Let’s talk about Uber

[scummie]

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Our ED recently started paying for patients to get Uber’s. Interested to hear if other places are doing this. Problems so far?

Pooping in said Uber’s, Uber driver returning patients who don’t have correct address, rewards patients who refuse the free bus token even if the bus is running.

Just yesterday had a patient who got one because she was tired of waiting and then cancelled it because her ride came.

Also yesterday had one for a patient who called an ambulance for a refill of stolen controlled substances and then demanded an Uber back home. And she got it!!

Where do we draw the line? It’s one thing to arrange a ride home for debilitated grandma, it’s another to just continually give into bad behavior. Where is this in EMTALA?

 

[Birdstrike]

it’s another to just continually give into bad behavior.

Administration doesn't care about "giving in to bad behavior. " Continually giving in to bad behavior is now codified into health policy at the corporate all the way up to the government level. The entire concept of patient satisfaction alone, does that, not to mention all other policy. The cardiologist telling you you need to exercise isn't as 'satisfying' as the guy who tells you you're "doing everything you can already." The doc doing the right thing gets worse cores. The endocrinologist telling you to eat less sugar isn't 'satisfying' like the guy down the street that blows it off and just up's your insulin and says "There's nothing you can do, you're a victim of this disease. I get you." Punishing doctors who refused to give in to patients posing as "chronic pain patients" and lie to get narcotics to sell, snort or inject, because the patient nuked the doctor on a satisfaction is probably the most egregious example. The doc doing the right thing gets worse scores.

But they have a touchy feely term for it all called "pay for performance," this is how they measure it and the government is tying our payment to it so they can punish us precisely for not "continually giving in to bad behavior." Yet we're expected to fight it upstream against the full force of Healthcare corporations and the US government. And they wonder why doc's are burned out and quitting despite their burnout roundtable sessions.

What's another free pass for ED abusing grandma to use uber to hitchhike home?

Just follow the money. The hospital paying a few bucks for an Uber to get grandma out of their ED is cheaper for them than losing thousands of dollars having to keep her in the ED or an inpatient bed they won't get paid for. Hospital administrations care about nothing but money. And that's why they pay for grandma's Uber. They don't care if it encourages toxic, unhealthy behavior that decays society. All they care about is the Almighty Dollar. And it's never going to change in our lifetimes.

Keep doing the right thing, but don't expect your administration to do the same or back you up.

 

[bravotwozero]

It’s an option, can be useful and cheap at times. For example, debilitated granny. I don’t see a problem with it as long as some level of discretion is used.

Hobo that came in for a sandwich? Sorry, go hang out in the waiting room until you can catch the bus or find some other way to get to your destination. I mean, if you’re homeless, you don’t really have a destination!

 

[TooMuchResearch]

"I'll have you talk to your nurse about how you're getting home."

That's about all I think about the situation.

 

[p1acebo]

"I'll have you talk to your nurse about how you're getting home."

That's about all I think about the situation.

This. I never make it my problem on how the patient gets home.

We do have taxi vouchers, but they are on the down low and not many know about them. As opposed to advertising the use of Uber, your institution could keep it a secret and use it sparingly at the discretion of yourself or whoever chooses to use it. That way you don’t have people coming in demanding it immediately.

 

[GonnaBeADoc2222]

Isn't it amazing how I can drive my daughter to her scheduled pediatrician appointment which I'm paying for (insurance) and still wait 45 mins? Yet these people can call for the most expensive taxi ever (EMS), demand to be seen within 10 mins for non emergent and unscheduled care, get a free Uber home and not pay a dime for the entire experience. Repeat next week, and the weekly after, etc etc , with no consequences at all.

Just amazing how this country works.

 

[GonnaBeADoc2222]

This. I never make it my problem on how the patient gets home.

We do have taxi vouchers, but they are on the down low and not many know about them. As opposed to advertising the use of Uber, your institution could keep it a secret and use it sparingly at the discretion of yourself or whoever chooses to use it. That way you don’t have people coming in demanding it immediately.

Same. My responsibility ends when I click discharge.

