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[MechEDoc]

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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

I might say something. It depends on the ED, how much I care about the doc and the patient. I've seen some interesting situations...

Some of my saltier (former) colleagues might have kindly responded f-off. I guess being on the road 180 days a year and waking up in a desert hotel where there isn't much for fresh food nearby and you're surrounded by a res with an average life expectancy of 60 will do that to you.

 

[GonnaBeADoc2222]

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 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.

You sound like someone who hasn't had to see 2+ pph on your own. Don't worry, y'all will soon.

The situations you describe are non-emergencies. This is the emergency room.

 

[GeneralVeers]

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.

I'm only going to be nice to you because you are a new attending. I seriously doubt you will ever be a functional community ED doc with the above attitude. I think you can hide out in a safe academic, low-volume place and do fine. But if you go into the community and practice I can guarantee the nurses will hate you, the administration will hate you, and your poor colleagues on shift with you will hate you.

The ED is NOT a homeless shelter. I'm not a social worker, case manager, psychotherapist, or any other fluffy-duffy profession. In my opinion if you present to the ED wanting food, shelter, drugs, or any other non-medical issue you are malingering and need to be kicked out ASAP. Every second one of these malingers stays in my PACKED department, takes up bed space and valuable nursing time from sick people who truly, legitimately need to be there. I'm happy to discharge them to the waiting room and have case management talk to them there, arrange bus passes, or homeless shelter referral, but I will not allow them to take up my time, or the valuable time of my nurses.

The way you practice above will mean you are an incredibly slow and inefficient doctor. Sitting and talking to a homeless person about their multiple psychosocial issue will mean your faster colleagues will have to pick up the slack and see the patients that you are unwilling to see due to poor time management. Furthermore by letting them malinger in your 3-star hotel, you will bed-lock the place and make it so your partners can't see patients, and the metrics will get worse. I can guarantee you that you WON'T be "counselling" any of your colleagues. I'm pretty sure you will be the one to get some heavy-duty "counselling" from your medical director once he/she receives all the complaints from the nurses who have to put up with your shenanigans, and your pissed-off colleagues who see their paychecks dwindle because you've locked down the department.

Just some advice.

 

[RuralEDDoc]

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...
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.

I really respect your passion. But I think it’s misdirected. None of those things are your role in a busy ER. If you see some red flags, request a social work consult and move on. You don’t have time for that. And if you’re making time for it, you’re not making enough time for the patient in DKA, or the real deal chest pain, etc. I recommend that you not try to be all things to all patients. You won’t survive and you’ll be distracted from finding real disease and treating it. Let others help you and do their jobs while you do yours.

 

[thegenius]

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

We’ve got a social worker position available at our hospital, sounds like you would be a great fit.

 

[GonnaBeADoc2222]

hes's from county guys...he's got this

 

[Birdstrike]

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.

I applaud your idealism. I think we all start out with a healthy dose of it and need to hold on to at least a spark of it, no matter how frustrating out jobs can get. And you're right, no one should take out their frustrations with the system on a patient. Ever. But let me ask you a question. Which did you see as your role in the ED?

A. To treat and stabilize patients critically ill and injured patients,
B. To maximize revenue for administrators or shareholders, focusing on pleasing "customers" who aren't critically ill or injured,
C. To treat chronic, non-emergency social ills, or
D. Create data for the government to track.

You're right, this thread is sad. It real, real sad. And I'll tell you why. It's because we went into emergency medicine hoping to treat critically ill and injured patients. We soon realize that all anyone cares about other than us (and nurses) is to maximize revenue for the hospital administrators or shareholders. Then, although 99% of you is dedicated in your heart to emergency care, you realize those in charge care about nothing but extracting money from the walking well, and expect you to spend 98% of your time doing B, C and D, no matter how little time that leaves for A. "And by the way, don't forget about those 'emergencies,' too, guys."

It's pretty soul crushing for a lot of people when that cognitive dissonance hits, that the people who care about the primary mission of the ED, caring for the critically ill and injured, aren't in charge and never will be, and that the people who are in charge, don't even care a lick about the tsunami current of emergencies, chronic social ills and data collection you're swimming upstream to tackle, as they heap more and more demands to extract maximum revenue from the walking well, not to benefit the critically ill and injured, not to treat those with chronic social ills, not to benefit you, but to benefit them.

"Make us money, make those 'customers' happy. The emergencies, the chronic social ills, the data collection? That's your problem Mr. Smarty Pants with the white coat and degrees on your wall. Not enough time? Tired? Stressed? Suck it up Buttercup and figure out a way to do it all, and don't let it get in the way of Our Money," so says the Administrator.

None of that makes you sad, just the people on this thread?

 

[alpinism]

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.

As someone who also trained at a county shop and recently graduated within the past couple years I can sympathize with your position but that being said we must have trained at very different places. I used to do those things when I was a junior resident and would sit down and just spend time with patients especially with the homeless vets since I also loved hearing their stories. Here's the thing no joke I got called into my PDs office midway through 2nd year and literally got yelled at because my attendings got pissed that I was not seeing enough patients. Im not sure how it works at your shop but the expectation where I trained was to be seeing at least 2 pph and sometimes up to 3 pph when it got busy. Its nearly impossible to do that when you're spending 15 min talking with every homeless drug addict. If they let you get away with it at your shop that's great but just realize that at most places you'll be out of a job very quickly. The other thing you have to realize is that for every minute you spend with them you get a minute less for the sick patients with an actual medical emergency. While most patients are completely fine and can wait there's usually a least a couple sick patients who deserve your attention and count on you to provide them with the best care possible.