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When good is not good enough

Discussion in 'Emergency Medicine' started by TrumpetDoc, 06.14.12.

  1. TrumpetDoc

    TrumpetDoc

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    So, at the expense of beating a dead horses thought I'd rattle on something that came up that was enlightening, and immensely disturbing.
    Now, I'm a visual person, so this is prob why it only sunk in now.but I have "known" about the press ganey methodology for some time in regard to the percentiles, and I have a baseline level of knowledge to know what this entails, we all do.
    So so rehash, a little I am a solid performer and I have nearly 100% positive pt encounters. I mean really positive. However, I have routinely been in the 10th percentile for PGs.
    I am surreally attending a patient satisfaction workshop and they put in graphical form the raw differences between a 5 percentiler and a 95 percentiler. Nearly freaking identical! What did I see when they showed the two docs? I saw two really good docs from a PG score standpoint. So on a 1-5 scale. 4 is pretty damn good.... But not good enough!

    I also came to realize, and this was hit home by one of the clinical psychologists where a lot of my job dissatisfaction comes from. Not because of poor performance, but her impression is that I cannot be happy doing this, or any field with a focus on " pt centered care" her advice, go into critical care or another field that does not deal with this, specifically path or rads. I actually demonstrate really good skills at listening, empathy during the evals, etc...but I am expelling huge amounts of energy doing this because it is not me.

    We talked for a while and I found that I chose this field bc I thought I was escaping the biopsychosocial bull$-// that is grabbing medicine by the (insert pvt part reference). I am symptom/problem oriented and That's what I want in anyone who is evaluating me for life threatening diseases, and that is my core principle. Now I am compassionate, don't get me wrong, but it's asinine that we need to play this game with pts to get good scores. If I wanted to go into customer service as a career I would have gone into plastics, or better yet, car sales. Because the powers that be wont be happy until there is little distinction between us and a car salesman aside from the outfit.
    I hear their reasoning and apparently thee is an 8x high likely hood of pt returning and/or rec the hospital from a PG of 4 to one of 5 (avd out). Also, the is somewhere along the lines of a 16pct higher risk of lawsuit based on poor PGs.
    However, I need to eval this data because the difference is so freaking microscopic between the freaking 95-5 that I cannot see that standing up to scrutiny. Anyone have these studies handy?

    Pardon typos;)




    Sent from my iPad using Tapatalk
  2. WilcoWorld

    WilcoWorld Senior Member

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    I don't have any studies for you, sorry. But I'd certainly be interested in seeing that data. It might help me deal.

    I really sympathize with your secondary point, and I think it's yet another good warning for med students interested in EM: If you think that going into EM is a good idea because you think you won't have to kiss up to people when your job is to save their lives, well your future bosses are going to differ on that point. Fortunately, my current job only assigns a token amount of my pay to PG - it works out to about 1%. However, I'm the kind of person who expects himself to score well. And no matter how much I tell myself PG's a poor measure of emergency care (which is how I felt about it before I ever knew how well or poorly I performed) I just can't help but be bothered if I'm not in a high %ile. It's so stupid! I don't care what my phrenological evaluation would show - it's an invalid measurement. If I got a terrible result, I'd shrug it off. But not PG. It still bugs me, even though my score seems to correlate better with the wait times that month than it correlates with anything I do.
    Last edited: 06.16.12
  3. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    Eh, just give everyone more percocets, and watch your PGs go through the roof.

    Also, the ones you worry about, diagnose them with anxiety or some other psychiatric disorder. Then they won't get a survey. Not sure if "drug seeking behavior" works in that place, but it should.


