Casualty of the iPhone era: Bay Area doctor suspended after incident with patient goes viral
El Camino Hospital ED doc fired
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She was definitely unprofessional, but I find it very interesting that he said he cannot breath but is talking in absolutely no distress, and he says he can barely raise his arms yet he pulls away from her forcefully when she tries to pull him up. She definitely did not handle this well, but I am sick of doctors being secretly recorded after patients and their family members push us to the point we lose our temper. Lots of problems would be solved if we were allowed to kick out any family member with a phone and lock away the patient's phones with their valuables. Hospitals will never allow this because it would decrease satisfaction, of course.
Agreed 100%. Notably, the doc worked for a contract group (Vituity, formerly known as CEP), making it extremely easy for her to be fired, (which is ultimately what transpired per the hospital's website), so she has no recourse at all.
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It's very easy to do some selective editing so that you can display the part where the doctor acts out of anger but not the part where the patient and their family acted like total jerks for 20 minutes beforehand. So many people mistreat healthcare staff, sometimes to the point of violence and nothing is done.
The patient is obviously in no respiratory distress (if you can't breathe then you can't tell people that you can't breath) and they're obviously able to move but they have stage 4 malignant klonopenia. I've only spent a month in the ED but the overwhelming number of drug seekers and personality disorders can drive anyone mad.
The patient is obviously in no respiratory distress (if you can't breathe then you can't tell people that you can't breath) and they're obviously able to move but they have stage 4 malignant klonopenia. I've only spent a month in the ED but the overwhelming number of drug seekers and personality disorders can drive anyone mad.
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There’s no way anyone is staying on the schedule after that video. Best case scenario is she’s pulled off schedule, hospital’s peer review decides matter is closed, and she pick up shifts at another Virtuity shop. Worst case is somebody decides an example needs to be made. Being pulled off the schedule “voluntarily” isn’t reportable to the board so her license could end up being ok.
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This is all due to the age of patient satisfaction. The patient is always right. The number of times a patient has called me a F****** F*** or made a racist comment to me due to the color of my skin, I can't even count. The number of times I've heard a patient checking out a female nurse, to her face, making flat out disgusting and disrespectful comments. Where are those phone recordings that never seem to make it viral? The hospital would throw me out of residency if they found out I was I recording a patient encounter and posting it on youtube. Hospitals should be ashamed of themselves, and we as physicians should be even more ashamed for allowing this to happen.
Looking at that patient encounter, I can't lie, I have had that patient thousands of times. Patients who want to be admitted to the hospital for BS reasons, who have no criteria for inpatient admission, who believe that they are not allowed to feel sick or anxious. They basically hijack your ED and want to be admitted to the hospital, do not take any responsibility for their own health by seeing their own PMD (and I'm not talking about uninsured patients, it's the insured ones who are sometimes the worst offenders), have no sense of awareness that patients around them are actively dying that you are trying to take care of, and then they secretly record you when you are at your wits end.
The way that physician handled that encounter was absolutely unprofessional. But her behavior is indicative of a much larger problem, the core of which really gets lost in a sensationalized youtube video that misrepresents an evil doctor who "makes tons of money and drives fancy cars".
On a side note, how about hospitals stand up for physicians (or alternatively, physicians demand hospitals stand up for them) and ban the use of any video recording under the guise of promoting patient privacy. I would like to see a security guard throw a family member out of the ER for recording a private patient encounter.
Looking at that patient encounter, I can't lie, I have had that patient thousands of times. Patients who want to be admitted to the hospital for BS reasons, who have no criteria for inpatient admission, who believe that they are not allowed to feel sick or anxious. They basically hijack your ED and want to be admitted to the hospital, do not take any responsibility for their own health by seeing their own PMD (and I'm not talking about uninsured patients, it's the insured ones who are sometimes the worst offenders), have no sense of awareness that patients around them are actively dying that you are trying to take care of, and then they secretly record you when you are at your wits end.
The way that physician handled that encounter was absolutely unprofessional. But her behavior is indicative of a much larger problem, the core of which really gets lost in a sensationalized youtube video that misrepresents an evil doctor who "makes tons of money and drives fancy cars".
On a side note, how about hospitals stand up for physicians (or alternatively, physicians demand hospitals stand up for them) and ban the use of any video recording under the guise of promoting patient privacy. I would like to see a security guard throw a family member out of the ER for recording a private patient encounter.
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I just always assume I'm being recorded. And I purposely make a pretty boring viral video.
When patient realizes you aren't going to play their game, eventually they will get up and leave. Especially when you cut off their room service (i.e. sandwiches, drinks, meds, etc).