 

[Birdstrike]

Isn't it amazing how I can drive my daughter to her scheduled pediatrician appointment which I'm paying for (insurance) and still wait 45 mins? Yet these people can call for the most expensive taxi ever (EMS), demand to be seen within 10 mins for non emergent and unscheduled care, get a free Uber home and not pay a dime for the entire experience. Repeat next week, and the weekly after, etc etc , with no consequences at all.

Just amazing how this country works.

Don't forget that they can slip and fall on the way out the door, sue and win a big settlement. We live in an entitlement society and there's an entire Grievance Industry that's sprung up around us to profit from it. If you think free cab vouchers are bad, just look at what they want next: Free college, student loan debt, reparations for slavery and monetary LGBTQ reparations. And yes, as a rich doctor, you will be expected to pay for it all, and your income will be too high to qualify for any of it.

 

[namethatsmell]

IMHO there's two ways to deal with issues like this (ie the system enabling bad pt behavior).

First way is as posted above: "talk to the nurse" and put it out of your mind. This is probably the way to stay the most sane during your career.

Second way: Do things to actively address the issues on a broad scale. Clearly it's not possible during a shift. It's also unlikely that simply trying to talk with your director or hospital admin will result in any big changes. Some things which may actually get your opinion noticed and heard include: joining a hospital committee, working with groups that focus on influencing public opinion or policy (ie municipal health dept, state medical board, AAEM, etc), working with groups that focus on changing patient behavior or perceptions, writing op-eds on the subject in local papers, getting involved in politics, etc. While there's a good chance you'll won't succeed, at least you'll feel like you're actually trying to move the needle in the right direction. At the same time, it will provide some networking and may open up some interesting doors and career paths.

 

[RustedFox]

IMHO there's two ways to deal with issues like this (ie the system enabling bad pt behavior).

First way is as posted above: "talk to the nurse" and put it out of your mind. This is probably the way to stay the most sane during your career.

Second way: Do things to actively address the issues on a broad scale. Clearly it's not possible during a shift. It's also unlikely that simply trying to talk with your director or hospital admin will result in any big changes. Some things which may actually get your opinion noticed and heard include: joining a hospital committee, working with groups that focus on influencing public opinion or policy (ie municipal health dept, state medical board, AAEM, etc), working with groups that focus on changing patient behavior or perceptions, writing op-eds on the subject in local papers, getting involved in politics, etc. While there's a good chance you'll won't succeed, at least you'll feel like you're actually trying to move the needle in the right direction. At the same time, it will provide some networking and may open up some interesting doors and career paths.

NOPE.



You're a physician. When the medicine is done, you're done. Wake up the administrators. Adios, MF'er.

 

[RustedFox]

Let me be clear.

They (admin) treat us like dog$hit. Replacable cog in the machine.
I will respond appropriately. You have a non-medical problem? Have fun with that.
After all, with a ratio of 10 administrators to 1 physician, I'm sure that they can find someone to deal with that situation.

ATTENTION ALL ADMINS:

You want me to do the medicines (sic) and then shut up

Okay. I did the medicines.

Byyyyyeeee.

 

[namethatsmell]

NOPE.



You're a physician. When the medicine is done, you're done. Wake up the administrators. Adios, MF'er.

Let me be clear.

They (admin) treat us like dog$hit. Replacable cog in the machine.
I will respond appropriately. You have a non-medical problem? Have fun with that.
After all, with a ratio of 10 administrators to 1 physician, I'm sure that they can find someone to deal with that situation.

ATTENTION ALL ADMINS:

You want me to do the medicines (sic) and then shut up

Okay. I did the medicines.

Byyyyyeeee.

I'd say we agree that admins treat us like crap. And physicians are, partly, to blame. We helped put the keys to the castle in the hands of the admins in name of things like "me bone doctor. me fix bone then me eat and me sleep."

Admins now have waaaaaay too much clout over a field the vast majority can't actually practice. Unless docs actually take action...nothing will change to make practicing medicine more tolerable. Admin will keep cutting pay, cutting staffing, monitoring you to ensure you're smiling enough when talking to patients and telling them that they're special, hiring NPs and putting them in situations they don't belong, etc. Perhaps some docs are cool with nothing changing. I'm not.

If you're saying that a physician taking action to counteract the power and actions of the admins somehow puts said doc on their level or is somehow beneath the doc...then we definitely disagree.

Apologies if I'm misunderstanding you.