    Or, get involved in fixing the things that we can fix. Put the boarders upstairs where they belong, not in the department. If admitting doc doesn't call back in 30 minutes, put in transition orders and let them find the patient upstairs. You know, things like that.
  4. Arcan57

    Arcan57 Junior Member

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    A "Good" gives you a raw score of 75, which translates into the 1st %ile for all of the doc questions on PG. Since nobody is incentivized/judged based on their raw scores, this means that good = piss poor. There are specific tricks to going from good to very good like consistently referring to the care you're going to provide/have provided as very good. "Hi I'm Arcan57, I'm the emergency doctor and I'm going to take very good care of you today" is my opening line on every patient that's conscious. Not excellent or fantastic or exceptional, but very good. Your nursing staff also needs to be using the term "very good" constantly during the visit. Sitting down during your history is another proven point gainer, as is introducing yourself to everyone in the room.

    Also, PG scores only come from discharged patients so if you have 2-5 free minutes it's much better to spend it rounding on a patient you know will be discharged then checking in on your stable patients that you know will be admitted.
  5. Arcan57

    Arcan57 Junior Member

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    Any hospital based specialty that has direct patient contact is going to be customer service driven. Everyone expects you to be a good clinician, you're ability to get along with people and satisfy the customers is what C-suite wants. Unless your hospital is a free spender, it's extraordinarily unlikely that there is any statistical validity to your individual PG score. PG claims that ~30 surveys gives you a reasonable margin of error, our particular hospital pays for 60 surveys/month. So our ED's score is relatively valid (although if you ever listen to the actual surveys it's eye-opening) each month, but I may get 0-2 of my pts surveyed/month. So it takes about 2 years to have enough data generated to get a stable picture of how I personally am doing with customer sat. For docs that work in shops with a high admit rate, the majority of your PG score is going to be generated by your midlevels since they're the ones seeing the discharged patients.
  6. Birdstrike

    Birdstrike

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    TrumpetDoc:

    You Can Tie, You Can Lose, But You Can Never Win

    What you’re getting at, is the core of why patient satisfaction scores in the ED are so soul crushing to some of us and what is so fundamentally different psychologically and philosophical about being a physician in the ED, compared to any other setting.

    Outpatient physicians have always had their own version of “Press-Ganey”. So does every business in a free market. In their case it’s “name”, “reputation”, and “practice building”. If their patients don’t like them and aren’t “satisfied”, they go elsewhere and the practice, and ultimately the docs pocketbook, suffers. If their patients are satisfied, the physician benefits with a more robust practice and fatter wallet. This is like any other “business”. The better a business is at providing a product or service, the better off the business is. This is how it should be. Doctor makes patient happy, happy patient makes doctor happy. It’s a positive feedback loop. (Although a physicians practice is more than “just a business”, it is a professional practice held to ethical standards, it has to pay the bills, with dollars and cents, according to the rules of business.)

    However, the ED is like no other business in the world. In the ED, you’re swamped no matter what. You have no control over your workflow. There’s essentially no risk, ever, of not being busy enough to “put food on the table”. Being overwhelmed with patients is the rule. Whether or not there are too many patients to see, or twice as many patients than you can see, or three times as many patients as you can see, does not affect your pocketbook, and does not increase your job satisfaction. In fact, the busier it gets in the ED and the more”customers” there are, the worse the job satisfaction. It’s a negative feedback loop. Unlike the outpatient doc, where the more satisfied the patients are, the busier the practice is, the healthier the pocketbook is and the happier the doc is. In the ED it is the exact opposite. In fact, you are grinding the machine to increase the job satisfaction (and profits) of someone else such as an administrator that you might not have even met or barely know.

    This is why outpatient physicians in private practice (and all good businessmen including hospital CEOs), especially ones in their earlier years building a practice (or business), just don’t see what all the complaining is about. To them, “patient satisfaction” is their lifeblood. Without it, they can’t pay their staff, their practice overhead or their own salary let alone have any profits left over. This is a crucial difference. Another crucial difference is that when they reach the point of saturation, there are several protective mechanisms not available to ED physicians, that keep the work load and stress load to a manageable level:


    1. “Office closed”.

