A little bit of a meltdown

[JacobMcCandles]

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"Difficulty navigating healthcare".

Please, 90% of these people are medicaid abuse. They pay nothing to get their free dose of Tylenol and Motrin. Charge them a dollar and they don't show up.

Would love to see some data on this claim. Where I am, I’d wager the highest majority of ED abusers are commercial insurance followed by self pay then Medicaid. I honestly wouldn’t be surprised if it was close to a third split.

 

[RustedFox]

I feel ya, I had a rough week that ended up resulting in me being “taken off the schedule.”. So essentially **** canned at a teamhealth site. Had a lady come in, sent in by her naturopath for LFTs bloodwork after starting oral antifungal medication for “systemic hives”. I Iost it, told her the blood test is unnecessary in the ED and her pcp can do it if he deems it necessary. Told her she should stop taking oral antifungal medication given to her by a naturopath. Of course this naturopath turned out to be the sister of one of the other staff docs. “shes the smartest person I know”. **** show ensues.

BRO.

 

[DeadCactus]

Im not even involved in this conversation and this pissed me off. Staying out of it though. Enjoy the holier than thou posts dudes. You all suck, are horrible human beings are selfish tax evaders, and hate immigrants. Back to the regularly scheduled bashing.

Maybe ask yourself why you identify yourself as the target of that post? I started this whole conversation acknowledging that these patients can be frustrating and it's normal to vent. I went into EM to deal with emergencies - it's draining to constantly pick up the slack for a failed healthcare system. That doesn't justify treating patient's as the villains and the arguments used to justify that demonization are hypocritical nonsense. The whole thread is full of arguments about how poor and stupid all these patients are because they mildly inconvenience our sense of what our job should be - but I'm the holier than thou one?

 

[sylvanthus]

Maybe ask yourself why you identify yourself as the target of that post? I started this whole conversation acknowledging that these patients can be frustrating and it's normal to vent. I went into EM to deal with emergencies - it's draining to constantly pick up the slack for a failed healthcare system. That doesn't justify treating patient's as the villains and the arguments used to justify that demonization are hypocritical nonsense. The whole thread is full of arguments about how poor and stupid all these patients are because they mildly inconvenience our sense of what our job should be - but I'm the holier than thou one?

Did I say I was a target? I can be pissed for others. You make broad assumptions in alot of your posts above. Take a good look in the mirror yourself.

 

[WilcoWorld]

these types will be infiltrating your school system, healthcare system (already seeing this) and inundating all social services (DMV etc).

What are "these types"?

 

[DeadCactus]

Did I say I was a target? I can be pissed for others. You make broad assumptions in alot of your posts above. Take a good look in the mirror yourself.

Assumptions? You mean directly addressing specific comments made by people here? Whatever you say. I'm capable of acknowledging things that frustrate me while being appreciative of the benefits society has afforded me and not trying to paint an immigrant mother as stupid and lazy because I need her to be the villain of my day for mildly inconveniencing me - let me just go commit seppuku out of shame.

 

[JacobMcCandles]

I feel ya, I had a rough week that ended up resulting in me being “taken off the schedule.”. So essentially **** canned at a teamhealth site. Had a lady come in, sent in by her naturopath for LFTs bloodwork after starting oral antifungal medication for “systemic hives”. I Iost it, told her the blood test is unnecessary in the ED and her pcp can do it if he deems it necessary. Told her she should stop taking oral antifungal medication given to her by a naturopath. Of course this naturopath turned out to be the sister of one of the other staff docs. “shes the smartest person I know”. **** show ensues.

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

 

[sylvanthus]

Assumptions? You mean directly addressing specific comments made by people here? Whatever you say. I'm capable of acknowledging things that frustrate me while being appreciative of the benefits society has afforded me and not trying to paint an immigrant mother as stupid and lazy because I need her to be the villain of my day for mildly inconveniencing me - let me just go commit seppuku out of shame.

