How to fix Medicine

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FulfilledDeer

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Hey everyone,

Sorry this is the wrong forum for this, but I'm thinking about going into EM (though just got accepted to med school, so who knows) and I generally appreciate the posters here more than some sub-forums.

My question: what am I supposed to do? If I'm frank I'm thinking about EM in particular, but also medicine in general I guess. I hear almost nothing but "don't go into medicine," "you'll regret it," or "become a vet" and yet here I am planning on matriculating. And if you look at this forum in particular, there seems to be little reason to go into EM.

I'm not looking for anyone to convince me I've made the right choice (I teach high school girls right now, I feel like anything is a step up from that :) ). I'm just curious what those who are actually practicing think I should do to help. What do I focus on? Mid-level encroachment? EMTALA? Big corporate groups?

And how? I mean, I look at all these posts and I get a sense (if not a feeling) of what's going on, but what would help that? The worst part about reading any of this is the fact it seems like I just have to close my eyes and hope that everything will work out. But I have time to shape things the way I want from the beginning....what should I do?

Anyway, thanks for looking at this! I suppose I'm just trying not to feel powerless in the face of...overwhelming odds.

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I've said a lot of times that I think EM is the place to be in medicine. I've also said many times I wouldn't go into medicine again.

At your stage I wouldn't focus on any of the negatives. Just learn and try to figure out where you'll be happiest. If you really need to get into the policy aspects of EM get involved with EMRA. I know you feel powerless. We all do. It's kind of like trying to help the environment. We can do some little things but it's really just beyond anyone's control.

Remember that most EPs just work their shifts doing the best that they can and they don't let the stuff they can't help get them down. They leave work at work which is one of the best aspects of the specialty.

SDN and this forum in particular tend to be more negative than the world at large. I know I am. We are all vocal and opinionated and we come here to feed off of each other. It's great therapy.
 
I've said a lot of times that I think EM is the place to be in medicine. I've also said many times I wouldn't go into medicine again.


If I may, you're one of the few reasons here that I continue to be interested in the specialty. :) Why not medicine if you had to do it again? (Sorry if that could be solved with a search - I tried and couldn't find anything.) That idea is partially what I'm worried about.
 
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That's a tough question. It's also really personal. By that I don't mean it's something that's particularly private. I mean the stuff that matters to me wouldn't bother someone else. So you can't take the stuff that I say I find annoying and know if it will bother you in your career.

I wanted to go to medical school because I was an ER tech and a firefighter/EMT. I really enjoyed interacting with patients. I liked talking to families in times of crisis and I liked answering questions. I really felt like I was making a difference by making bad situations better. I wanted to move up to the next level where I could do more and be the one calling the shots. I always had to explain that this was the way things usually went but the doctor would have the final say. I wanted to have the final say.

Fast forward 10 years and I'm the doctor. But I feel like when I answer people's questions they are usually unhappy with it. The system is so difficult that people are rarely satisfied with what I'm telling them. They want things I can't give like cures to chronic conditions or a quick and easy solution to their lack of resources. I feel like all of society, the hospitals, the cops, the employers, the lawyers, the nurses and so on are doing everything they can to focus all of the responsibility and liability on me for issues I could never resolve. I definitely don't feel like I'm making bad situations better. I feel like a cog in the machine.

I think I might have been happier still being a firefighter or going into law enforcement. I know the grass is always greener but I still think it a lot.

There are still some good things. Critical cases if I'm not too busy. When it's too busy you can't stop to think about anything. I like doing my administrative stuff and my EMS stuff. Those are great outlets. EM gives you a number of side things you can do.

The good things about medicine are that it is relatively recession proof. As and EP you will always be able to get a job, at least for the foreseeable future. You are portable (the reason most of us are stuck where we are for the time being is due to the housing market). It's prestigious even if people totally misunderstand what we do. Medicine pays well. Even if that continues to get chipped away we do well. You can argue that we spend so long in school that we need to do well enough to catch up and that's true but neither business nor law will guarantee the money you will make as a doctor.

My goal is not to dissuade people from going into medicine. If you really have the bug it's impossible to be talked out of it anyway. My goal is to see that more people going into medicine have their eyes open to these issues. It's a lot less jarring to get there and think "I knew some of this was coming."
 
That's a tough question. It's also really personal. By that I don't mean it's something that's particularly private. I mean the stuff that matters to me wouldn't bother someone else. So you can't take the stuff that I say I find annoying and know if it will bother you in your career.

I wanted to go to medical school because I was an ER tech and a firefighter/EMT. I really enjoyed interacting with patients. I liked talking to families in times of crisis and I liked answering questions. I really felt like I was making a difference by making bad situations better. I wanted to move up to the next level where I could do more and be the one calling the shots. I always had to explain that this was the way things usually went but the doctor would have the final say. I wanted to have the final say.