When patient realizes you aren't going to play their game, eventually they will get up and leave. Especially when you cut off their room service (i.e. sandwiches, drinks, meds, etc).
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One of the hospitals I work at has a no recording hospital. We can ask them to stop. If they continue, security is called. I've personally never had it come to this, but I wonder how many times I've been recorded without noticing.
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I don't allow patients to do audio or video recording. If I see someone obviously trying to record, I politely ask them to stop. If they still won't stop, then I walk out of the room.
I doubt if she was aware
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I get the news stories on my phone. One of them was this story covered by theroot.com. If you are not acquainted, at theroot.com, if you are not black, you are not welcome. The comments were atrocious, and, what's worse is that they all seemed VERY well read (by the writing style). The one thing on which most of them harped was this doctor's appearance, like that means anything. A few others questioned whether this person was a "doctor", and one called for the med board to pull this doctor's license.
Oh, and there was one person that said that "freezing cold" IV fluids made her hypothermic for 2 days. She said that she had norovirus, and got IVF in 1 or 2 hours, but, later, that had treatment was "delayed for 4 hours". All of the people, though, without fail, ascribed all failed behaviors to racism.
There's a hospital relatively close to where I live where the patient base is white, Jewish, Indian, Pakistani, black, and Hispanic, but they're all well to do - upper middle class to upper class. What is the ONE word they NEVER say? "Racism".
Oh, and there was one person that said that "freezing cold" IV fluids made her hypothermic for 2 days. She said that she had norovirus, and got IVF in 1 or 2 hours, but, later, that had treatment was "delayed for 4 hours". All of the people, though, without fail, ascribed all failed behaviors to racism.
There's a hospital relatively close to where I live where the patient base is white, Jewish, Indian, Pakistani, black, and Hispanic, but they're all well to do - upper middle class to upper class. What is the ONE word they NEVER say? "Racism".
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California is a two-party state. Hopefully the patient is wealthy so she can sue the patient. She also can have the DA prosecute the patient for failure to obtain consent from her for recording it. She can sue for lost wages, etc.
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Patients can cuss, swear, call a doctor a piece of ***t, threaten and verbally abuse a doctor all day and all night, and nothing happens except they're sent a survey asking they to review the doctor. The minute a doctor is caught on video being unprofessional, for 1 second, they're fired. This is the unfortunate reality of the world we live in. Be professional at all times, because anything you say, can and will, be used against you.
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As mentioned earlier, CA is a 2 party consent state so this recording is illegal.
The patient and his dad are doofuses.
If you say you can't breathe and can carry a normal conversation, you are fine.
But the doctor acted like an idiot. You can't lose your cool with patients, especially with stories of patient's surreptitiously recording encounters and posting them online for the court of public opinion. Even if recording capabilities weren't available, you don't do yourself any favors by getting confrontational with a patient or their family.
I read in another website that the dad was looking to sue or something. Not exactly what for though. Just because he got his feelings hurt? I don't think there are even any damages in this situation.
The patient and his dad are doofuses.
If you say you can't breathe and can carry a normal conversation, you are fine.
But the doctor acted like an idiot. You can't lose your cool with patients, especially with stories of patient's surreptitiously recording encounters and posting them online for the court of public opinion. Even if recording capabilities weren't available, you don't do yourself any favors by getting confrontational with a patient or their family.
I read in another website that the dad was looking to sue or something. Not exactly what for though. Just because he got his feelings hurt? I don't think there are even any damages in this situation.
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There aren't any damages, and he would be really ignorant to sue when he filmed without the doc's consent. Apparently he does not know California law very well.
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This patient with his imaginary complaint and father enabling it. Pathetic. I don’t even think the doctor acted THAT unprofessionally. She is likely just a bit awkward at baseline but nothing that was too crazy here. The patient and father don’t realize they filmed their own idiocy.
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These patients are a dime a dozen. She has done this for 20 yrs, and this really pisses her off? Come on.
You are an ER doc, you will see/have seen worse and can't let these pts get to you. don't stoop to their level.
But if I had to work in the Bay area, work a bunch of hours to be able to afford a condo then I may be alittle pissed too when I go to work. 🙂
You are an ER doc, you will see/have seen worse and can't let these pts get to you. don't stoop to their level.
But if I had to work in the Bay area, work a bunch of hours to be able to afford a condo then I may be alittle pissed too when I go to work. 🙂
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Forget whether or not the doctor should have been fired or not, for a minute. When you watch that video, are you seeing that pesky little thing that when we're medical students interviewing for EM residency we're told isn't real?