Naww no assumptions here at all, totally specific comments….I definitely saw villian and stupid thrown around alot. Go back and read the thread. Im out, your high horse likely needs feeding and rest. Youve been on it too long.

 

[sylvanthus]

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

Wow that was a bit of a jump to counseling, but uh thanks?

 

[WilcoWorld]

I'm concerned about this forum. I used to view it as a place to commiserate with people who had similar frustrations to mine.

Now it seems like everyone is really quick to defense and willful misunderstanding.

@DeadCactus isn't wrong - the patients aren't the enemy
@thegenius isn't an evil person - he's having a rough go of it for now

Why don't we try harder to understand each other? Why do we put so much effort into misunderstanding each other?

 

[RustedFox]

What are "these types"?

Predictable.

 

[JacobMcCandles]

Wow that was a bit of a jump to counseling, but uh thanks?

Maybe I’m completely wrong and none of those scenarios are at play but you just essentially got fired after one patient interaction. There’s a very good chance counseling would be beneficial in that situation.

 

[turkeyjerky]

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

Sorry to "pile on", but this is such condescending BS. Like, really, F off dude.

Have you ever dealt w/ one of these patients? The chronic Lyme, MCAS, systemic fungal weirdos? They all "know their bodies", know exactly what they need and when (right now!) and have enabling family members right alongside them. If one doesn't watch themselves like a hawk during these interactions, they will 100% raise a major stink about it. And CMGs will 100% dump a prn doc like their hot after nothing.

Recommending counseling for normal human behavior? Pfft

 

[JacobMcCandles]

Sorry to "pile on", but this is such condescending BS. Like, really, F off dude.

Have you ever dealt w/ one of these patients? The chronic Lyme, MCAS, systemic fungal weirdos? They all "know their bodies", know exactly what they need and when (right now!) and have enabling family members right alongside them. If one doesn't watch themselves like a hawk during these interactions, they will 100% raise a major stink about it. And CMGs will 100% dump a prn doc like their hot after nothing.

Recommending counseling for normal human behavior? Pfft

Every shift. And everyone of my partners and nobody has been fired or even remotely fired for an interaction like he described. There’s something deeper going on, there always is.

Look around at this subforum. So many people hate their jobs and their jobs are clearly affecting their personal lives.

 

[sylvanthus]

Maybe I’m completely wrong and none of those scenarios are at play but you just essentially got fired after one patient interaction. There’s a very good chance counseling would be beneficial in that situation.

Was three years ago. The wounds are scarred over by now, but ya there was other stuff, thats just an example. Now my self confidence is shot to ****, after the last couple of years, I now dislike people even more, and have become numb. Work is now just work. I gain no satisfaction from it but a paycheck. Counseling isnt going to fix a broken country, selfish patients, and collapsing medical system. No need to hijack the thread, back to bashing each other.

 

[JacobMcCandles]

Was three years ago. The wounds are scarred over by now, but ya there was other stuff, thats just an example. Now my self confidence is shot to ****, after the last couple of years, I now dislike people even more, and have become numb. Work is now just work. I gain no satisfaction from it but a paycheck. Counseling isnt going to fix a broken country, selfish patients, and collapsing medical system. No need to hijack the thread, back to bashing each other.

You’re right. It won’t fix the system but it can definitely help with your outlook and help work on things you can control. At a minimum, sometimes it feels good just to rant to somebody and get all your frustrations out.

 

[VA Hopeful Dr]

I feel ya, I had a rough week that ended up resulting in me being “taken off the schedule.”. So essentially **** canned at a teamhealth site. Had a lady come in, sent in by her naturopath for LFTs bloodwork after starting oral antifungal medication for “systemic hives”. I Iost it, told her the blood test is unnecessary in the ED and her pcp can do it if he deems it necessary. Told her she should stop taking oral antifungal medication given to her by a naturopath. Of course this naturopath turned out to be the sister of one of the other staff docs. “shes the smartest person I know”. **** show ensues.

