Can some one cure my misanthropy?

[furfur]

Are Americans really that dumb/lazy? I am finishing up a pain mgmt fellowship and the experience has led me to revile my fellow human. How else am I to react when I see a 350lb 30yr old on medicare disability for backache, addicted to narcotics, and threatening to sue the entire clinic for having too much pain during her injection, which was akin to needling a fat pig? Numerous other stories abound that have led be down the inevitable path of repulsion and almost loathing of people like this. I tell myself that it's the system that is at fault and not them. But I can't seem to believe myself anymore. Please advise.

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[Noyac]

Get a Life!

 

[pgg]

Please advise.

How about more drinking and less trolling?

Honestly, what kind of advice are you looking for?

 

[coprolalia]

Psych consult. For the patient... and you.

-copro

 

[AK_MD2BE]

Psych consult. For the patient... and you.

-copro

Couldn't agree more. I am convinced that a significant amount of the obesity in our country is linked to an addiction to food (with a concomittant aversion to exercise ).

 

[ProRealDoc]

Are Americans really that dumb/lazy? I am finishing up a pain mgmt fellowship and the experience has led me to revile my fellow human. How else am I to react when I see a 350lb 30yr old on medicare disability for backache, addicted to narcotics, and threatening to sue the entire clinic for having too much pain during her injection, which was akin to needling a fat pig? Numerous other stories abound that have led be down the inevitable path of repulsion and almost loathing of people like this. I tell myself that it's the system that is at fault and not them. But I can't seem to believe myself anymore. Please advise.

I think your experience is not uncommon. Patients like the one you describe are seen in every facet of healthcare. It is unfortunate that some care so little for themselves. As a physician, your job is to treat your patients with respect and without prejudice. Don't pamper them but be compassionate.

If you can't help but loathe your current patient population, then go back to the OR.

 

[Impromptu]

I can relate. I began to dislike women during my med school OB/GYN clinic. Fortunately, I fully recovered from those two weeks and began to date again.

Many health problems are self-induced and the public expects the doctors to fix them. Entitlement leads to that sort of behavior.

 

[cfdavid]

I think the OP's just venting. This is a frusterating aspect of medicine that we've all dealt with, and unfortunately all too common. I don't think even the most saintly among us is immune to patients like the OP described.

Is it unnatural to have less empathy for those that clearly don't want to help themselves? It's only human. The challenge is to do what one of the other posters suggested, try being impartial and nonjudgemental.

That being said, obesity IS a risk factor for so many insidious diseases, so as a physician, I think it would be appropriate to address that issue with the patient in an appropriate manner.

Also, when you become an attending, if you really feel this patient is a liability to your practice, you can "fire" the patient. You don't need to put up with open threats of legal action in the way you've described, assuming you're being accurate.

 

[RabbMD]

We wonder why health care costs so much and we hear numerous sob stories from Obama's camp (just like Clinton in 1992). While these are true and unfortunate I think the number of wasteful situations patients engage in vastly outnumbers the sad stories....

For example, I was on call during a weekend and get a call about a lady who fell off her dirt bike who scrapped her knee. They tried to numb her up in the ER for cleaning the wound but she was freaking out so much about her excruciating pain (albeit not actually at the laceration site) they called me. Well she was already in a panic and it was Saturday night midnight so I just said lets take her to the OR and do general if this needs to be done now. So Prop-sux-tube and we clean it out. She goes home that night. That would be bad but it gets worse. She had a follow up appointment with ortho Monday morning. However she calls in and says she is in such excruciating pain from her knee scrape that she can not possibly get into a car (now over 36 hours from the time she injured it). So you guessed it, she calls an ambulance and is admitted for IV diladid overnight for pain control.

Yes this is why Kennedy wants to make universal medicare and make anesthesiologist accept a fiat mandated 60% pay cut....

 

[ProRealDoc]

We wonder why health care costs so much and we hear numerous sob stories from Obama's camp (just like Clinton in 1992). While these are true and unfortunate I think the number of wasteful situations patients engage in vastly outnumbers the sad stories....

For example, I was on call during a weekend and get a call about a lady who feel off her dirt bike who scrapped her knee. They tried to numb her up in the ER for cleaning the wound but she was freaking out so much about her excruciating pain (albeit not actually at the laceration site) they called me. Well she was already in a panic and it was Saturday night midnight so I just said lets take her to the OR and do general if this needs to be done now. So Prop-sux-tube and we clean it out. She goes home that night. That would be bad but it gets worse. She had a follow up appointment with ortho Monday morning. However she calls in and says she is in such excruciating pain from her knee scrape that she can not possibly get into a car (now over 36 hours from teh time she injured it). So you guessed it, she calls an ambulence and is admitted for IV diladid overnight for pain control.

