emergency physicians = prostitutes?

Discussion in 'Emergency Medicine' started by tigress, Nov 21, 2005.

  1. tigress

    tigress queen of the jungle
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    hmm, hope that thread title gets some attention :p

    I've been going to med school interviews. Actually, I'm probably finished with them. In any case, at my last interview I was asked, as I often am, what field I may want to go into. I usually say that I'm not at all sure as I've never actually experienced most fields, but that at this point I am considering emergency medicine. On Friday, for the second time in 2 weeks, I was told that emergency physicians are prostituting themselves. The reasons were similar both times: emergency medicine flies in the face of what good medicine should be, including a real doctor-patient relationship, preventive care, a focus on total health and wellbeing, etc.

    Aside from the fact that that definition of medicine seems extremely idealistic, I suppose I have a few questions. First, do y'all often face that attitude from other physicians? And if so, how do you respond? Lastly, do you feel that any of that characterization is correct?

    The interviewer on Friday ended his little tirade (that's really what it was, in a way) by saying that of course even in a perfect world we would need doctors dealing with emergencies, but he didn't seem to feel that was enough justification for going into the field :confused: I wasn't quite sure what to say after that. I just said that he was the second person to say these things to me in the the space of a short time, and I appreciated this perspective and would think about it as I went through my clinical training.
     
  2. BKN

    BKN Senior Member
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    Your response was as good as you could improvise. well done.

    I think I'd ignore these gentlemen. A call from the ED is never good news, particularly at 2 am. However, in the old days (pre 1970s), they still got the phone call AND they had to come in for all of them. There was some of this attitude back then, but I rarely get it today.

    Just remember, we get all the fun. ;)

    bkn
     
  3. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Hey tigress,

    Remember me from the discussion on national health care? :) Anyhow many of their views are idealistic! I am an MS4 so others perspectives may be different. A lot of docs dont like EM for a number of reasons. EM docs think differently, when you do medicine and develop a (differential diagnosis) DDx you list the most likely causes. In EM it is whats gonna kill this guy and as such the lists are often jumbled up. IMO my view of medicine pre med school was more like EM. We dont have as big a role in controlling long standing health issues. We do develop relationships with patients but they are not long term relationships. Many of the patients I have cared for have thanked me for helping them. You are truly the one there for those people when things go bad so a good repoire is key. In IM the same 85 yr old lady comes to see you after waiting for 2 hours in your waiting room to have her BP checked and a refill on her HCTZ. It is true that EM docs dont worry about the whole patient. If we did the waiting rooms would triple. The point of EM is to treat the big problems not chronic ones. Obviously we are a key part to the health care system as we see everyone insured or otherwise. Also how many times has someone been sent from their primary to the ED.

    I dont think many docs look down on us (none I know of). Of course I could see this being different in a private setting where there are no residents. I dont know how much help I gave you but I would wait to figure what you want to do until you experience it.

    Truth is EVERY rotation I did talked smack about other fields. Med hates Surg and vice versa. Psych hates Med and vice versa. This is the nature of medicine for some weird reason.

    Take a look at people in the hospital. The happiest tend to be in EM and a few other fields. As one of my classmates who ended up doing Ob said to me. The coolest people in the hospital are in the ED. This statement holds very true.. Thats why I will be there next yr! :)
     
  4. quideam

    quideam Too tired to complain
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    I'm an MS2, and not only did my research advisor (surgery) in undergrad call EM docs "ambulance drivers" and "triage nurses", but i've gotten occasional comments from classmates that EM is, exactly like your interviewer said "not medicine the way it's supposed to be practiced". I especially get this comment from MD/PhD students. Also, the typical response from friends/ family when I say that I want to go into EM is either "wow, that's really intense, like on the tv show, right?" or "right, but what are you going to specialize in?", or more commonly, both.

    So yeah, i've heard it all and I'm sure that i'll hear more. So will you. But here's the big question: who cares? Personally, i'm glad that my medical career isn't going to involve (for the most part) management of HTN or looking at sore throats all day long. I'm also glad that I'm not going to be in surgery 12 hours a day for the rest of my life. I'm glad that my career will be interesting, challenging, and fulfilling, but that I'll still have time to travel and pursue other interests. If you like EM, that's all that maters, because medical fields will always continue to bash each other no matter what you specialize in.

    Good luck!
    Q
     
  5. WilcoWorld

    WilcoWorld Senior Member
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    It is my opinion that preventative medicine has a role in EM, and that ER Docs who fail to recognize this are not only remiss in their duties to their patients, but also clogging up their own waiting rooms.