It does take a lot of smarts to bamboozle this many people into believing you're not a quack.

 

[RustedFox]

ROYAL RUMBLE!!

 

[GonnaBeADoc2222]

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

Lol what a clownshoe post

 

[RustedFox]

Get it out, everybody.
Get it all out.

MODS, DON'T YOU DO ANYTHING.

 

[bravotwozero]

*eats popcorn, enjoys the show*

 

[AMEHigh]

For serious conversations about real stuff I use a real translator. Like explaining a new diagnosis of cancer, for instance.

If you owned a dog you would educate yourself on how to be a good owner of a dog. You would do research on the cost of ownership. And if you wanted reassurance from a professional, you are going to pay $$. You will become a more educated dog owner.

Ehh, all I’m saying is health literacy is at about the 4th grade level. Taking a child to the doctor for a fever doesn’t seem like they needed to be "scolded."

I have a family member who had something minor happen to him in the middle of the night and freaked out and went to the ER. It def was a problem that could’ve waited till the morning to call their pcp, but they just had a family member die and I think they were just in a heightened state of anxiety.

So anyway, yes there are frequent fliers who "abuse the system" but for 1) the system is trash and very difficult to navigate and access and 2) I think most people would prefer not to see the doctor/go to the ER if they didn’t feel like that was the right thing to do. So it’s not like people show up for fun to ruin doctor’s days.

Even in the outpatient world we def see people for things that don’t need to be seen so I just try to keep calm, reassure and educate. I do find it can be particularly challenging with people whom don’t speak English so I try to be extra sensitive and patient with those patients because I know it’s even more difficult for them.

 

[turkeyjerky]

Ehh, all I’m saying is health literacy is at about the 4th grade level.

Not uncommonly I see parents brings their kids in "because they said they wanted to see the doctor, so it must (!) be serious".

Spoiler alert--it's never serious.

 

[RustedFox]

Ehh, all I’m saying is health literacy is at about the 4th grade level. Taking a child to the doctor for a fever doesn’t seem like they needed to be "scolded."

I have a family member who had something minor happen to him in the middle of the night and freaked out and went to the ER. It def was a problem that could’ve waited till the morning to call their pcp, but they just had a family member die and I think they were just in a heightened state of anxiety.

So anyway, yes there are frequent fliers who "abuse the system" but for 1) the system is trash and very difficult to navigate and access and 2) I think most people would prefer not to see the doctor/go to the ER if they didn’t feel like that was the right thing to do. So it’s not like people show up for fun to ruin doctor’s days.

Even in the outpatient world we def see people for things that don’t need to be seen so I just try to keep calm, reassure and educate. I do find it can be particularly challenging with people whom don’t speak English so I try to be extra sensitive and patient with those patients because I know it’s even more difficult for them.

Some people need to be scolded.
Sometimes, the correct medicine is a good dose of "Hey, knock it the hell off."

 

[Janders]

*wades into the ring swinging a metal folding chair wildly in all directions*

 

[southerndoc]

Urgent Care is a thing...

Online-schooled NP for the win...

 

[dadaddadaBATMAN]

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

If you’re a newish guy to them and it’s a crappy team health site it absolutely could get you canned.

Also just to say it openly but outside of a cash based practice where the notes are paper I (and many others) would never go to counseling.

Going to the hospital sponsored counselor feels a lot like handing hr a paper with everything they can use to justify firing you, and reporting you to physician data base, and getting to check that box on all future license apps.

I get that there is theoretically confidentiality but it doesn’t pass the smell test.

I don’t know you and it is not a judgment on you, But I think that idea is hot garbage.

 

[JacobMcCandles]

Also just to say it openly but outside of a cash based practice where the notes are paper I (and many others) would never go to counseling.

Going to the hospital sponsored counselor feels a lot like handing hr a paper with everything they can use to justify firing you, and reporting you to physician data base, and getting to check that box on all future license apps.