    There is no law stating that the overwhelmed pediatrician, plastic surgeon, dermatologist or business owner has to keep the office open after 5pm, through 2am and until 7 am and around the clock because there is a line of patients with no ability to pay him or with government insurance that pays $0.08 on the dollar lining up around the corner. There is no contract with the hospital corporation stating he and his partners MUST find a way to provide coverage to all customers, no matter how rapid and unmatchable the increase in volume all the while meeting some arbitrary “door to doctor” time-, and patient satisfaction goal.

    The legal burden, at the threat of $50,000 dollar fines, to ever expand your workload to non-urgent patients, regardless of the ability to do so, and regardless of the support staff provided, while being held to a “boutique standard” of satisfaction is an oppressive burden.

    2. The ability to tell an abusive insurance provider, “Your payments aren’t worth my time” and go “non-par” (non-participating).

    The fact that EMTALA makes this option almost impossible, even for non-emergency patients that abuse the ED, is further oppressive. The only thing providing any significant upward pressure on the payers in this country to pay physicians acceptable wages, is the ability of physicians to individually opt out or insurances that arbitrarily, and unfairly cut or eliminate payments for services to an unacceptable level. This dissatisfies the customers (patients), who switch insurances to companies that have more doctors in their network since they pay doctors more fairly.

    It’s like walking into a convenience store paying for your groceries and being told even though you paid for a gallon of milk, you only get a quarter cup. Even though you paid for 10 rolls of toilet paper, being told, “From now on, you only get two for the price of ten, and we reserve the right to give you even less, for any reason, at any time” and being bound by a law that prevents you from taking your business to a company that treats you ethically.

    Not having this ability, in relation to non-emergency care, and being bound to “satisfy” such “customers” who use EMTALA as a means to pillage your services to have to keep your job, is wrong.

    3. “The schedule is booked”.

    A human being should know that there’s some limit to his potential daily workload. What other profession expects you to show up at work and be told upon arrival, “Here, you have twice the work to do today,” then before you can get halfway through the first part of the days double workload, “Here you go, here’s four times the work. Get it done. Get it done as fast as you would get a single days work done. Don’t cut corners because that could be devastating and dangerous and keep a smile on your and the customers faces. Yeah, I know it’s tough but you can do it. If not, that’s okay too because we have a mega-group that wants your job for 20% cheaper anyways”?

    Ever walk in for a shift and there’s 4 patients waiting? You go see those four as fast as you can and when you come out of the fourth room, there’s eight on the board. You and your wing man dig your heels in deeper, dive in and see those eight together and when you resurface, there are 12 patients on the board. As the shift goes on, the harder you work, the worse it gets and the sicker the patients get? Of course you have. Do administrators work under these conditions? Hell no. Only a fraction of a fraction of a fraction of people reach this level of education, knowledge, professionalism and ability to handle stress that would leave most people naked, in tears, shivering in a bathtub. Yet administration doesn’t even have the respect to evaluate physician performance with something other than a sloppy, unqualified patient satisfaction survey, that out of context and in numbers not up to scientific standards, means nothing.

    Treating all patients with respect and dignity is part of being a physician and a professional. However, being expected to function within this model, while following the standards of medical care and ethical practice, while being expected to take care the multiples of the sickest and most critically injured patients in the medical world, yet be subjected to standards of “customer service” designed for luxury product salespeople standing around showrooms waiting for customers to arrive……is just plain wrong.

    4. Abusive, non-compliant and insatiable patients can be turned away, permanently, and discharged from non-EMTALA bound practices like any other free business.

    Plain and simple, it is basically humane to allow physicians this ability. Yes we all know ED physicians signed up to take care of such patients. It is well known that ER physicians cannot turn away people that are drunk, violent, abusive or rude. All other doctors can. All other businesses can. You can’t walk into the hospital CEO’s office drunk, violent, abusive and rude and have you’re a-s kissed. ER physicians cannot turn away patients who have threatened to kill their staff and coworkers. All other doctors can. Hospital CEOs can. ER physicians have to take care of the child run over by the drunk driver, and turn around and treat the drunk driver in the next room, and stay professional and keep their cool, then suffer the consequences of a negative patient satisfaction survey of a patient who is upset they waited “too long” while the physician ran the trauma codes.