    Good discharge instructions which clearly state what should and what should not prompt a return to the ED can allow one to discharge a significant number of people who might otherwise be admitted (see diverticulitis management for one clear example of this). They can also help prevent future recurrances/exacerbations (see just about everything else).

    One of the most important parts of a peds visit is parent education. (Babies do cry sometimes, it doesn't mean you need to bring them to the hospital. Don't feed your kid 8 oz at a time and she wont puke verytime you feed her. 99.8 degrees is not a fever...etc) Preventing some further visits that are unneceassry, painful & traumatic to the child, and costly to the parents and/or health care system.

    I almost always congratulate male smokers on their impending impotence.

    Not that I really know what I'm doing, I am first year. But it seems like the above-stated opinions were uninformed. And if you are a medical student who thinks that going into EM will allow you to avoid primary care issues you are mistaken.
     
  6. tiene dolor?

    tiene dolor? ...for me to POOP on!
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    You are right, that statement was incredibly idealistic/naive/silly. There are very few clinical encouters these days that actually focus on "total health and wellbeing". I think that holds true whether you're in an FP clinic, an ER, or anywhere else in the hospital. Most doctors these days are pressed for time and have little time to explore every aspect of a patient's well-being. That's true pretty much across the board.

    I would also point out that "good medicine" exists primarily in the eyes of the beholder. Medicine docs tend to view patients from a medicine perspective. For nephrologists it's all about the kidneys. Cardiologists? Well, naturally, cardiac is numero uno. Surgeons view patients from a surgical perspective, and so on.... So, when this interviewer says that EM docs practice "bad medicine" you have to understand his perspective. It is entirely possible that what he considers "good medicine" may, just in fact, be "bad emergency medicine."

    As for not establishing "real" doctor-patient relationships...that's just a load of crap. You can establish a pretty good relationship with a patient when you save their life. I would say, however, that to be a good EP you must be very good with people. You're dealing with a lot of stressed people and you need to establish a good repoire very quickly. There is a definite art to that.

    So what school is allowing these numbskulls to represent their institution to future students? :laugh:
     
  7. tiene dolor?

    tiene dolor? ...for me to POOP on!
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    by the way, by the title of your thread I thought you were proposing some radical new "moonlighting" scheme... :laugh:
     
  8. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Certainly much of what we do is primary care but I wont be the guy trying this HTN med or that HTN med.. Nope leave that to the true primary docs. One of my classmates who was going into surg said that people in EM go into it cause they couldnt hack surgery. I looked at her :rolleyes: and said.. hmm no, then I reminded her that while she will be working 73.2 hours as an attending ill be with my wife my kids (when I have them) and also enjoying doing the things I like to do. I really dont think you need to worry about what people think about your profession. I respect all fields of medicine and all people that go into medicine but that being said I dont know how I could go into a lot of the fields in medicine. It makes me happy that there are lots of options in this field. Everyone is different and thats what makes this beautiful.
     
  9. colforbinMD

    colforbinMD "Thanks, I'm very funny"
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    I'm sorry, I'm confused. :confused: Is being a prostitute supposed to be a bad thing? :idea:
     
  10. tiene dolor?

    tiene dolor? ...for me to POOP on!
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    there's no business like ho-business.
     
  11. ms1finally

    ms1finally Senior Member
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    For an average of 210K I will happily be somebody's prostitute - especially considering the fact that any STDs involved will not be mine!!!

    (Just dropping by, dreaming of the days when I can actually validly post in this forum!)
     
  12. docB

    docB Chronically painful
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    You know where you can find a great assortment of discharge instructions? Sitting on your patinet's bed right after they leave. They'll be right there next to the scripts for everything but the narcotics.
     
  13. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Hey actually considering there was a brothel here in chicago where the chicks were making >350K a peice and the madam was banking like 2-3 mil a yr. I think I would rather be a prostitute. Better than those other fields being the crack whores of medicine.

    Or Gas being the crack dealers and as we know from the great book Freakonomics they make less than minimum wage. :) Im kidding of course about Gas.
     
  14. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Hey actually considering there was a brothel here in chicago where the chicks were making >350K a peice and the madam was banking like 2-3 mil a yr. I think I would rather be a prostitute. Better than those other fields being the crack whores of medicine.