 

[RustedFox]

I'd say we agree that admins treat us like crap. And physicians are, partly, to blame. We helped put the keys to the castle in the hands of the admins in name of things like "me bone doctor. me fix bone then me eat and me sleep."

Admins now have waaaaaay too much clout over a field the vast majority can't actually practice. Unless docs actually take action...nothing will change to make our lives better. Admin will keep cutting pay, cutting staffing, monitoring you to ensure you're smiling enough when talking to patients and telling them that they're special, hiring NPs and putting them in situations they don't belong, etc. Perhaps some docs are cool with nothing changing. I'm not.

If you're saying that a physician taking action to counteract the power and actions of the admins somehow puts said doc on their level or is somehow beneath the doc...then we definitely disagree.

Apologies if I'm misunderstanding you.

Oh, I think that we agree more than you think.

If you hest responsibility upon me, then I will wield power. If you don't want me to wield power, then you will also take responsibility with it.

I do a good amount of "bouncing". I have worked with dchristismi. I trained Tenk. They'll corroborate my attitude. With regularity, I give the patient the "get up and get out of here!!!" talk.

I never got congratulated for my bouncing. I only get harassed. "Patient satisfaction" and all that.

Okay.

My only motivator is to sit at a screen and click buttons. The less involved I am, the better.

Wake up, admins. YOU have a problem.

 

[namethatsmell]

Oh, I think that we agree more than you think.

If you hest responsibility upon me, then I will wield power. If you don't want me to wield power, then you will also take responsibility with it.

I do a good amount of "bouncing". I have worked with dchristismi. I trained Tenk. They'll corroborate my attitude. With regularity, I give the patient the "get up and get out of here!!!" talk.

I never got congratulated for my bouncing. I only get harassed. "Patient satisfaction" and all that.

Okay.

My only motivator is to sit at a screen and click buttons. The less involved I am, the better.

Wake up, admins. YOU have a problem.

Yup, at the particularly dysfunctional shops there's a certain joy in waking up admins in the middle of the night for their "assistance" to solve a ridiculous issue they've either created or not helped address during their bankers hours. Nothing like helping them "contribute to the patient experience" with the rest of us.

I've got no beef with docs who do nothing but practice. But if not enough docs try to improve the current dumpster-fire condition our "system" is in and challenge the current status quo of non-physician administrators running the show...the lunacy will continue.

 

[deleted547339]

“I’ve heard the waiting room has a nice snack machine and I think i saw someone left a pillow out there.”

Next patient.

 

[Interpolfanclub]

"I'll have you talk to your nurse about how you're getting home."

That's about all I think about the situation.

Exactly my stance. As much as I can (given I'm an EM doc) I stay out of the social stuff. Most people figure out how to get home if they just get put in the lobby. We have taxi vouchers but do not advertise these.

 

[RustedFox]

Not my problem.
I do mean it.

The nightshift nurses love me at my shop, because my door-to-discharge time borders on :10 minutes.
GO THE HELL HOME.

They know (from triage) to not list every little ache and pain that they've ever had in their entire life.

CC: "Cough"

Okay, bye.

CC: "Sore throat"

Okay, bye.

I see "Med eval" at 3:20 AM, and I know it's "Okay, bye, go the hell home" time.

Byeeeeee.

 

[RustedFox]

I've got no beef with docs who do nothing but practice. But if not enough docs try to improve the current dumpster-fire condition our "system" is in and challenge the current status quo of non-physician administrators running the show...the lunacy will continue.

See, here's the thing. I was "that guy" at my present gig.
All I got was heat, to the point where I was called into a big conference room of admins and had to explain how I got so many patient complaints.

I straight up said: "Come down to the ER and you'll see how this happens."

I said: "If people behaved like they do in any other place, the police would be called. Yet, we accomodate them."

I looked at the table. There's the CEO (an actually good guy), an orothopod, an OBGYN, and radiology. Other paper pushers.

No ER representation.

This was last year sometime.

They looked at me like I had a penis on my forehead.


I have since limited the face-time I spend with patients.

I stopped telling them the truth. "Here are your prescriptions. Bye."

Less complaints! No awkward meetings with paper-pushers!

Byeeee.

