Normal patients

[Apollyon]

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I was thinking about this yesterday, because it happened over a month ago, and then again yesterday. I've often remarked that the only time we see normal patients in the ED is if they're having crushing chest pain, or they've had an accident - ranging from a cut finger to an MVC. I've also recently begun muttering under my breath that, if you are younger than I am, and seen in the ED, and do not get admitted, you're a loser (with the accidents excepted).

Well, yesterday, in Fast Track (umm..."Minor Emergency Care"), had a guy that was an engineer for the US office of a German automaker, who also is a pro skier in the winter (has a school in Germany). He was mountain biking, and was carrying his bike across a slippery rock, and, in less than a second, boom-crack-ouch! He clinically diagnosed his patellar fracture, and I agreed, and films displayed it - most comminuted patella I've EVER seen - just exploded.

Well, when I went in to see this guy, I greeted him in German - he responds. I then switch to Spanish - he answers. I then switch to French - he answers again, and finally I start in English, and his accent is clean, but also difficult to peg. He told me he grew up in Munich, but has lived in Arizona, Toronto, and South Africa.

The nurse was rather cute, and I said to her, "This guy is smarter than I am, speaks more languages, is younger than me, more athletic, and better looking. I gotta get out now, while I can!" This made the guy chuckle, and the nurse laughed right out loud.

I emphasized to ortho that this guy was a pro athlete, and so he got referred for close f/u with one of the good knee guys in the area.

Otherwise, pts were just as dim, but at least not as dirty (literally) as they were on Friday.

Oh, one other anecdote - one patient at the end of the day was having a nonproductive cough, and I go in, and his wife is dominating the conversating, and is wearing a surgical mask. The verbatim transcript: Me: "Are you immunocompromised?" Her: "No, I'm OCD."

Well, thanks for honesty!

 

[kungfufishing]

Going to hijack your thread although tangentially related. The patients that drive me crazy are the relatively well who just can't accept that they or their child have a a viral or otherwise mild illness. I had this lady this morning who just sat there with this look of utter disbelief on her face as her 2 year old tore apart the room with his runny nose. "Isnt there some kind of blood test you can do to find out why he is so sick?" What bothers me the most about these patients is that there is NOTHING I could say short of admission that will be acceptable, even though half the time they often only came to the ED out of convenience. Of course, these are the ones who complain, too.

It makes it that much nicer when you see a really sick person with a reasonable family, or an awake patient with a legitimate injury.

 

[Greenbbs]

the worst is when the crazy patients have family members that are equally as crazy or psychotic.

i had a kid (and by kid, i mean 20 year old), who was pink slipped for psychosis and threatening the cops with a gun, and his mom came up to us (she didn't want him to be sent to the loony bin again), and she said "Hypothetically, if i was to block you from getting to him, and he ran out of the ER, what would happen?"

we gave her a very short "after being tackled by security and/or the police, he'd be tied to the bed, medicated and you'd be arrested for assault."

She promptly sat down and the two of them continued to be psychotic again.

 

[Jeff698]

I had a dad bring in his 13 year old girl with abdominal cramping and diarrhea, just home from a lengthy trip abroad. They're both reasonable people ("real" people) and this is clearly abnormal for her.

Labs normal, benign exam. I go into my radiation exposure speech, dreading the waste of my time because I know they're going to insist on a CT. Dad says "if you think she doesn't need the scan, I'm perfectly happy following up with her pediatrician tomorrow morning for a re-exam".

I sat there stunned for a couple of seconds. Wow. Normal people. Nice, too.

Of course, I walked out of the room and next door was another 13 year old who'd bonked her head yesterday, felt a twinge of nausea today. Mom was convinced she was the next Natasha Richardson and thought I was on crack for even discussing the risks of radiation.

Compared to residency, though, I now have a higher "normal/troll" ratio at my community hospital. I'd guess I'm running about 50-60% normal/"real" to 40-50% troll/stupid/poor protoplasm.

Sad that I'm happy with that signal/noise ratio, huh?