    Or Gas being the crack dealers and as we know from the great book Freakonomics they make less than minimum wage. :) Im kidding of course about Gas, crack dealers have more personality I wouldnt want to offend them! :p
     
  15. ClubberLang

    ClubberLang Member
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    I think it's too bad these docs had to approach the issue this way. I mean they are entitled to their opinions and all, but i think its a bit unprofessional for them to rip into what you just finished saying may be your ultimate career choice in medicine.
     
  16. EctopicFetus

    EctopicFetus Keeping it funky enough
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    Truth is this is just the beginning. Any field you choose will become scrutinized by someone. You really have to be happy with your choice and be confident enough to stick to it. Now I am not saying that this was ok for these people to do.. I am simply saying what happened to you was just a taste of what will come.
     
  17. DropkickMurphy

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    So how is medicine supposed to be practiced? Are we all supposed to be the lovable town doc who does house calls and knows every patient by first name? Give me a break.

    If physicians were forced to only practice in primary care type situations there would be no way you would find me being a doc. I value my sanity entirely too much to hand out prescriptions for antibiotics and spend my days trying to convince tje same group of hypochondriacs that there is nothing wrong with them, as I have witnessed time and again while shadowing family practice docs.

    Give me pathology any day of the week.....although EM is quite interesting to me, even though it is largely primary care with occasional emergencies, so at least there will be challenges.
     
  18. USCDiver

    USCDiver Percocet-R-US
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    While it wouldn't be prudent in a medical school or residency interview, if I were an attending and someone said that kind of thing to me, my response would be "Then I don't ever expect to see a patient of yours sent to the ED from your clinicfor 'further eval' and any patient of yours that presents to the ED, be it by ambulance from a MVC or cut their finger on a knife carving the turkey, you better believe I'm gonna be calling you to come in and see them on your own."

    It really irks me the attitude and lack of gratitude so many private physicians have toward the services we provide for them. How many patients do you see that are sent from a PMD clinic with chest pain for the ED to evaluate? And how many times do you try to call the clinic to tell them what's up or arrange for followup and they've gone home for the day? Where's the compassion for that patient that you couldn't even be bothered to call the ED to check on them before going home? I know where it is, it's up your ass because the hospitalist does all your admissions and you don't have to think about patients once they've left the front door of your clinic. Come to think of it, two of the most satisfying encounters I've had with private physicians have been from dentists that have acknowledged they are out of their league when something goes wrong with their patients and they call to see what happened and discuss what went wrong and how to ensure it doesn't happen again. How many times has that happened with a Internist? Can't think of ONE!
    :D
     
  19. NinerNiner999

    NinerNiner999 Senior Member
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    Well put Diver! I also think that any "doctor" who supervises a nursing home or assisted living facility defines the word prostitute. They sign medication orders (usually that are renewed from the patients original PMD), and when they get the slightest HINT of anything going wrong (a sniffle, a sneeze, a patient with baseline dementia with 'altered mental status' - that's my personal favorite), they get an all-expense paid trip by private ambulance to the local ED for the $3000 workup and probable discharge back to the home.

    On a different note, there is a definite validation for our specialty (yes - specialty) that goes beyond interpersonal skills and triage. In one of my shifts I managed 38 patients, had 7 intubations, 8 central lines, a handful of arterial lines, and basically ran an ICU while waiting for the "MICU team" to wrap up their decision-making on the five patients they took four hours to round on. Our decision-making is directed toward medical emergencies, and treating those without emergencies as quickly and thoroughly as we can. Many can say that any general pracitioner can practice EM and I agree - there really isn't anything too complicated about what we do. The real question is whether they are capable of managing the volume with the accuracy that we are trained to provide. My point? I went home happy that night knowing I had fulfilled my time and actually helped people who needed it. We all joke about the patients who show up at 4am with toe pain, but if they waited 8 hours to be seen for their toe, it was pretty important to them. I would hardly consider doing what we do whoring around. Then again, we have the luxury of whoring around after our shifts all night long without a pager ;)
     
  20. tigress

    tigress queen of the jungle
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    Thanks for all of the answers! I appreciate everybody's perspectives.

    btw, the physician I was referring to, from the interview Friday, is a pediatrician at the university where I was interviewing. The first doctor who said this to me is in general IM.

    We sent a patient of ours to the ED today. I work in a neurology clinic with ALS patients. One of them arrived at the clinic in respiratory distress, so we ended up calling 911 and sending her across the street to the hospital. I don't really get it, since our clinic is actually part of the university, just like the hospital; why do we call 911? It's odd to me. In any case, I thought this time, as I did the first time I saw this happen, that it's interesting that a whole clinic full of doctors sees this patient in respiratory distress and their best option is to send them to the ED. And then I thought that that really makes sense, in a way. Right there is an excellent defense for EM (as if it needed one).
     