    As far as I’m concerned, the least society and hospital administrators could do, to thank us for routinely handling some of the worst situations in the medical world, under the worst conditions, with a huge portion of services provided for free, is to qualify patient satisfaction scores?

    Is this asking too much? If a patient comes into a family practitioners office, is late, rude to staff, hasn’t taken his medication, and writes a complaint letter to his doctor complaining that his blood pressure is still high, that he’s upset and switching doctors, the physician has the ability to qualify this complaint and verify its validity. He rips it up and throws it in the garbage. He knows this patient likely can’t ever be satisfied and puts very little weight on it. He does not question his own performance as a physician and shouldn’t, nor does anyone else.

    On the other hand, a complaint such as this: “Doc, your staff is rude. I always have to wait 2 hr to see you and when I finally do, you’re out of the room in 5 minutes. You don’t listen. I’m feeling sicker. I’m thinking of switching doctors” has great value. The physician may be offended at first, but after thinking about it, he realizes there is an element of truth to it and he actually thanks the patient for letting him know. It’s qualified. It’s given much greater weight than the complaint of a patient who has unrealistic expectation and makes inappropriate demands.
    The outpatient private practitioner serves a master: the master is his patients and the master is himself. If his patients dislike him, he suffers. If they’re HAPPY, he GAINS. It’s a positive feedback loop.

    In the ED, if patients dislike the ED doc, and his ED, it’s no loss. There’s a waiting room full of desperate people waiting to fill the void. There’s no loss. In fact, there’s often a subconscious (false) belief that if a few patients are steered away, it just might lighten the load.

    This is wrong. The revolving door never stops bringing in work. There’s often also a false belief that, “If I just push it a little bit more past max velocity that I’ll get a break”. The faster you go, the harder you work, the more the billboard says, “one hour wait………45 minute wait……..15 minute wait…….13 minute wait” and sends more piling in. As more masses pile in, the ED physician won’t ever earn more, he’s working at or very close to maximum capacity all of the time. It’s a negative feedback loop: the faster you cut through the never ending workload, the more satisfied you keep the many times insatiable patients, the more pile in to generate money for the corporate suits bonuses. It is exceedingly unlikely that any “increase in customers” will increase the ED physicians “business, paycheck, job satisfaction or livelihood”, because as I stated before likely he has already settled in to his maximum sustainable pace and has an oversupply of patients to begin with.

    Making matters worse is that there is NOT a linear correlation between “quality of medicine practiced and patient outcomes” and “patient satisfaction scores”. In fact, often times it is the opposite (see thread on topic). Telling someone they may have cancer is not “satisfying” to the patient, but it may be your job to do it. How do you send someone a satisfaction survey after that? Telling someone you have the ability to do their ingrown toenail repair, but don’t have the time, because it’s 3am, you’re working single coverage, have two critical care patients in your ED and have a ped vs motor vehicle coming in, and that a podiatrist can take his time and do it much better Monday morning is not likely to ever “satisfy” a patient, but it’s the right thing to do. How do you send that patient even a level 1 or 2 bill for your time spent evaluating them and their toe and ruling out infection/abscess/osteomyelitis and explaining the situation and treatment options, knowing that the patient going to say “he did nothing for me”, when in fact your decades of training allowed to rule out life and limb threatening causes of the toe pain within seconds of looking? (Yes, toe pain can be life and/or limb threatening.)

    A lay persons view of what “feels most satisfying” often has no correlation with proper medical practice, and in fact, often is the opposite. This is what makes the application of the current model of corporate centered patient satisfaction to the ED setting immoral and unethical and incentivizes the physician to perform outside of the standard of care to support not better patient outcomes, but corporate revenue.