Fast forward 10 years and I'm the doctor. But I feel like when I answer people's questions they are usually unhappy with it. The system is so difficult that people are rarely satisfied with what I'm telling them. They want things I can't give like cures to chronic conditions or a quick and easy solution to their lack of resources. I feel like all of society, the hospitals, the cops, the employers, the lawyers, the nurses and so on are doing everything they can to focus all of the responsibility and liability on me for issues I could never resolve. I definitely don't feel like I'm making bad situations better. I feel like a cog in the machine.

I think I might have been happier still being a firefighter or going into law enforcement. I know the grass is always greener but I still think it a lot.

There are still some good things. Critical cases if I'm not too busy. When it's too busy you can't stop to think about anything. I like doing my administrative stuff and my EMS stuff. Those are great outlets. EM gives you a number of side things you can do.

The good things about medicine are that it is relatively recession proof. As and EP you will always be able to get a job, at least for the foreseeable future. You are portable (the reason most of us are stuck where we are for the time being is due to the housing market). It's prestigious even if people totally misunderstand what we do. Medicine pays well. Even if that continues to get chipped away we do well. You can argue that we spend so long in school that we need to do well enough to catch up and that's true but neither business nor law will guarantee the money you will make as a doctor.

My goal is not to dissuade people from going into medicine. If you really have the bug it's impossible to be talked out of it anyway. My goal is to see that more people going into medicine have their eyes open to these issues. It's a lot less jarring to get there and think "I knew some of this was coming."

Thank you for your thoughtful post. I know nothing about the practice of EM, however, the statement "I definitely don't feel like I'm making bad situations better" is very interesting considering it is emergency medicine.
 
I'm on a similar track, considering I'm in the midst of paramedic training and have had leanings toward law enforcement.

It's interesting. Both sides generally say do the other. I'd venture that its not really so much greener grass, per se. I just believe that both sides have separate issues that affect people differently.

I would be interested to hear thoughts on fixing medicine though, particularly the shortage of primary care. But since I'm leaning toward EM at the moment, thoughts on that too would be great.
 
I'm not looking for anyone to convince me I've made the right choice (I teach high school girls right now, I feel like anything is a step up from that :) ).

Young teacher, the subject
Of schoolgirl fantasy
She wants him so badly
Knows what she wants to be


Sorry.
 
Yeah, but what about a 30 year mod to that...what if it is:

"She wants HER so badly..."

(I have no idea as to the gender of the OP.)

Male.

Reggatta de Blanc is a great album, but I'd say Synchronicity is more EM:

Every Breath You Take
King of Pain
Murder by Numbers

Hahaha, that made me laugh. I actually got to see them on their reunion tour a couple of years ago (2007?) - perhaps it was a bad night, but resuscitation would not be a bad free association word for the concert.
 
i totally get what docb is saying but... i feel like i am able to more than he does.

having worked in 3 regions now, in 3 very different healthcare systems/models of care... i think that your patient population and hospital system make a HUGE difference in how efficacious you feel.

if you have a county hospital nearby, you will be encouraged, if not forced, to send out people you don't want to discharge to go to "the county". specialists in your area will NOT see the uninsured - you'll hear stories of hand/plastic/ent surgeons asking for thousands up front before treating people.

patients w/ money and great insurance are very entitled. if there are too many of them in your ED, your hospital admin will totally cater to them. you will be seriously under the gun for door to doc times and LOS, even though your staffing at any given time of day may make this impossible. many of your specialists may be CASH ONLY (think ortho, GI, gen surg, not just concierge PCP's). many of your HMO patients will use the ED as primary care b/c well, even that doesn't pay enough to keep regular PCP's on the list.

if your city has no "county" hospital, there will be HUGE variations in how good the followup will be. if you really just want to treat and street people - this may not bother you. i readily admit i'm one of the bigger patient advocates out there. i consider a return visit by someone i saw to be a loss.

you want to work in a locale where the local docs feel a responsibility to the COMMUNITY. where i am not is FAR from perfect, but knowing that i can get people subspecialist followup, and even primary care in most circumstances, makes me rest better and helps me move patients through better.

choose where you work wisely. i'll go out on a limb and say that Vegas is not a primo EM city ;) based on docb and veers' takes.
 
choose where you work wisely. i'll go out on a limb and say that Vegas is not a primo EM city ;) based on docb and veers' takes.

I agree:thumbup:.

I think the EM that is practiced in Vegas (whether by my group, Veers' group and the other group) is pretty good. Only a tiny percentage of docs working in the EDs are not BC. What la gringa said about follow up being a huge issue does impact us greatly.
 
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I agree:thumbup:.

I think the EM that is practiced in Vegas (whether by my group, Veers' group and the other group). Only a tiny percentage of docs working in the EDs are not BC. What la gringa said about follow up being a huge issue does impact us greatly.

I second that. Follow up here sucks. And I feel for pts with complex pathology bc there is no good resource for them.