 

[RustedFox]

Isn't it amazing how I can drive my daughter to her scheduled pediatrician appointment which I'm paying for (insurance) and still wait 45 mins? Yet these people can call for the most expensive taxi ever (EMS), demand to be seen within 10 mins for non emergent and unscheduled care, get a free Uber home and not pay a dime for the entire experience. Repeat next week, and the weekly after, etc etc , with no consequences at all.

Just amazing how this country works.

Those that want to copy the (Canadian, Scandanavian, etc) healthcare model need to also realize that the abuse cannot be tolerated. Lets see the Liberals enact some legislation to punish the abusers. Won't happen? Surprise!

#FULLVEERS.

 

[GeneralVeers]

Those that want to copy the (Canadian, Scandanavian, etc) healthcare model need to also realize that the abuse cannot be tolerated. Lets see the Liberals enact some legislation to punish the abusers. Won't happen? Surprise!

#FULLVEERS.

You are an evil, uncaring doctor. It's your job to be empathetic, do whatever patients ask, give them all the drugs they want, and NEVER talk about money!!

 

[RustedFox]

Never, ever, ever change your avatar.

 

[thegenius]

"I'll have you talk to your nurse about how you're getting home."

That's about all I think about the situation.

I say that too....until I get a taxi voucher put in my face 30 minutes later saying they need MD approval to send her pt home in a taxi. I call BS....and if I don’t sign pt stays in the ED in-perpetuity

 

[TooMuchResearch]

I say that too....until I get a taxi voucher put in my face 30 minutes later saying they need MD approval to send her pt home in a taxi. I call BS....and if I don’t sign pt stays in the ED in-perpetuity

I don't think about any kind of voucher, I just sign it if it shows up.

 

[bravotwozero]

What's another free pass for ED abusing grandma to use uber to hitchhike home?

Just follow the money. The hospital paying a few bucks for an Uber to get grandma out of their ED is cheaper for them than losing thousands of dollars having to keep her in the ED or an inpatient bed they won't get paid for.

I don’t have a problem with this. I don’t want to admit someone just because they can’t get a ride home either.

 

[deleted547339]

I say that too....until I get a taxi voucher put in my face 30 minutes later saying they need MD approval to send her pt home in a taxi. I call BS....and if I don’t sign pt stays in the ED in-perpetuity

What’s wrong with the street? I DC people to the waiting room every night. Somehow they never end up there in the morning.

Rain is a good motivator to get a damned ride.

 

[Birdstrike]

There will always be conflict between what we as doctors see as the right thing to do medically and ethically and what the money people thinks is necessary from a business standpoint. I don't think there's any way to make this totally go away. It's like oil and water. They just don't mix but we try to force it to mix every day. I've always been the first to rant about administration and how they ruined Medicine and continue to do so every day. That we have to deal with them at all, has chapped my *** since day one.

Then one day I'm asked to be on the board of directors of my group (multispecialty, mostly primary care, some inpatient subspecialties, mostly outpatient, past ED/Hospitalist contracts but not currently) which suddenly puts me in the position of having to make business decisions on a regular basis. And it's hard.

Those that run the group are a mix heavily dominated by doctors (the business people are a minority) which is the opposite of most hospitals, and that helps a lot. We're able to look at a situation and say, "Yes, we could make more money if we made choice 'A' but all of us would prefer to work in an environment where we choose 'B.' So we can choose 'B' without being overrun by non-physician administrators. I do think that often at the most aggressively for profit hospital settings the non-medical administrators dominate with such a heavy hand this balance gets tipped way too far towards the non-medical side and the results feel terrible.

I think it would help to have more doctors in powerful positions in hospital administration and government to make the day to day work of practicing Medicine feel more fulfilling and less dystopian, but you still have no choice but to make the dollars and cents work in a system that has many rules and regulations that don't make much sense. In my group we definitely try to balance what's best for the patients, doctors, staff and company while still being a company profitable enough to stay afloat. I can't say for sure that hospital administrators are working very hard to do that, although they probably would claim that they do. More often than not, if feels more like they're getting a directive from very high up, from people you'll never see, in powerful positions sometimes in other cities, that send the message, "Maximize profits or else."

 

[VA Hopeful Dr]

There will always be conflict between what we as doctors see as the right thing to do medically and ethically and what the money people thinks is necessary from a business standpoint. I don't think there's any way to make this totally go away. It's like oil and water. They just don't mix but we try to force it to mix every day.