Yes this is why Kennedy wants to make unviersal medicare and make anesthesiologist accept a fiat mandated 60% pay cut....

This is largely due to the high expectations the public has and that we've helped to create along the way. Americans expect nothing but the best regardless. Then they complain when such expensive care bankrupts them. You can' t have it both way people. You either cut back on the unreasonable expectations you have of healthcare or be ready to pay through your nose for it.

 

[lfesiam]

 

[cfdavid]

This is largely due to the high expectations the public has and that we've helped to create along the way. Americans expect nothing but the best regardless. Then they complain when such expensive care bankrupts them. You can' t have it both way people. You either cut back on the unreasonable expectations you have of healthcare or be ready to pay through your nose for it.

Agreed. This all comes back to the entitlement society that BOTH political parties have played a role in creating. In a sense, it's just pandering to the public which happens in a democracy (i use that term loosely these days...), but man....

I just finished up 3rd year (amen), and did IM as my last rotation. We had a 77 yo dude that comes in for chest pain (and you know how that goes) on average >2 times per month. He comes in to the ED with the same complaints (you know how you do a computer search for the frequent fliers and see a list about a mile long with dates that make your jaw drop). Dude has CHF EF 20%, DMII, an ICD, A-fib, crack cocaine use (regularly even at his age), COPD (still smokes cigarettes), and that's it, I think. Note that most of his CP is atypical and when my team admitted him for a COPD exacerbation, he stated he smoked crack prior to his symptoms. No joke.

Dude has the audacity to lecture our entire team on how he feels the accomodations at the hospital have been "decent".....LOL
It WOULD be funny if this kind of thing wasn't literally bankrupting our entire system. This dude's been offered everything under the sun in order to aid him in compliance, including free clinic follow up appointments and $4 meds from the likes of WalMart etc. Yet he comes in every few weeks through the ED for the same shi.t, and quite often gets admitted and gets the kind of work up that kings and dictators in developing nations would envy..... This can't last, and so it won't.

 

[ProRealDoc]

Remember the movie Traffic (2000) where Michael Douglas was one of the stars? There's one scene where Douglas (the US drug Czar) was talking to his mexican counterpart about rehabilitation of drug users.

When asked about what their gov't was doing to help drug users kick the habit he responded something along the lines of "Well, we give them more drugs so they can off themselves and stop being a burden to society".

 

[QofQuimica]

This is largely due to the high expectations the public has and that we've helped to create along the way. Americans expect nothing but the best regardless. Then they complain when such expensive care bankrupts them. You can' t have it both way people. You either cut back on the unreasonable expectations you have of healthcare or be ready to pay through your nose for it.

Unrealistic expectations of outcomes are a huge part of the problem too. Some people expect their lives to be completely free of suffering, which is not possible for mere mortals such as ourselves. Not everything can be fixed or replaced so that the body works absolutely flawlessly.

When I was on my neuro rotation, I had an enlightening conversation with one attending who worked with chronic headache patients. These people were completely dysfunctional: on disability, couldn't work, couldn't do social things, couldn't enjoy life at all, etc. etc. Now, I get frequent headaches myself, so I have a pretty high level of sympathy for other people who get them. But I have obligations that sometimes must be fulfilled even when I feel like my head is about to split open. Fortunately, there are medications that help take the edge off the pain and make it possible for me to still function, albeit maybe not at a 100% level of charm and sunshine. I've seen other chronic headache sufferers work through their pain too. So I asked this attending how bad someone's chronic headaches had to get before they became dysfunctional to the point where they had to go on disability. What was the turning point that made it impossible to cope? The neurologist told me, "You have chronic pain. They have a chronic pain *syndrome*." We then went on to discuss the importance of managing chronic pain syndrome patients' expectations so they would understand that even with treatment, they will still get *some* headaches. Eureka.

 

[jd1572]

Here is a quote (somewhat mangled) from Nietzsche that sums it up

Those who fight with monsters should take care lest he thereby become a monster. And if you gaze for long into an abyss, the abyss gazes also into you.

 

[urge]

Are Americans really that dumb/lazy? I am finishing up a pain mgmt fellowship and the experience has led me to revile my fellow human. How else am I to react when I see a 350lb 30yr old on medicare disability for backache, addicted to narcotics, and threatening to sue the entire clinic for having too much pain during her injection, which was akin to needling a fat pig? Numerous other stories abound that have led be down the inevitable path of repulsion and almost loathing of people like this. I tell myself that it's the system that is at fault and not them. But I can't seem to believe myself anymore. Please advise.

That's why I don't do pain.

 

[Gern Blansten]

Here is a quote (somewhat mangled) from Nietzsche that sums it up

Those who fight with monsters should take care lest he thereby become a monster. And if you gaze for long into an abyss, the abyss gazes also into you.

That could be applied to med school and residency as well. We all hope that we never become those physicians whom we despise.