I work at Veer's shop and frankly it sickens me now. The way medicine is going, ridiculous hospital mandates, etc. (only to get worse the more f ing govt. you allow to take control [see active thread on that])
Just today it was insinuated that we are doing a poor Job of explaining to the pts about if they are going to be observation versus full admit status. Told we need to discussed the financial risk:benefit with the pts so they can decide bla bla bla. Really!

Just change jobs? Would actually seriously entertain it now.



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choose where you work wisely. i'll go out on a limb and say that Vegas is not a primo EM city ;) based on docb and veers' takes.

It is interesting to take the political posts in the context of the practice area payor mix. My experience is colored by being in MA, everyone gets followup. Obviously, I haven't started looking for a job yet,and my view may change (though I have never aspired to the uber-luxurious lifestyle) For now it's reassuring to know that not only do I get to treat all comers without that pushback, but as a resident I'm getting the advantage of seeing all the pathology, not pathology sorted by have vs have-not.

And, morally, it feels correct to participate in this kind of care. Its not that I feel everyone needs those grinding final 5 weeks of ICU style palliative care, but I do believe that everyone should at least have stabilizing care, and if we're going to fund that it only makes sense to fund preventive care. Either we let the have-nots complete their MIs pushed back out the ED doorway, or we fund statins and anti HTNsives for all. Plans that aim for the in between lead to financial ruin.
 
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I second that. Follow up here sucks. And I feel for pts with complex pathology bc there is no good resource for them.

I work at Veer's shop and frankly it sickens me now. The way medicine is going, ridiculous hospital mandates, etc. (only to get worse the more f ing govt. you allow to take control [see active thread on that])
Just today it was insinuated that we are doing a poor Job of explaining to the pts about if they are going to be observation versus full admit status. Told we need to discussed the financial risk:benefit with the pts so they can decide bla bla bla. Really!

Just change jobs? Would actually seriously entertain it now.



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Wow, how many of you work in Vegas? Is there something in the water there that compels you to post on SDN?

So at the risk of sounding....naively persistent, what can you do? Other than choose where you work carefully (that is, far away from Vegas). Anything? Any sort of study? Or some concrete....advocacy?
 
Unfortunately, most of my problems can easily be found anywhere.
Gotta get lucky with the hospital you/your group staffs.



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you gotta ask a lot of questions... but a lot of it won't be so clear til you start, unfortunately.

like i said before - some areas have more of a community focus than others. in my limited experiences, medium sized cities do this far better than large, and it gets better the farther south you go (not including florida, that's another planet!).

also good to work in a diverse hospital - where the un/underinsured are not the majority nor very rare.
 
Focus on what you can control (passing your first anatomy exam). Don't worry about "the system" for now. Keep an open mind about specialty choices. (There are some very good specialties left). Know that you're entering a noble profession that has some problems, but still has many positives compared to other professions.

And most important of all know that you've just joined the worlds biggest group of whiners, so stay on SDN and start bi---in' like the rest of us! It's much preferable to trying to actually change the system and ending up "feeling powerless in the face of overwhelming odds" Join in on the fun.

See, this exemplifies the issue I have. There are perfectly legitimate reasons I want to go into EM, but there are reasons other specialties sound good to me as well. But I feel like I'll end up going into EM because that seems to be where all the fun people go.

Anyway, thanks for all your advice. I think I'll do what you suggested and focus on one thing at a time - doesn't make sense to worry about a career I may not even get to.
 
My question: what am I supposed to do? If I'm frank I'm thinking about EM in particular, but also medicine in general I guess. I hear almost nothing but "don't go into medicine," "you'll regret it," or "become a vet" and yet here I am planning on matriculating. And if you look at this forum in particular, there seems to be little reason to go into EM.

I would wait to see what happens to Obamacare. Right now, there are four possibilities.

1) Obamacare is overturned in its entireity by the supreme court.
2) The individual mandate of Obamacare is overturned by the supreme court, but the rest of the law is allowed to stand.
3) All of Obamacare is allowed to stand.
4) Obamacare is repealed by the congress, and the repeal is signed into law by the president (or a veto of this is overriden by a supermajority).

Only under the first scenario will it be reasonable to continue to practice medicine. The second scenario is the worst possible outcome, as it will accelerate the slide of private insurance companies into bankruptcy and movement towards a single payer system that initially will leave doctos holding the bag on malpractice without the ability to practice defensive medicine. Three is bad, but collape of the existing system will be slower. Four will not happen if Obama is re-elected. Any scenario that allows Obamacare to stand will hit Emergency Medicine especially hard.

The bottom line about American medicine today is that we all practice defensive medicine. We document, word our discharge diagnoses, order imaging tests and labs as a matter of routine to keep lawyers off our backs. Get rid of malpractice, and you'll go a long way towards fixing medicine.
 
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