I've always been the first to rant about administration and how they ruined Medicine and continue to do so every day. That we have to deal with them at all, has chapped my *** since day one.

Then one day I'm asked to be on the board of directors of my group (multispecialty, mostly primary care, some inpatient subspecialties, mostly outpatient, past ED/Hospitalist contracts but not currently) which suddenly puts me in the position of having to make business decisions on a regular basis. And it's hard.

In my current situation those that run the group are a mix heavily dominated by doctors which is the opposite of most hospitals, and that helps. We're able to look at a situation and say, "Yes, we could make more money if we made choice 'A' but all of us would prefer to work in an environment where we choose 'B.' So we can choose 'B' without being overrun by non-physician administrators. I do think that often at the most aggressively for profit hospital settings the non-medical administrators dominate with such a heavy hand this balance gets tipped way too far towards the non-medical side and the results feel terrible. I think it would help to have more doctors in powerful positions in hospital administration and government to make the day to day work of practicing Medicine feel more fulfilling and less dystopian, but you still have no choice but to make the dollars and cents work in a system that has many rules and regulations that don't make much sense.

One of the things I've learned, at least about myself, is that I need to know the why.

If admin comes up with what I think is a stupid rule, but explains to me why its needed, I find myself getting much less angry about it. If they can't explain why its needed, then it shouldn't be a rule.

 

[Birdstrike]

One of the things I've learned, at least about myself, is that I need to know the why.

If admin comes up with what I think is a stupid rule, but explains to me why its needed, I find myself getting much less angry about it. If they can't explain why its needed, then it shouldn't be a rule.

I agree 100%. If they tell me, "The government passed a stupid regulation and we had to choose between 3 bad options and this is the least terrible option, sorry but it's the best we do do for you," I'm more likely to get over it than if it's people pulling levers from some office three states away, making $8 million per year and all you hear is, "Suck it up or quit," or simply silence. That tends to create a lot of resentment and fuels burnout, and understandably so. A little communication goes a long way and I don't think is too much to ask for.

 

[Birdstrike]

One thing I'd like to do is to sit down with a hospital CEO, face to face with no one around, maybe with a few beers in them and pick their brains.

Why do you insist on doing this or that terrible thing?
What's your goal here a this job?
What do you see as your purpose in this position?
Do you feel that you're doing the 'right thing' on a day to day basis?
Do you like your job and those above you as much as your employees do, or are you loving every minute up this, raking in cash?

I'd love to here their honest answers, unfiltered and without the PC, focus group tested answers you get in the hallways or at cocktail parties. I did get to have a conversation with a guy who's 4 or 5 years retired from a CEO position at one of the most aggressive for-profit hospital systems. He was very clear that he hated the corporate higher ups as much as we did in the pit. He also claimed he fought for us (ED docs) daily against corporate's even more insanely aggressive anti-physician suggestions. At the time I would have called BS on that statement, as our ED director used to claim this all the time. As hard as this is for me to believe, seeing how much they cut the knees out from the EM docs since he left, I actually think he's telling the truth.

 

[scummie]

Has anybody found this more useful instead of cab vouchers? Specifically why?

Let's just come up with a 24/7 bus route, goes to shelter, casino, detox, liquor store. Like those tourist trolleys, all day long, hop on, hop off. Would probably save money for EMS.

 

[RustedFox]

There is one woman that I have dealt with for seven years now.

Seven years. Three jobs. She has shown up at all of them.

She is like, the OG of drug seekers.

New docs come, and I tell them; "NO!"

She wants a cab voucher at every visit.

Someone, please murder this woman. Hot dose? Sounds good to me!

 

[thegenius]

I don't think about any kind of voucher, I just sign it if it shows up.

Yea I do too...it’s one of about 50 pieces of paper I have to sign in my shift...I feel like those drama TV shows where you are walking, talking to someone, and someone else thrusts a piece of paper in your face and you sign it without even looking at it.

Why do doctors have to sign so much s$&t?!?!?!

I’m not the expert on the best modes of transportation home.

 

[TooMuchResearch]

Yea I do too...it’s one of about 50 pieces of paper I have to sign in my shift...I feel like those drama TV shows where you are walking, talking to someone, and someone else thrusts a piece of paper in your face and you sign it without even looking at it.