Burnout.
Pre-burnout, she walks out of the room, orders a po dose of klonopin, and Rx for 6 tabs (no refills) and instructions to call the PCP in the am. It's a 5 minute case, that rates a 1/10 on the frustration and difficulty scale. She moves on to the next patient, quickly and smoothly. She feels well rested after her post-shift sleep.
Post-burnout, it's an epic battle between a patient and a doctor who feels tired, worn down, manipulated, abused and that her time is being wasted, that rates a 10/10 on the scale of difficulty and frustration, leading to job loss. She puts up an epic psychological battle of wills and ends up winning the battle and losing the war, and job.
Burnout? What's that?
That thing the overlords of Emergency Medicine say doesn't exist? Then when it does exist, is not Emergency Medicine's fault, it's the doctor's fault?
That "burnout"?
Nah. Couldn't be.
Burnout.
Pre-burnout, she walks out of the room, orders a po dose of klonopin, and Rx for 6 tabs (no refills) and instructions to call the PCP in the am. It's a 5 minute case, that rates a 1/10 on the frustration and difficulty scale. She moves on to the next patient, quickly and smoothly. She feels well rested after her post-shift sleep.
Post-burnout, it's an epic battle between a patient and a doctor who feels tired, worn down, manipulated, abused and that her time is being wasted, that rates a 10/10 on the scale of difficulty and frustration, leading to job loss. She puts up an epic psychological battle of wills and ends up winning the battle and losing the war, and job.
Burnout? What's that?
That thing the overlords of Emergency Medicine say doesn't exist? Then when it does exist, is not Emergency Medicine's fault, it's the doctor's fault?
That "burnout"?
Nah. Couldn't be.
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Burnout needs acknowledged as a necessary and unavoidable feature of a career in Emergency Medicine. Increased time, money, resources and pre-planning should be spent by the leadership and community of Emergency Medicine, on treatment and prevention of this occupation-caused illness, just like for concussions in pro-football, asbestos exposure in ship builders, radiation exposure in nuclear plant workers and PTSD in the military. It should not have it's existence ignored, denied and blamed on the doctor when it does inevitably afflict, essentially everyone. It should be recognized for what it is; it is a disease. Shift-work sleep-disorder is one name that explains part of it. Substance abuse in endemic as attempted self treatment. Early career exits are another. Depression and anxiety can be a result or exacerbated. It's a constellation of symptoms; a syndrome. It shortens life span.
In addition to time, money and resources being spent on prevention and treatment, there should be work rules instituted like for medical residents, pilots and others; shift length limits; pace limits, minimum time between shift, mandatory night, weekend and holiday pay differentials. The effect of metrics, false malpractice accusations, and other job stress on physician anxiety and depression should be studied. There should be mandatory training and assistance for mid-career changes. Young people should be told, "You will face burnout symptoms. You are required to have, and we will help you formulate, a plan as to how to prevent this as much as possible, and handle it when it occurs. You will want to change your practice life, in your mid career and we committ to helping you do so in a way that benefits you. You will face various physical, social and psychological occupational hazards from taking on the commitment to this career. This is what they are _______ and this is how we'll help you prevent them to the extent possible, and treat them_______ when they do occur." ACEP, ABEM, ABMS and EMRA should all be tasked with leading the charge on this, with the help of the AMA.
Emergency Medicine Work Related Illness.
It's real. It can be prevented. It can be treated.
I hope someday headway is made on this front, in my lifetime, for the sake of future generations. Things can and will, get better.
In addition to time, money and resources being spent on prevention and treatment, there should be work rules instituted like for medical residents, pilots and others; shift length limits; pace limits, minimum time between shift, mandatory night, weekend and holiday pay differentials. The effect of metrics, false malpractice accusations, and other job stress on physician anxiety and depression should be studied. There should be mandatory training and assistance for mid-career changes. Young people should be told, "You will face burnout symptoms. You are required to have, and we will help you formulate, a plan as to how to prevent this as much as possible, and handle it when it occurs. You will want to change your practice life, in your mid career and we committ to helping you do so in a way that benefits you. You will face various physical, social and psychological occupational hazards from taking on the commitment to this career. This is what they are _______ and this is how we'll help you prevent them to the extent possible, and treat them_______ when they do occur." ACEP, ABEM, ABMS and EMRA should all be tasked with leading the charge on this, with the help of the AMA.
Emergency Medicine Work Related Illness.
It's real. It can be prevented. It can be treated.
I hope someday headway is made on this front, in my lifetime, for the sake of future generations. Things can and will, get better.
