Khaos

I beat the game, now what
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Dec 18, 2006
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The system has taken the care out of me. I am at a low point right now. I am just venting. I just don't care right now. I have been out only 3 years and I feel just pounding on by administration and the doctors that I work with. I know it will get better and I have a couple days off but right now, I'm venting.

After recent complaints and one action, I was taken off the schedule from the hospital that I moonlight. Mind me, not suspended, they'll meet for that, but taken off the schedule. I did not admit a child for obvious behavioral issues and not psychiatric so the mother complained (of course after yelling and cursing me out). I did not give narcotics to a frequent flyer and when it was time to give him abx for infection he refused to let me touch him and complained to the hospital. When the urgent care center owned by the hospital and 2 buildings from the ER (1 minute walk) called for help for a status epilepticus, I walked over. After realizing child is hypoxic, seizing for past 25 minutes and transport was going to take another 10 to 15 minutes I carried the child over to our ED and proceeded to intubate and transfer the patient, the hospital said I did the wrong thing. They asked what if I tripped. A family member overheard me talking to case management and psychiatry, at my desk, concerning a patient and then posted on facebook how she heard everything about these patients, who do you think gets the blame despite this being completely protected by HIPAA. All of this in the past 2 weeks.

At my hospital I get an email about a review. Even though I stayed completely within the guidelines of the group (treated an asymptomatic hypertension with home meds) they said I shouldn't have since it brought her blood pressure down too quick. Remember, it was her home medications that she forgot to take.

I have been one of the few at my hospital to stand against the overuse of opoids and abuse of the ER. That doesn't mean that I don't treat those patients, but I do explain that I do not treat chronic pain with opoids and that is for their primary care doctor. As a nocturnist, I unfortunately see a significant amount of these people since express care shuts down at night. That also means that the 25k bonus for PG everyone gets is much harder for me since I don't give it out like candy as some in my group. I've even had a couple tell me they have given up their morals because of it and just don't fight it anymore but they are proud of me for still fighting. Their words, not mine.

And to just add insult to injury my mother was put in the hospital yesterday for infarct to the left with right sided weakness and slurred speech.

Can I just say AAAAHHHHHHHH right now.
 

EMdoc10

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Aug 23, 2013
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Sorry man, sounds like a rough patch. I have zero advice 2/2 to zero experience (EM bound MS4). But I commend you for being a EP with good morals.
 

Janders

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Good luck to you.

My advice:
(1) Take a bit of time to breath, have a beer or take a jog, and sleep in.
(2) Calmly re-evaluate your situation, and these complaints. Preferably with someone you can truly trust to be honest with you, if such a person exists.

You need to practice the best, most ethical medicine you can. This means occasionally irritating people because you won't give them opiates or antibiotics. If your practice environment does NOT support you, then find a new one. I know, easier said than done...

On the flip side, there is something to learn from every complaint. If you honestly analyze the situation, you may learn ways to continue to practice ethical high quality medicine while lessening your complaints. You can tell people no without fighting with them. It might feel like customer service BS, but there IS value in it (even if its just keeping you out of trouble!).
 

WilcoWorld

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That sucks. I know it isn't easy, but it sounds to me like you should stop working at that hospital.
 

dotcb

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What's that saying? "To thine own self be true."

If you're at peace with your management and decisions, which it sounds like you are, it sounds like you have nothing to worry about. You acted reasonably and acted in what you perceived was the best interest of the patients. That's what they hired you to do.

If your group over-values things such as profit or customer service above responsible medical practice, then it's them who have a problem.

Your job is probably not at high risk because a reasonable nocturnist is hard to come by, but voting with your feet can always be worthwhile. In my ED we do not refill narcotics, give un-indicated antibiotics, admit BS for profit, etc. You can find a better gig if you feel trapped. You're not.
 

GeneralVeers

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I was where you were a year ago. I assumed that the system was the problem. There are indeed problems with the system, but a malignant group/administration can go a long way to making things intolerable

I switched to a place with a better work environment, better schedule, and better patient care, and it has made all the difference. I strongly suggest you explore alternate places to work. Even if it means you have to move to a new location, it will be worth it for your long-term sanity.

Also any group that gives a 25K patient satisfaction bonus should be avoided. It's indicative of a toxic environment that puts Press-Ganey numbers ahead of patient care.
 
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Groove

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Ditto. It sounds like you're current group/hospital administration is disynchronous with your practice style and philosophy of care. A new job might be in order.
 
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Khaos

I beat the game, now what
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Dec 18, 2006
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Thanks guys for the support. I went out with friends, had a good time, and feel better. I would not change what I did for that kid. I'm certain the family didn't want me to wait 10 to 15 minutes for transport.

In the almost three years I have worked in my base job I have significantly improved with the complaints and the drug seekers. I don't argue with them anymore, I don't bother confronting them (all that gets is arguing and yelling) and just tell them upfront that I am not a pain specialist and don't treat chronic pain or treat their specific complaint with narcotics. I do try to learn from the complaints and know that it still gets to me every once in a while. I could've shown more tact with the one about the abx but just had enough of him showing his tail and yelling at everyone when he comes in.

My group has a horrible peer review system and it is very discouraging at times. If you are the type that is even remotely aggressive about sending some patients home then you are much more likely to get reviewed since anyone, including the tech, could ask the case to be reviewed. Heck, even if you are the guy in our group that has a 44% CT scan rate (yes we have one) you get peer reviewed, as he did just recently. I hear about it from the other docs all the time and as you have already seen have been a subject of it.

As for press ganey scores...what a farce. I see docs checking the patients visit list and if they are due for a PG score, you see them giving quite a bit more pain medication. Some just give it out like candy anyway. I had one doc tell me to just give a guy a few percocets to make sure he wouldn't come back in a day or two so we would be off and we wouldn't have to see him again. This guy had been there 6 times that month for pain meds already. Plus, you add the growing studies finding the link between increasing press ganey scores and mortality and it just makes it better.

I have found a new job and will be leaving in 3 months. It is a site that is rebuilding at this time and it is a slight gamble on my part. But the current job has lost 17 doctors in the past 2.5 years and has the audacity to send the CEO of the firm to our hospital and tell us this is normal. Well, I hear 6 more docs are leaving in the next 6 months and all I gotta say is good luck with covering 10 shifts a day with 12 doctors until July comes when you pick up only 4 docs that are just coming out of residency...
 

southerndoc

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I'm sorry you're in such a situation. It sounds like you are in a toxic work environment. Who wants to be overly QA'd for everything? If what you say is true, then I would look for a job elsewhere.
 

Arcan57

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I'm glad you're getting out of that job. I understand that it was a rant, but there's a lot about your current shop that doesn't sound fixable . While PG and metrics aren't going away, it sounds like the beatdown is just going to get worse as you hemorrhage docs and are asked/forced to pick up the slack.
 

Old_Mil

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I bailed on a job this spring. At my new place while some of the same issues arise (ER patients are ER patients) having a great group of nurses and good administration helps a lot. Sounds like you need a change of scenery.

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