    The current corporate model of “Patient satisfaction” in the ED goes like this:

    You can tie, you can lose, but you can never win.

    An A+ is the only grade accepted. A “5 out of 5″ is expected. A “4 out 5″ is not a “B” grade. It drops the “B grade” physician, not down a rung, but to the very bottom of the not bell-shaped, but steeple shaped curve. Also, it dis-incentivizes good medicine, it incentivizes catering to unhealthy demands by many patients, it is fueled by non-physician administrators desire to generate money for themselves with no regard to proper practice, and is powered by coercive threats to physicians that if they truly do the right thing, instead of “getting in line” for administration that they lose their contract and jobs.

    The reason that the application of patient satisfaction surveys to yourself in the ED feels disturbing and wrong, is because it is. It’s unethical, bad for the patients and bad for the physicians involved.

    For those of you that demand proposed solutions:

    1. EM leadership (ACEP, ABEM, SAEM) should have the courage to support their own and make a statement that current patient satisfaction surveys are ill suited to ED setting and promote substandard care, and are fundamentally unfair to ED physicians as currently applied to the ED setting.

    2. EM physicians should demand that their leadership be allowed to construct their own model of monitoring patient satisfaction that qualifies cases of inappropriate patient expectations (for example, unsatisfied because ED physician refused demand to violate standard of care, order inappropriate CT, prescribe inappropriate antibiotic/pain medication, etc). This could involve anything from reverting to “the old fashioned way” of dealing with complaints such as ED director addressing complaint with ED physician based on merit, to developing a new model of formal patient satisfaction surveillance as a joint project between EM leadership and polling companies.

    Any solution should center on EM physicians being active partners in developing and applying any patient satisfaction monitoring systems that apply to ED settings. EM physicians need to take this specialty back. This could be one small step.
    Last edited: 06.24.13
  7. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Did you write that, or copy it? The change in typeface makes me wonder (starting at "The reason that the application of patient satisfaction surveys...").

    If you did write it, I am impressed, and I was thinking to whom it could go, who would read it, and had any kind of juice to start a dialogue. If I was personal friends with a senator, I would (but the closest I get is 3 people removed - me --> friends --> fellow professor --> US Senator). Likewise, if this was published by Bill Gates or Warren Buffett or Larry Ellison or Sergei Brin, it would get some traction.

    Regardless of who did, though, bravo!
  8. la gringa

    la gringa Senior Member

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    your post is so right it makes me wanna cry... and have my own darn office.
  9. Birdstrike

    Birdstrike

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  10. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Consider EP monthly, with WhiteCoat. You might be able to get this widespread that way.
  11. Birdstrike

    Birdstrike

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  12. BJJVP

    BJJVP

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    It's as if you read my mind. Nice to see you're back.
  13. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    If I can spread it, I will. You will get credit as "birdstrike" only, so anonymity is retained.

    Again, this is good stuff.
  14. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    OK, shot an email off to WhiteCoat. Let's see if we can get the ball rolling.
  15. D P356

    D P356

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    Hey, I appreciate what you guys/gals do. I'm going into my second year of med school, and went in for a shift in the ER during first year. Only a couple patients seemed really thankful to the staff that were taking care of them. Unfortunately, others were too intoxicated or oblivious and just looking for pain meds.

    I saw one of the docs discharge a patient, and the patient was upset and complaining saying "I've had this for a week, and you don't know what it is?" More than likely he was a smoker, but I didn't see his chart, I'm just stereotyping.

    I've wrote a note to birdstrike after my shift in the ER, and I can understand what he/she has been frustrated with. That would be draining as a career to take care of folks who won't even take care of themselves, but only to turn around and be graded on pt satisfaction. Honestly, that is double whammy similar to eating a sh*t burger with a side of sh*t fries. It would just suck all around.