I get that there is theoretically confidentiality but it doesn’t pass the smell test.

I don’t know you and it is not a judgment on you, But I think that idea is hot garbage.

Well, you would be wrong. Just like we can't change the system with one patient interaction, I don't expect an anonymous internet stranger to actually help any other anonymous burned out strangers who hate their jobs.

I couldn't care less if someone goes to a hospital-sponsored counselor, a private-practice cash-based counselor, etc. but anyone who goes through life numb, fired from their job because of a patient interaction, with zero self-confidence, etc. should probably do something to change things up.

 

[turkeyjerky]

 

[ER BlueBlood]

You're in a profession where your degree is propped up by taxes, your medical education is propped up by taxes, your customer base is propped up by taxes, regulations force customers to see you for access to the goods and services they want, you can still game the system for tens to hundreds of thousands of dollars in tax benefits, foreign competition is kept out by regulations, internal competition is limited by regulations, and you're paid hundreds of thousands of dollars a year by government payors but the Mom getting $5 in over-the-counter medications is the one getting free stuff from the government. Detached from reality. Some of you work really hard to keep your victim fantasy going and find a way to villainize poverty.

My degree? My degrees are private and I can assure you whatever gov subsidy was involved was dwarfed by my tuition cost. You act as if the government generates money magically and props up Doctors lollll. Where do you think it comes from? I can assure you the gov is giving out well beyond $5 for medication; here’s a fun example, the federal gov buys more than half of the baby formula used in this country, guess who gets that “free” baby formula and who pays for it?

Competition “limited” for very serious reasons. And becoming less limited by the hour. I guess we should let online NPs do our job.

Have fun paying $500 billion of free student loans - well I will agree with you on that one, the gov “propped” up the loan market with TAXPAYER money.

 

[DeadCactus]

Cool, glad we cut the pretense and just dove straight for the up-by-the-bootstraps nonsense.

 

[JacobMcCandles]

It’s like the Who’s Who of SDN Burnouts in here. Is something on fire in this thread?

 

[RustedFox]

Cool, glad we cut the pretense and just dove straight for the up-by-the-bootstraps nonsense.

Is there another way?
Like, has the government ever actually gotten someone up out of poverty, self-sufficient, and no longer dependent without any effort by the individual themselves?

 

[Lexdiamondz]

What bull****. It's Medicaid abuse to use their benefits but if everyone here trying to maximize every barely related 1099 tax write-off isn't tax abuse? And there is just some epidemic of people who want nothing more out of life than to sit in some ****ty ED waiting room and catch an attitude from half-a-dozen bitter staff for a few dollars worth of over-the-counter medicine? You don't want to be there for hundreds of dollars an hour but they want to for some Tylenol just for the rush of gaming the system. What a racket! Some of you are so desperate to be angry at people for being poor.

I think there's a pretty big difference between maximizing saving money you earned vs. maximizing spending money others put in the system.

 

[RustedFox]

I think there's a pretty big difference between maximizing saving money you earned vs. maximizing spending money others put in the system.

 

[thegenius]

Would love to see some data on this claim. Where I am, I’d wager the highest majority of ED abusers are commercial insurance followed by self pay then Medicaid. I honestly wouldn’t be surprised if it was close to a third split.

100% bollocks. I don't believe that at all.

Our ED abusers, defined as >1 visit/week, pay nothing and never even see the ER bill.

 

[VA Hopeful Dr]

Online-schooled NP for the win...

I tend to think even that is probably more schooling than is needed for the majority of UC visits.

 

[JacobMcCandles]

100% bollocks. I don't believe that at all.

Our ED abusers, defined as >1 visit/week)), pay nothing and never even see the ER bill.

Defined by who? I would consider 1-2 times per month but now that’s just semantics. We may have one patient in the entire system that averages out to >1 visit/week and she’s neither Medicaid or self pay. Nonetheless, it sounds like you don’t have the data to back up your 90% claim.