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I really don't think ACEP, AAEM etc are the driving force for this. My guess is the president of ACEP is burned out. These organizations, the specialty of emergency medicine and the institution of medicine itself is victim to a much larger problem: the disaster of a health care system that we have agreed to work in.
I'm convinced that burnout will improve once nuances of documentation, metrics, patient satisfaction scores, malpractice suits, student loan debt etc are mitigated first. Probably won't happen in my lifetime, but hey, I can dream.
I'm convinced that burnout will improve once nuances of documentation, metrics, patient satisfaction scores, malpractice suits, student loan debt etc are mitigated first. Probably won't happen in my lifetime, but hey, I can dream.
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I have days when I am burned out, less now than when I worked a full hospital based schedule flipping through all of these shifts.
but I NEVER ever go really pissed off at a patient. Irritate that they came in for dental pain at 2am, or argued with me for more narcotics - Sure. But never pissed off.
I get paid $200+/hr, 99.9999% of the world would kill for our Job.
Plus its soooooo much easier and quicker just being quick/decisive/firm with these patients.
Even for the most difficult patient, I never get into a prolonged discussion. At most I would hear them out, give them my Professional Medical Opinion, and if they don't agree will be discharge/sign out AMA.
I had a pissed off patient that chewed my head off 5 sec after I came in and introduced myself. I didn't try to speak over her but did cut her off with, "blah blah blah, I am the gatekeeper of the ER so you need to follow what I want to do and if you think different, can get your PCP to order whatever he wants". After a few more of these redirections, and they continue to argue, I just tell them, "We are done. I have been doing EM medicine for XX years, and you are free to leave if you disagree and get a second opinion". If they continue to be argumentative, or threatening, I walk out and tell the Charge nurse/security that the pt can leave/discharged.
I have never spent more than 5 minutes arguing with a patient. Some patients just want to be argumentative and no matter what I say will change their mind. This viral EM doc took it personal and felt a need to show the pt who was Boss. We all know who the boss is, and there is no reason to have to prove it to everyone. It just makes her look bad and no different than the patient.
but I NEVER ever go really pissed off at a patient. Irritate that they came in for dental pain at 2am, or argued with me for more narcotics - Sure. But never pissed off.
I get paid $200+/hr, 99.9999% of the world would kill for our Job.
Plus its soooooo much easier and quicker just being quick/decisive/firm with these patients.
Even for the most difficult patient, I never get into a prolonged discussion. At most I would hear them out, give them my Professional Medical Opinion, and if they don't agree will be discharge/sign out AMA.
I had a pissed off patient that chewed my head off 5 sec after I came in and introduced myself. I didn't try to speak over her but did cut her off with, "blah blah blah, I am the gatekeeper of the ER so you need to follow what I want to do and if you think different, can get your PCP to order whatever he wants". After a few more of these redirections, and they continue to argue, I just tell them, "We are done. I have been doing EM medicine for XX years, and you are free to leave if you disagree and get a second opinion". If they continue to be argumentative, or threatening, I walk out and tell the Charge nurse/security that the pt can leave/discharged.
I have never spent more than 5 minutes arguing with a patient. Some patients just want to be argumentative and no matter what I say will change their mind. This viral EM doc took it personal and felt a need to show the pt who was Boss. We all know who the boss is, and there is no reason to have to prove it to everyone. It just makes her look bad and no different than the patient.
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I'm not sure why doctors EVER get into screaming matches with patients. Whenever I feel myself getting angry or my buttons pushed, I just leave the room. I explain my case to the patient once: "I don't prescribe Klonopin, your doctor has to do that". I will listen carefully to their response. I will then apologize: "Again, sorry we just can't prescribe that from the ER". At that point if there is any hostility I tell them I am discharging them and leave the room. I usually notify security at that point to stand by.
Honestly these things shouldn't take more than a couple minutes of your time, and should take none of your brainpower or emotional energy to dispo.
Honestly these things shouldn't take more than a couple minutes of your time, and should take none of your brainpower or emotional energy to dispo.
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I also leave the room when I feel angry. The doc probably wouldn't have been fired if she didn't drop the F bomb.
I learned my lesson when I had a kid "faking" paralysis one day. I finally ordered an i-STAT BMP only to find his K to be 1.6. He was having hypokalemic paralysis. If this kid truly had trouble moving, he could've had this if he were working out pretty hard.