    I appreciate the work ya'll do.
  16. beanbean

    beanbean 1K Member

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    Excellent post, Birdstrike. Glad you are back!
  17. RustedFox

    RustedFox LOL in NAD S/P FDGB.

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    Emailed my PD with it. She's very involved with ACEP.
  18. EM_Rebuilder

    EM_Rebuilder Member

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    "1. EM leadership (ACEP, ABEM, SAEM) should have the courage to support their own and make a statement that current patient satisfaction surveys are ill suited to ED setting and promote substandard care, and are fundamentally unfair to ED physicians as currently applied to the ED setting."


    Are you an ACEP member? If you can find one other person, you can draft a resolution to submit to the ACEP Council. Ask for your states support and drum up support with friends/contacts you know to get their states on board...

    Thats how it all happens.
  19. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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  20. 8654Marine

    8654Marine

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    After seeing what happens at ACEP, I ain't holding my breath, but it's better than nothing.

    BStrike, you da man.

    The most cynical ED staff (nurse or doc) is still the most compassionate.
  21. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu... Lifetime Donor

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    As an M3, I am only comfortable using Birdstrike's post as my SDN signature. So I did.
  22. Cerberus

    Cerberus Heroic Necromancer

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    This is all truly depressing to me. How did we let medicine come to this? We are NOT baristas at a starbucks. The customer is most often wrong in our line of work (and this is even more true in regards to the subset of discharged patients who get PGs).

    I'm not sure I want to go out into community practice if this is the way it is out there. There is a lot of BS in academics, but I'd rather fight turf battles and fight with other services than deal with making the customer happy 100% of the time.
  23. Birdstrike

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  24. EM2BE

    EM2BE Elf

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    Birdstrike, you need to be a professional writer if you are not already. Happy to have you back!
  25. Apollyon

    Apollyon Screw the GST Lifetime Donor

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  26. WilcoWorld

    WilcoWorld Senior Member

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  27. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    WhiteCoat told me that administrators look at his blog. Hope it's the start of something.
  28. Birdstrike

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  29. 8654Marine

    8654Marine

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    BStrike, can I get an autographed copy of your "Declaration"?
  30. ERDude

    ERDude

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    This piece is so accurate and so well written. I hope this continues to go viral and everybody disseminates it to all the ER (and non-ER) colleagues they know. Everything stated in this article is why, after 1 year out in the real-world, I'm already planning my own escape (which, I presume will be after about 10 years in the community). Well done, Birdstrike.
  31. Birdstrike

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  32. Birdstrike

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  33. Birdstrike

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  34. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu... Lifetime Donor

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    :thumbup:
  35. EvoDevo

    EvoDevo Sm00th... Moderator Emeritus

    Joined:
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    Land of Female Abdominal Pain...
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    Attending Physician
    SDN 10+ Year Member
    Outstanding writing, BS.
  36. ERDude

    ERDude

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    SDN 2+ Year Member
    Emailed the link to the docs in my ED and got a pretty robust response (about 1/2 responded with a very positive reaction to the article) and our director even replied that she was going to forward it onto the CMO.

    It'd be nice to see something like this really get legs.
  37. Flapjacks

    Flapjacks

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    02.09.10
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    400
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    Other Health Professions Student
    SDN 2+ Year Member
    Subbed for later.
  38. Birdstrike

    Birdstrike

    Joined:
    12.19.10
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    SDN 2+ Year Member
  39. dotcb

    dotcb ---------

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    10.15.01
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    586
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    Attending Physician
    SDN 10+ Year Member
    Thank g-d my ED doesn't use PG.
  40. goodoldalky

    goodoldalky Member

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    Attending Physician
    SDN 7+ Year Member
    All of that said -

    I will still say that there is no other job in the hospital I would do, outside of working in the ED. I think it's one of the best jobs in the world... however

    It is not perfect. There are problems (as with most jobs). As the going gets tough, I encourage those of you out there to become involved, whether that is by donating your time or money to politically active organizations within our field. Whoever it is that you feel can represent your interests, work with them, support them, etc. Physicians are notoriously hands off politically but the fact is that without people and money in Washington and your individual state legislatures we can and will be at the mercy of what others decide for us.