Edit: It's tough to find good data but slide 7 of this presentation () gives some info. I can't find the original paper (Hunt 2006) but this quotes that 86% of what they define as frequent flyers have insuranace and "more commonly have Medicaid (53% vs 39%) or Medicare. So, my numbers are likely a little off and your 90% number is likely incorrect as well.

 

[CoolDoc1729]

Ehh, all I’m saying is health literacy is at about the 4th grade level. Taking a child to the doctor for a fever doesn’t seem like they needed to be "scolded."

I have a family member who had something minor happen to him in the middle of the night and freaked out and went to the ER. It def was a problem that could’ve waited till the morning to call their pcp, but they just had a family member die and I think they were just in a heightened state of anxiety.

So anyway, yes there are frequent fliers who "abuse the system" but for 1) the system is trash and very difficult to navigate and access and 2) I think most people would prefer not to see the doctor/go to the ER if they didn’t feel like that was the right thing to do. So it’s not like people show up for fun to ruin doctor’s days.

Even in the outpatient world we def see people for things that don’t need to be seen so I just try to keep calm, reassure and educate. I do find it can be particularly challenging with people whom don’t speak English so I try to be extra sensitive and patient with those patients because I know it’s even more difficult for them.

My sister is a first language English speaking attorney - over the weekend she wasn’t sure what she should do over a mild msk issue .. she was clearly embarrassed to ask me what to do about it but she wasn’t able to triage herself urgent care vs pcp vs ER … as the only doc in the family, I receive text messages with pictures of rashes and cold sores .. if there’s not a doc in the family there’s no free text a doc for those sort of inquiries.
Something an attending that I really didn’t like told me in residency , was to try and see one of your family members in a frustrating patient, even if it’s wacky alcoholic Uncle Melvin or your most annoying in-law. It doesn’t hurt. I also tend not to argue against unnecessary minor things (Tylenol for the pedi fever, LFTs for the Lyme nonsense) unless it’s actively harmful. Anymore they will generally weed themselves out of the waiting room anyway, and in the morning I go home either way.
But vent on! I think that’s a lot of what this forum is for, right? Our job is much more frustrating than even most physicians realize.

 

[GonnaBeADoc2222]

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

This guy will make a great Team Health site director one day.

 

[CoolDoc1729]

I’m really sorry to hear that. I don’t want to pile on but several things are likely going on if you were essentially fired for that interaction.

1.) The encounter was way more hostile on your part than you made it seem. Pissing off the sibling of some random staff doc doesn’t result in something like that.

2.) This wasn’t the first interpersonal issue you’ve had and it’s been an ongoing trend and you were already on the radar.

3.) If this was a one time issue that was bad enough to result in this outcome, there’s likely a fairly significant personal issue going on (i.e. marriage difficulty, substance abuse, etc.).

Regardless, many hospitals offer totally free, confidential counseling services for physicians. That may be a beneficial direction to go regardless if you think you need it or not. Either way, I wish you the best of luck.

Whether it was more or less a hostile interaction, it shouldn’t be easier to fire us than the cafeteria staff. All sorts of people are hostile to me all the time, and they don’t get fired! At my work and at their work (ie grocery store). I would have just ordered the LFTs because it’s easier (maybe I’m part of the problem) but it’s wrong that this is how our employment works. Maybe my gaslight burned out? But I don’t think we should need counseling to cope with BS stuff that these corporations find acceptable to do to us. They are the problems; we are not the problem and neither are most of the patients.

 

[DeadCactus]

I think there's a pretty big difference between maximizing saving money you earned vs. maximizing spending money others put in the system.

I'm sure you think that. Lots of people are emotionally invested in creating artificial differences between different groups of people gaining financially at the loss of public funds.

 

[TJRock]

Venting online is a good way to blow off steam. I'm glad that you (plural) are doing it.

