of what I do and understands very well if I tell them that there isn't much I can do except treat symptomatically.

The well off community is so insufferably entitled. There is one room with a broken tv. Storming out of the ER or asking for the AOD by name (how can they all know who the AOD is?) is crazy common in that room. They freak out to be put in a room with no tv. The other hospital has no TVs and much longer wait times and everyone just chills there and plays with their phone for hours waiting for their CT.

 

[Old_Mil]

I feel like being an ER doctor is like being the last man on earth during a zombie apocalypse.

Yep. A lot of truth to that, depending on where you work...

 

[deleted480308]

Dont be dense... its the entitlement, condescension, and the generalized hysteria in the face of little pathology that this "clientele" (lets not call them patients, thats for "poor people") displays that stirs my anger. Ive worked in a diverse array of shops... funny how its the impoverished and tbe disenfranchised that have patience, show gratitude, and understand that their complaint "can wait a bit... its not like (I'm) dying this second."

I'd call expecting treatment without payment to be "entitlement" too so you can't lay that word on only the wealthy

 

[alpinism]

N=1, my program is split between true inner city and a truly privileged upper class hospital.

The inner city people are much more crude and have a higher rate of trying to malinger and opiate seek. ... but the overall community is SO MUCH more thankful of what I do and understands very well if I tell them that there isn't much I can do except treat symptomatically.

The well off community is so insufferably entitled. There is one room with a broken tv. Storming out of the ER or asking for the AOD by name (how can they all know who the AOD is?) is crazy common in that room. They freak out to be put in a room with no tv. The other hospital has no TVs and much longer wait times and everyone just chills there and plays with their phone for hours waiting for their CT.

After working at both types of hospitals, I've also had the same experience. You get entitled patients at every hospital, but its generally the upper class folks who have unrealistic expectations of the ED. Its far more common for them to complain about waiting, demand specific tests, or ask to be seen by a specialist.

As an example, at one upper class hospital, it was almost a daily occurrence to have patients refuse to tell us their medical history because "I already told the nurse and I'm not repeating myself again" or "Where's the doctor I saw here last week? Just ask them" or "Its all in my medical chart so why don't you read it before coming in my room."

And this is all while the patient continues to watch TV the whole time...

 

[Xerxes1729]

I'm much more sympathetic to misbehavior by poor and disadvantaged people. Do homeless people malinger when the shelter is full and waste my time? Absolutely.

On the other hand, they're homeless. I can't even imagine what it would be like trying to sleep under a bridge in New England in January. Is it their own fault? Some of the time. But it doesn't really matter, at least to me.

But if you're coming in because you tweaked your knee on your ritzy vacation and want an MRI and to see an orthopedic surgeon at midnight...well, I don't have much patience.