  21. tiene dolor?

    tiene dolor? ...for me to POOP on!
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    Situations such as these are great ways to decide if you EM is really for you. The next time this happens stop and think whether you'd rather remain in clinic and continue the routine of clinic work or whether you'd prefer to leave the clinic with the patient that is in distress and continue treating that patient in the ER. :thumbup: Or, the next time you're doing medicine sit-down rounds and you hear the life-flight helicopter coming in, think to yourself whether you'd rather be down in the ER to see what's coming in. :)
     
  22. EctopicFetus

    EctopicFetus Keeping it funky enough
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    tiene dolor,

    good call on that. I think you have to experience the fields before you decide but there is nothing wrong with having an idea of what you want to do. EM rock!
     
  23. tiene dolor?

    tiene dolor? ...for me to POOP on!
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    True that. :D
     
  24. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Prostitutes?!? Really? I think we are more the sluts of medicine. I mean we give medical care to anyone who wants it - even if the can't pay. How many pediatricians or internists routine treat patients for whom there is NO compensation at all? I mean I know that MA pays little, but they do pay. They sell it, we just give it away. When "John Smith" signs into the ED for treatment for the nasty little infection he picked up (what happens in Vegas stays in Vegas right DocB?) we treat him. When the gang banger shot three times with no ID shows up, we treat him. Try getting follow up for a patient who insists on remaining a "John Doe" sometime!

    Say it with me, loud and proud, "We ain't hos, we be SLUTS! (and proud of it)!"

    - H
     
  25. docB

    docB Chronically painful
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    Yeah, it stays here alright... and ping-pongs back and forth 'cause NOONE EVER actually tells their partner "Bythe the way Honey I gave you the clap so go to your doc and get checked out tomorrow 'K, Kiss, kiss. G'night"
     
  26. bartleby

    bartleby Senior Member
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    The sooner you stop worrying about what other people think about you and start doing what actually makes you happy, the better off you'll be.
     
  27. EMIMG

    EMIMG Senior Member
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    The whole NH doctor is an interesting point. I had a pt a couple weeks ago sent into the ED from the NH. THe staff at the NH said that he had a change of mental status. THat he kept on hitting the call light and that he had said he had wanted to fall out of bed and die. Also said that he was not taking his meds (including some for his dementia/psychosis). It really seemed weak to me and it just seemed like the nurses did not want to keep on running to the room to answer the call light of this demented patient. Well, the pt arrived and said that the only thing that was bothering him was the people who brought him to the ED. Nurses at the ED had seen him before and saw him as no different.

    So, I called the covering NH doc who was not really familar with this particular patient. And, I said it seems like if he is not taking his meds including some for his psychosis, he may benefit froma depot injection instead of pills....at which point the NH doc asked me if I could recommend anything. I just laughed at him and said that this was something best followed by his primary. I should have hased him if he wanted me to adjust his BP meds while he was there.



     
  28. GeneralVeers

    GeneralVeers Globus Hystericus
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    Working at a community hospital, we once had an 80 year old woman dropped off in the triage lobby by the nursing home transport company. They did not leave a note or documentation or anything, just left the patient in the lobby.

    When I called the nursing home and yelled at them, they claimed that the patient was sent to the hospital for "r/o TIA". I asked them exactly how they'd like me to rule that out, seeing that the patient was currently asymptomatic. They had no further suggestions.
     
  29. tiene dolor?

    tiene dolor? ...for me to POOP on!
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    After my last nursing home dump I got the social work department at my hospital involved. They brought suit against the home for abandonment. Long story short, the nursing home lost, and the ruling obligates them to return all compensation received for patient care on behalf of this patient and pay a penalty (in the thousands). Serves the bastards right too. :smuggrin:
     
  30. tigress

    tigress queen of the jungle
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    I think the issue is more how to respond when people make these sorts of comments.

    Re: nursing homes: The patient I mentioned earlier who we sent to the ED from the clinic came here from her rehab/nursing home facility. At the NH, apparently, they didn't want to deal with her BiPap (too much trouble), so they just put her on oxygen. Which was a bad idea, since the reason for her respiratory distress was an inability to control her muscles/diaphragm from progressive neuromuscular disease; the more oxygen they gave her, the less she breathed, etc. (sorry for the un-medicalness :p...I'm not in med school yet!)

    Aren't there good nursing homes out there? It's a shame to think of all of the elderly people without other options who have to live with such indifferent people caring for them.
     