For what it is worth, as a non-physician, I greatly appreciate what y'all do and what you have to put up with. I hope y'all find some peace.

 

[Jabbed]

Defined by who? I would consider 1-2 times per month but now that’s just semantics. We may have one patient in the entire system that averages out to >1 visit/week and she’s neither Medicaid or self pay. Nonetheless, it sounds like you don’t have the data to back up your 90% claim.

Edit: It's tough to find good data but slide 7 of this presentation () gives some info. I can't find the original paper (Hunt 2006) but this quotes that 86% of what they define as frequent flyers have insuranace and "more commonly have Medicaid (53% vs 39%) or Medicare. So, my numbers are likely a little off and your 90% number is likely incorrect as well.

Citing a 16 year old survey (that actually identifies Medicaid patients as the single largest group of frequent fliers) hardly supports your argument. Back of the envelope math:

14% uninsured + 86%x53% Medicaid = 60% of frequent fliers as of 2006 were either uninsured or Medicaid and probably did not pay for their healthcare. Fast forward 16 years and I’m sure that those numbers have inflated significantly.

 

[Birdstrike]

<vent>

I had two small meltdowns in front of patients the other day:

1) mom brought in her 2 yo daughter because of fever for 2 hours. That's it. She felt hot at home. Temp was 100.9 in ED. Everything is normal. After I looked at the daughter for 5 seconds, listened to lungs for 5 seconds, pushed twice on the belly, I spent the next 7-8 minutes using the Google Translate app from English to Spanish explaining how this isn't the right use of the ER, nobody in their right mind is going to workup a fever for 2 hours, she is fine, and loads of other stuff. I remember saying "no child in the history of mankind has died after having a fever for 2 hours". then i said "Seriously! Maybe once like 200 years ago. 1 child died right after having a fever for 2 hours." Then I said "There is no doctor that is going to workup a fever for 2 hours." "There is nothing to do." Then I said "I will only consider trying to figure this out if she has a fever for 5 days." then I quipped "Do you understand what I'm saying?"

She said "yes".

I left the room. I think Mom was upset with me.

2) 45 yo woman comes in with epigastric pain for 45 minutes. It resolved prior to coming to the ER. Every vital sign was normal, and her exam was normal. The description was such that it was either hepatobiliary or gastric, not cardiac. Nonetheless the EKG was normal. I wouldn't have even ordered labs but they were ordered by triage. Normal. I again spoke to her (and her son translated from English to Spanish) that she must have made an immediate decision to go to the ER the moment she had this pain because it takes time to drive and come to the ER. Did she bother taking any meds? Did she bother to say "maybe I should just wait and see what happens?" 98% of all doctors are out in the world, not in the hospital, and you need to see them. They are there for a reason. The hospital and ER are only here if you are dying. Literally dying like you are in a car accident and there are bones sticking out of your body. Or if you are unconscious. If you are unconscious then I hope you get yourself to an ER and get treated for that. There are 100 things that can cause her transient upper abdominal pain and I'm not going to do anything about it because it went away. I can't test for all of these 100 things. Honestly next time this happens take some tylenol and motrin and lay down in bed. Just wait a little bit. then I said "I'm not trying to be dismissive here...but no doctor is going to do anything about having pain for 45 minutes that just goes away."

</vent>

I think it’s impossible to practice EM without eventually getting this way, once in a while. I’ve been there.

 

[JacobMcCandles]

Citing a 16 year old survey (that actually identifies Medicaid patients as the single largest group of frequent fliers) hardly supports your argument. Back of the envelope math:

14% uninsured + 86%x53% Medicaid = 60% of frequent fliers as of 2006 were either uninsured or Medicaid and probably did not pay for their healthcare. Fast forward 16 years and I’m sure that those numbers have inflated significantly.