The lesson learned is that before you discredit somebody or push them out the door, you'd better be damn sure that you haven't missed anything and the retrospectoscope is going to view what you did appropriate. The doc that recently lost the suit after seeing a patient for a 3rd visit for chest pain can attest to this. He discharged the patient before they left the EMS stretcher. The patient was suffering a missed MI and died a few hours later. Careless and wonton disregard for patient safety without thoroughly assessing them and documenting such assessment will get you in trouble the vast majority of times. Even the frequent fliers will have problems sometimes. Don't get me wrong. I have my share of patients who are shown the door by security/police, but I always ask myself if the news media picked this up, could there be something that was inappropriate or missed?
I learned my lesson when I had a kid "faking" paralysis one day. I finally ordered an i-STAT BMP only to find his K to be 1.6. He was having hypokalemic paralysis. If this kid truly had trouble moving, he could've had this if he were working out pretty hard.
The lesson learned is that before you discredit somebody or push them out the door, you'd better be damn sure that you haven't missed anything and the retrospectoscope is going to view what you did appropriate. The doc that recently lost the suit after seeing a patient for a 3rd visit for chest pain can attest to this. He discharged the patient before they left the EMS stretcher. The patient was suffering a missed MI and died a few hours later. Careless and wonton disregard for patient safety without thoroughly assessing them and documenting such assessment will get you in trouble the vast majority of times. Even the frequent fliers will have problems sometimes. Don't get me wrong. I have my share of patients who are shown the door by security/police, but I always ask myself if the news media picked this up, could there be something that was inappropriate or missed?
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As far as burnout goes, I've actually found it helpful to sit down and spend a few extra minutes up front with perceived difficult patients/situations. I find that many are honestly confused about what the ED can/can't do (obviously doesn't apply to frequent fliers). We all know that the system and society doesn't give us the tools to solve everything, and I take the time to convey that to patients up front. Once you've established that resources are limited, it makes it much easier to adjust their expectations of how their ED visit will play out. I've actually received a few thank yous from these pts/families for taking the time to explain why they're not getting the MRI or being admitted. Others will simply walk out which also simplifies things. At this point, changing expectations is probably my favorite procedure. Since starting to do this I've actually found myself happier in general and less apathetic and probably less burned out.
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My standard in making sure patient's expectations are reasonable is, "I am an ER doc, my job is to make sure something serious is not going on. I can not in 2-3 hrs tell everyone why they have CP, Abd pain, or any other issues."
That usually calms 99% of the people down.
If this Viral pt was mine, I would have just listened/agreed with his concerns/Lab him up/gave him a dose of xanax so he doesn't bother the nurses for 2 hrs and then D/C when everything is fine. Would have taken me 2-3 minutes and I agree sometimes you do find something really wrong.
I can name 2-3 times in my career when some young guy in no distress comes in with CP only to find out he had a spontaneous Pnuemo.
That usually calms 99% of the people down.
If this Viral pt was mine, I would have just listened/agreed with his concerns/Lab him up/gave him a dose of xanax so he doesn't bother the nurses for 2 hrs and then D/C when everything is fine. Would have taken me 2-3 minutes and I agree sometimes you do find something really wrong.
I can name 2-3 times in my career when some young guy in no distress comes in with CP only to find out he had a spontaneous Pnuemo.
Doctors should NEVER behave this way. However, when they do, most of the time, it is NOT their fault. We work in a dysfunctional system, frequently with dysfunctional patients, and we are often right at the intersection of multiple conflicts of interest. We should be asking ourselves, "How did a person who had devoted the majority of their education and efforts into helping others come to this point?" Doctors are human and can only take so much.
D
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So I feel really bad for this lady. We can all agree that forcefully grabbing his arm or dropping the F bomb doesn’t constitute professional behavior. Regardless - that doctor was not saying anything we all haven’t felt at some point or another during encounters with these soul sucking, entitled, pain in the rear patients. Throw in enough years of back to back shifts juggling sick patients and trying to navigate difficult encounters like this, and we could all get to this point. If I had a horrible day fighting with hospitalists, getting pooped on by specialists, shuffling through 100 pages of records for a very complex and potentially ill patient, and having patients getting pissed at me for having to wait 45 minutes in the waiting room - and then I encountered a patient like this who was CLEARLY NOT SICK and was an entitled, indulged prick BSing his way through his “paralysis” to get meds, heck, i might get to that point too. The video was sad for me because it shows me what a pickle we have gotten into in emergency medicine. Patients abuse the ER for non-emergent reasons. Providers are stretched to their limits, expected to turn and burn, all while providing “good customer service” even to folks who don’t need to there. Burn out is inevitable in this field it seems and it scares the heck out of me.