Why do doctors have to sign so much s$&t?!?!?!

I’m not the expert on the best modes of transportation home.

Although every time I encounter a form with a checkbox that the nurse can sign it without me, I empower them to do so.

 

[deleted547339]

There is one woman that I have dealt with for seven years now.

Seven years. Three jobs. She has shown up at all of them.

She is like, the OG of drug seekers.

New docs come, and I tell them; "NO!"

She wants a cab voucher at every visit.

Someone, please murder this woman. Hot dose? Sounds good to me!

RF, I normally love your posts, but it seems like you need a couple days off. Same with Veers. Seems like y’all have both been a little extra crispy lately, lol. Said from the grumpy SOB about to go in for a night shift.

 

[bravotwozero]

Has anybody found this more useful instead of cab vouchers? Specifically why?

Let's just come up with a 24/7 bus route, goes to shelter, casino, detox, liquor store. Like those tourist trolleys, all day long, hop on, hop off. Would probably save money for EMS.

UBER is almost always cheaper than a cab fare, so I would argue it's more cost effective than a cab voucher. I think the cheapest idea would be to find the closest pizza place around the hospital that delivers to the patient's address, and pay for the patient's pizza delivery. Have the patient walk over to the pizza place and say hey, since you're delivering to my address, can you give me a ride? They get a free ride and a piping hot pizza to boost!

 

[RustedFox]

RF, I normally love your posts, but it seems like you need a couple days off. Same with Veers. Seems like y’all have both been a little extra crispy lately, lol. Said from the grumpy SOB about to go in for a night shift.

I got "warned" for that post.

But for realsies, that woman is going to die sooner or later.
Why not sooner?

We will save hundreds of thousands of dollars.

If you're going to talk ways to save money in the health system, welp..... lets start.

 

[southerndoc]

Arizona Medicaid now pays for Lyft.

 

[scummie]

UBER is almost always cheaper than a cab fare, so I would argue it's more cost effective than a cab voucher.

I’d be interested to see how the data pans out. Here, let’s publish that in a journal, quick!

 

[deleted547339]

I got "warned" for that post.

But for realsies, that woman is going to die sooner or later.
Why not sooner?

We will save hundreds of thousands of dollars.

If you're going to talk ways to save money in the health system, welp..... lets start.

Lol. Don’t get banned. We need you here.

 

[Birdstrike]

Lol. Don’t get banned. We need you here.

You have to work pretty hard to get banned from this forum. Being extra crispy from a stretch of brutal nights usually isn't enough to do it.

 

[d2305]

You all need a signature stamp.

 

[MechEDoc]

I got "warned" for that post.

But for realsies, that woman is going to die sooner or later.
Why not sooner?

We will save hundreds of thousands of dollars.

If you're going to talk ways to save money in the health system, welp..... lets start.

Oh boy!

You put in a post (somewhat anonymously) what so many of us have thought on some occasions. The House of God explored it in elaborate detail, a medical school professor openly disclosed assisting a patient's departure in a 1991 New England Journal article*, and you got on the naughty list! I am sure every single one of us know a number of frequent flyers by name, remember their medical problems, the state of their volume overload, and how hyperkalemic they can be before they have arrhythmia. These folks are all deceased and yet we spent months or years wondering when their last visit would be and how many resources they would burn through before their lonely existence ended.

One of the many problems of our healthcare system is there is no incentivization for good stewardship of resources. As Charles Dickens said we are all "fellow passengers to the grave".

*The DA apparently investigated, considered bringing him up on charges, and realized that a pillar of his community who was acting in good intentions would never be convicted by a jury and decided not to pursue any criminal action. https://www.nejm.org/doi/full/10.1056/NEJM199103073241010

 

[RustedFox]

There's a joke at one of my part-time shops that I "killed" a frequent flyer.

Old man comes in with chest pain all the time. Nearly every day. He has been cath'd by every cardiologist in the county.

I "bounced" him one night.

Hasn't been around since.

The joke is that acute dilaudidopenia killed him, and I wouldn't give him the dose.

 

[RustedFox]

Lol. Don’t get banned. We need you here.

Thanks.