Take care,
Jeff

 

[docB]

You know I've had this very thought floating around in my head for about a year. I am continually amazed at how few people I see who have no comorbidities. So many of the pts I see, for the whole spectrum of presenting complaints, have chronic pain issues and psych histories.

I often wonder if the fact that they have these issues makes them more likley to go to the ER or if the fact that they have lots of vague, non-specific issues has gotten them diagnosed with "depression" and "fibromyalgia." I'm pretty sure it's a combo of both.

 

[dchristismi]

Interesting questions... and I do wonder if the segment of the population we see on a regular basis is biased towards us or because of us. Is it sad to admit that I really love the old demented folks because they don't really talk?

I saw a couple of real sickies last night, one of whom I really couldn't peg. Well, other than sick. Older gentleman had been here one other time, was nearly obtunded with a 60-60 on his gas. Guy had "homeless toenails" but was wearing cologne. It just didn't "fit," and I had no real history to go on. I have to admit that I was shocked he'd only been seen once before, and that was 2 years prior.

And another patient, a baby, whose mom was doing everything right. Baby with fevers/URI x 2 weeks, seen at other ED twice (second visit being a follow up), most recently 2 days prior with nl CXR. Kid looked really sick, grunting, hypoxic... turns out had a complete spontaneous pneumo with some mediastinal shift. Family was very reasonable, understood (eventually) that the other hospital had a normal CXR (I love my rads guys - they apparently cover the entire area), and let me do what needed to be done: IE chest tube and get the kid the heck out of old-person-central to a real PICU.

I hadn't put a chest tube in a baby in a loooong time.
That's why I did a residency.
Not to hand out percocets.
It's nice to feel validated that all that frickin hard work was worth it.

 

[Stitch]

I had a dad bring in his 13 year old girl with abdominal cramping and diarrhea, just home from a lengthy trip abroad. They're both reasonable people ("real" people) and this is clearly abnormal for her.

Labs normal, benign exam. I go into my radiation exposure speech, dreading the waste of my time because I know they're going to insist on a CT. Dad says "if you think she doesn't need the scan, I'm perfectly happy following up with her pediatrician tomorrow morning for a re-exam".

I sat there stunned for a couple of seconds. Wow. Normal people. Nice, too.

Sad that I'm happy with that signal/noise ratio, huh?

Take care,
Jeff

This kind of thing makes my day. It's so hard not to get forced into an unneeded scan, treating the parent instead of the patient.

 

[beyond all hope]

The ER definitely represents a very biased sample of humanity

1) Can't wait for PMD: I've been waiting two hours!

2) Want a second opinion: It's been months/I've been to five doctors. Why can't you tell me what's wrong?

3) Seekers/psych: Nuff said

4) Multiple comorbidities: when you're DM, HTN, OSA, COPD, 400 lbs and eat fried chicken for breakfast, everything's an emergency

5) Bad/nonexistant PMDs: good PMD's pts rarely end up in ED. Bad PMDs pts end up there frequently.

6) Drama queens: ack! everything's an emergency in their eyes

7) Accident-prone people: often synonymous with stupid/reckless

8) ER as primary care

Those represent a good 50-80% of your population, even higher in some urban areas. So when you see normal people using the ER appropriately, you are stunned.

For awhile I was a 'clinic' doc in an upscale neighborhood in Brooklyn. Lots of normal, hyperanxious parents and well children. 50% of my pts left with NO workup, Dx URI or AGE, 30% were strains/sprains with one x-ray. It was awesome, but kind of boring. Give me a good DKA or STEMI and I'll be happy the rest of the day.

 

[Arcan57]

Last night was extra heavy on workman's comp/ground level fall. The 86yo with the highly comminuted Colles' fx didn't complain at all. The 42 yo spent an hour arguing with the staff because I wouldn't prescribe one of the "D" narcotics for her trapezius contusion.

 

[GeneralVeers]

I'd like to know what it is with 18-32 year old females.... They clog up my ER every day with pleuritic-type chest pain, and low abdominal pain. Is female anatomy seriously so messed up that they get severe chest and abdominal pain constantly, or is it just a female anxiety thing where they have to come in for every little twinge?