He said 90% was Medicaid and I said probably 33% of the ones I see are Medicaid, with another third being self-pay, and another third being private insurance. I did a quick Google search and that's all I could find but I'm happy to look at more recent data

 

[GonnaBeADoc2222]

There should be a little iPad in each exam room to let the patient add on whatever labs they want to what I order, with the caveat that I dont see the results, nor am I responsible for them.

 

[JacobMcCandles]

This guy will make a great Team Health site director one day.

CMGs aren’t my style and I’d probably be burnt out dealing with all the other burnt out docs.

 

[JacobMcCandles]

Whether it was more or less a hostile interaction, it shouldn’t be easier to fire us than the cafeteria staff. All sorts of people are hostile to me all the time, and they don’t get fired! At my work and at their work (ie grocery store). I would have just ordered the LFTs because it’s easier (maybe I’m part of the problem) but it’s wrong that this is how our employment works. Maybe my gaslight burned out? But I don’t think we should need counseling to cope with BS stuff that these corporations find acceptable to do to us. They are the problems; we are not the problem and neither are most of the patients.

Again, my assumption is that there are other things going on and this was not an isolated incidenct, hence, my recommendation for counseling. But again, everyone is more than welcome to pretend to be aghast at someone who got fired because of one patient interaction, states they feel numb with life, and has no self-confidence to meet with someone and talk. It’s not my career and it isn’t my life but I’d rather see a fellow doc find some joy in their life and be confident in themselves.

 

[cyanide12345678]

Obviously OP is burned out. I’m obviously burned out myself so i get it. It’s gets really hard to see these silly complaints especially if a big bolus of people check in at the same time. There is definitely some defeat i feel at times when i open my pended notes. I understand the frustration and I’m all for a $5 copay for Medicaid patients.

I did however want to offer an alternate perspective of an immigrant since i am technically one myself having been born and raised in pakistan. While I’m not exactly Hispanic but i think i can understand the perspective of the worried non English speaking mother.

I don’t think Americans truly understand poverty and lack of education. In pakistan the literacy rate is around 60 percent. To be considered literate, you have to be able to read a simple article and write a simple letter. So 40 percent of the country, 100 million people can basically not read or write anything. That forms the labor class of pakistan, the farmers, the construction workers, the household help etc. that uneducated chunk of pakistan wouldn’t even know what tylenol is (paracetamol in pakistan). Let alone know what it’s used for.

Mexico is probably along the same lines in literacy, maybe a little better? But expecting somebody with a very low level of education, if even any level of education, to know what tylenol is, how much to give, to read the bottle instructions, is a lot. All im saying is that it’s not easy. I see a decent number of non English speaking immigrants at one of my shops, most of them truly just don’t know any better. It is truly a lack of education.

Having been raised in a household with uneducated household help. I assure you, if there were two medicine bottles on a table, and i asked my household help person in pakistan to bring one of the bottles by name, there would be a 50 50 percent shot that they would bring the correct one. You have to tell them the color and size of the bottle to get them to bring the correct thing. Recognizing the correct item within an aisle of hundreds of bottles probably is much harder if you can’t read or write.

Lastly, i studied English all my life in private schools, was a part of the debating club and comfortably spoke English in front of large crowds. Yet in America i found myself struggling to speak in groups, couldn’t keep up with conversations for a good 1 year until i got comfortable speaking the language on a daily basis. There was an incident which i remember very well - i went to get my state ID made, the guy at the front desk said something, he spoke fast, i didn’t understand anything. He said it again, i didn’t understand crap. Then i looked at my brother who was with me and told me he wants proof of address -_- on paper i had a 96% in English language in the British educational system (o levels). But i couldn’t even understand a person asking for my address in the first month of being in the US.

Heck it took me two days to muster courage to make phone calls where i would have to speak English to call apartments to inquire about vacancy when i first moved to the US. And i actually spoke English, i can’t imagine the hesitancy one would have in approaching a store employee with a question when you didn’t speak the language.

It’s not easy being an immigrant. And i had a cushy life compared to the labor class immigrants who have significantly less education than me.