Sometimes, I really do just curl up in my office with a bottle and SDN.
You guys and girls really are all I have sometimes.

 

[deleted109597]

Don't get me wrong. We can all be crispy. Things like greyhound fares and other things are part of our gallows humor. But this is a public forum, and openly wishing patients would die (even the GOMERs) looks very poorly on us. Nobody wants to risk being outed in the doxxing generation, and no matter what, we aren't as anonymous as we would like.

 

[EM_kindaguy]

Longtime lurker, but I made an account to post here, because this thread makes me really sad.
I just graduated from a county based 4 year EM program and am staying on as faculty, and I would reprimand the crap out of any of my resident or colleagues I heard talk this way about patients.
Yes, our jobs are frustrating, but y'all CHOSE (as I did) a specialty where we take care of the vulnerable, the challenging, the homeless, the addicted, the abused, and the needy patients. Our patients are not easy, and y'all are insane for wanting to apply a medical algorithm to try to fix everything.

Have you never spent time with the patient who "just wanted food" to find out they were being abused at home?
Have none of you had an addict that decided to give suboxone a chance and is now living a better life?
Have you not had a patient that was screaming wildly in a psychotic episode, only to wake up from their haldol/ geodon coma and talk about how scared their delusions make them?
It's really not that hard to treat the whole patient, find out if the need a place to sleep, if they are safe, if they need help with their immigration status, or if they just need someone to treat them like a person and look them in the eye instead of just stepping over them all day on the street.
Yes, it seems more "badass" to just discharge a patient who is asking for a 4AM sandwich in <10 minutes, but doing that is not what what my friends who are EM doctors do. To me, an EM doctor finds out if that person needs meals on wheels, that they don't know that they qualify for food stamps, that they can come to the ER to get HELP.
People come to us because they need HELP, and y'all seem surprised that we take care of a needy, underserved, and somewhat challenging population.

 

[VA Hopeful Dr]

I would hope you aren't as jaded right out of residency. That would be a very bad sign indeed, and exactly why you should talk to your residents if they start showing signs of something like that (though I would hope you'd be as thoughtful with them as your patients and not just reprimand them for it). Near the end of my intern year, I had a brief outburst not unlike RF's. My attending sat me down later and her first question was "is everything OK?" and then we talked about things similar to the second half of your post. At no point was I reprimanded.

 

[EM_kindaguy]

I would hope you aren't as jaded right out of residency. That would be a very bad sign indeed, and exactly why you should talk to your residents if they start showing signs of something like that (though I would hope you'd be as thoughtful with them as your patients and not just reprimand them for it). Near the end of my intern year, I had a brief outburst not unlike RF's. My attending sat me down later and her first question was "is everything OK?" and then we talked about things similar to the second half of your post. At no point was I reprimanded.

you have a great point - reprimanding is not the point- and this sort of talk can absolutely be a sign of somebody having a rough go of it.. You are totally right, and I will keep that in mind going forward- making sure to treat my residents with the same care that I expect them to give our patients.

I DEFINITELY admit that I have said things during/ after shift that I regret when I have been tired/ stressed/ hungry/ overworked. I guess what bugged me in this thread was not the venting, but the joy that people seemed to be taking describing how they kick people out of the ER without helping them. Thank you for your thoughtful and non-judgmental reply.

 

[MechEDoc]

I don't mind some people being kicked out the ER. There are dangerous and toxic people in this world, sometimes I meet them at work. When they don't have an emergent medical problem, I have no problem with them being somewhere other than the ED.

I can imagine reprimanding your colleagues is going to work out well in the long term...

 

[EM_kindaguy]

I can imagine reprimanding your colleagues is going to work out well in the long term...

You seriously wouldn't sit down and have a serious conversation with a colleague if you saw them treating patients disrespectfully? Reprimanding is definitely too strong of a phrase, for sure, but definitely having a serious conversation, a "hey- what's up? that's not like you" talk.
I'd rather practice conscientious medicine with docs that give-a-damn about social welfare than be liked by people who gleefully kick out patients without digging to see what really is going on.

Related tangent: I hate this stay-in-my-lane medical BS. 99% of our patient's lives occur outside of the ER, so if we're content with only helping patients with medical issues and medical issues alone, we're really not doing much good for most of them

-EDIT: singular->plural word correction