  31. totalbodypain

    totalbodypain banana bag in hand
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    un-medicalness...? I try to stick to four letter words only man. Were car crash docs not linquists.
     
  32. davvid2700

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    That guy who interviewed you should never be allowed to interview students ever again
     
  33. bartleby

    bartleby Senior Member
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    Yeah well... I had a med school interview with a cardiologist who literally didn't let me finish a sentence because either his pager was going off or his phone was ringing. It was so disgusted by the end of the interview I almost walked out. He was also chair of the department, so I didn't expect to see him un-invited from the interview committee anytime soon.

     
  34. EctopicFetus

    EctopicFetus Keeping it funky enough
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    This is what happens when you have the power and lowly students are there at your mercy. Sorry the guy was an ass. I hope he realizes that he reflects really poorly on the school. I was at the SAEM conference and we were meeting with PDs and one of them answered a call, the other PD at the table just went off talking smack about the first PD. I think they were both in the wrong and both rude. I gave no consideration to either of these programs. No loss in my mind..
     
  35. Jeff698

    Jeff698 EM/EMS nerd
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    Great analogy. On the other hand, I was just thinking we were the "candy man" of medicine.

    I now have this ritual that I'm sure annoys the crap outta everyone around me. Each time I write a vicodin 'script, I bob my head and chant "I AM the candy man". I can't seem to stop myself.

    Take care,
    Jeff
     
  36. Febrifuge

    Febrifuge Grizzled Old Newcomer
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    Hey, nothing wrong with a little ritual. Plus, people might not get it if you just start out singing, "who can take a sunrise/ sprinkle it with dew..."

    Today's kids apparently don't remember Sammy Davis, Jr. :(
     
  37. Dr.Evil1

    Dr.Evil1 Senior Member
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    I think that you handled the situation very well. As an EM intern I occasionally hear people trash EM on my off service rotations. I don't let it bother me at all. I think to myself there are all types of people who enjoy all types of medical practice. I try not to badmouth any other speciality since I consider it unprofessional and generally bad practice.
     
  38. totalbodypain

    totalbodypain banana bag in hand
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    If we're officially prostituting ourself out does that mean I can start charging my girlfriend for sex? :idea:
     
  39. docB

    docB Chronically painful
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    Sure, but you should bill it as a level 3 with a pelvic exam.
     
  40. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    I once had a stripper come in for (guess what) PID. As I'm starting the pelvic she says to me "most guys pay me for that view". Of course I replied (before that check valve between my brain and mouth could kick in) "that's funny, most women pay me to look". (Which is true...) :thumbup:

    - H
     
  41. kungfufishing

    kungfufishing Senior Member
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    oh my. i just laughed really loudly and got some "he really IS crazy" looks after reading that one. wow.
     
  42. totalbodypain

    totalbodypain banana bag in hand
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    sorry, just hit enter twice
     
  43. totalbodypain

    totalbodypain banana bag in hand
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    On that note, I just recently saw a well known fine young woman from our community who just so happens to have sex for money and habitually smoke crack cocaine (in the ED not in my social life as that is another story). She came in gorked out mumbling about her vagina hurting (she actually phrased it in a much more colorfull way). After a little bit of resucitation and some bug juice I go and do the pelvic and pull out a 100 dollar bill. (I guess there is a santa).... ;) But seriously, would this fall under the prostituting my self out or am I reaching and is there ever going to be hope for me to look at another woman in a normal light with out a serious amount of very expensive therapy?
     
  44. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    I think the big question is: did you keep the money that the pelvis fairy left there?
    I have a great way to separate your work women from girlfriend/wife. Make your significant other pay you. That should differentiate her from your work cases, yes?
     
  45. basementbeastie

    basementbeastie Senior Member
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    "the pelvis fairy"...HA!!! usually the pelvis fairy is not so generous...
     
  46. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    :laugh:
    Another GREAT SDN quote. You can take it in context, out of context and it's still gross!
     
  47. Iownhonda

    Iownhonda Member
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    Seems like you know prostitutes very well.
     
  48. totalbodypain

    totalbodypain banana bag in hand
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    I've been to enough.
     
  49. UCLA2000

    7+ Year Member

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    I know I'm a slut! :laugh:

    Med school interviewers just want to hear that you have a love for learning and an open mind.
     
  50. UCLA2000

    7+ Year Member

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    I know I'm a slut! :laugh:

    Med school interviewers just want to hear that you have a love for learning and an open mind.
     

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