    BTW... Slow clap, Birdstrike.
  41. Kahreek

    Kahreek

    Joined:
    06.01.13
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    1,292
    Status:
    Medical Student
    PG is useless, it helps nobody but the administration to pressure docs into doing certain things certain way, the patient gets to make decisions they arent qualified to make and there are others decision that they could have a word on it (eg, treatment plan) and dont.
    It is healthcare not a restaurant you cant evaluate it based on costumer satisfaction. Patients are not costumers and considering them to be provides worse medical outcomes.
  42. RustedFox

    RustedFox LOL in NAD S/P FDGB.

    Joined:
    08.21.07
    Messages:
    1,901
    Location:
    Land of Eternal Summer
    Status:
    Attending Physician
    SDN 7+ Year Member
    Ah, so you're new here then. :)
  43. TimesNewRoman

    TimesNewRoman

    Joined:
    05.14.13
    Messages:
    542
    Status:
    Resident [Any Field]
    Nice.
  44. e30ftw

    e30ftw peace

    Joined:
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    253
    Status:
    Resident [Any Field]
    SDN 2+ Year Member
    ... coming off a crazy azz shift (on my bday no less) where everyone from 20 y/o to 90 y/o were stealthily trying to die, everyone got admitted, medicine stopped taking patients because they' couldn't handle the admits, etc etc..

    birdstrikes post is awesome.

    also, is it possible to just not look at PG scores when you're an attending? i dig the customer service angles and generally have good rapport with patients, so i think that BS would be easier to swallow once you get out if you just threw the envelope away before reading it..
  45. GeneralVeers

    GeneralVeers Globus Hystericus

    Joined:
    03.19.05
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    3,538
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    Las Vegas
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    I stopped reading mine a year ago. Most of the comments were insane, and made me angry. Half of them would comment on something I had no control over, or wasn't even related to my care.
  46. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

    Joined:
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    A fibrotic stroma
    Status:
    Attending Physician
    Physician PhD SDN 7+ Year Member
    Only half? Sounds like you were doing well.

    When I get dinged because people bitch about the facilities, there's a serious problem.
  47. WilcoWorld

    WilcoWorld Senior Member

    Joined:
    11.02.04
    Messages:
    1,801
    SDN 7+ Year Member
    I think that the two of the three most common complaints are things that both, I have no control over, and demonstrate a lack of understanding of what an emergency is:
    1) Parking isn't convenient enough (even though sick folks can pull right up to the front door and get a wheelchair to bring them in).
    2) People don't like that there are other patients in the ED because sick people are yucky (multiple people have actually suggested that our Emergency Department build a separate area for sick people!).

    Then, of course there is the complain about the wait times. I do have some control over that, but that control is at the mercy of a lot of other factors.
  48. RustedFox

    RustedFox LOL in NAD S/P FDGB.

    Joined:
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    Location:
    Land of Eternal Summer
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    SDN 7+ Year Member
    We have a separate area for sick people, its called the emergency department. The place for not sick people is called the PMD's offi-.... wait a minute.... I see what you did there.
  49. Birdstrike

    Birdstrike

    Joined:
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    Messages:
    2,366
    SDN 2+ Year Member
    Thanks. Likewise.
  50. Birdstrike

    Birdstrike

    Joined:
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    Messages:
    2,366
    SDN 2+ Year Member
    Thanks, but Whitecoat deserves the credit. His post is at the level investigative reporting. Why isn't ACEP, SAEM, AAEM and the AMA doing this leg work exposing these conflicts of interest involving patient satisfaction policies that profit venture capitalists, while harming patients and doctors alike? Why isn't the "media" doing it?
    Last edited: 06.26.13

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