 

[xaelia]

is it just a female anxiety thing where they have to come in for every little twinge?

If they opened an ob/gyn complaint-only urgent care next door to my ED they would make millions. Even just a vending machine with flagyl, azithromycin, vantin, and doxycycline in the waiting room....

 

[Jeff698]

If they opened an ob/gyn complaint-only urgent care next door to my ED they would make millions. Even just a vending machine with flagyl, azithromycin, vantin, and doxycycline in the waiting room....

With all the talk of regionalization, picture the following "Centers of Excellence":

Vag bleeding/dripping
Hypovicodinemia
Fibromyalgia/Anxiety
Worknotemia
Zpack-needing-URIs
Psychoses of all sort

Those centers would pretty well empty out my ED except for the following patients:

real ACS
CVA/TIA
GI bleeders
CHF/COPD/Asthma
Pneumonia
Sepsis
Fractures
Lacerations that actually need wound care
Real trauma

In other words, the only thing left would be what we actually trained in EM for. Emergencies.

Take care,
Jeff

 

[GeneralVeers]

In other words, the only thing left would be what we actually trained in EM for. Emergencies.

Take care,
Jeff

True, but your salary would drop enormously. I only see 1-2 "Emergencies" per shift. The rest is bread and butter not-sick BS that would be turfed to one of your specialty centers.

 

[Jeff698]

True, but your salary would drop enormously. I only see 1-2 "Emergencies" per shift. The rest is bread and butter not-sick BS that would be turfed to one of your specialty centers.

Hey, it's my dream. No need to wake me up. Meanie.

BTW, there are lots of non-emergency things that come in to us that are perfectly appropriate uses of an ED. It's just the personality deficient frequent flyers of all of our EDs that so sour us on the other stuff.

Sometimes I dream of opening a free-standing ED. We'll see your sick folks and your urgent care stuff but you need to pay up front if you're not dying. Happy to see you for your healthy child who vomited once as long as you pay up front. Work note? No problemo, that'll be $100, thank you.

I think my attitude about the non-sick stuff would change dramatically if I knew I was actually making money off of my labors.

Take care,
Jeff

 

[GeneralVeers]

I think my attitude about the non-sick stuff would change dramatically if I knew I was actually making money off of my labors.

Take care,
Jeff

That's one thing that really bothers me: "I didn't see my regular doctor because he wants SEVENTY DOLLARS to be be seen!"

Yet apparently I work for free, and my time isn't even worth a dime to you.

 

[Jeff698]

That's one thing that really bothers me: "I didn't see my regular doctor because he wants SEVENTY DOLLARS to be be seen!"

Yet apparently I work for free, and my time isn't even worth a dime to you.

Yep, that's among the most irritating things you can say to an ER doc.

Another one I hate is from the mother of the child currently munching on cheetos as he swings from the bed railing annoying everyone in the ED:

"he's been lethargic all day, hasn't peed at all and won't take any liquids".

Take care,
Jeff

 

[Stitch]

Yep, that's among the most irritating things you can say to an ER doc.

Another one I hate is from the mother of the child currently munching on cheetos as he swings from the bed railing annoying everyone in the ED:

"he's been lethargic all day, hasn't peed at all and won't take any liquids".

Take care,
Jeff

And she demands IV fluids...Plus maybe a CT to rule out an appy.

 

[Apollyon]

True, but your salary would drop enormously. I only see 1-2 "Emergencies" per shift. The rest is bread and butter not-sick BS that would be turfed to one of your specialty centers.

See, you dystopian you, that is exactly the point at which I was trying to get. As I am prone to say, the only time we see normal people in the ED is if they have crushing chest pain, or they have an accident (ranging from cutting their finger, to piling up their car).

That's exactly the work environment to which I'm moving; two hospitals, one the average acuity is 4, the other 4.8. People don't come in unless they're just about dead.

 

[GeneralVeers]

See, you dystopian you, that is exactly the point at which I was trying to get. As I am prone to say, the only time we see normal people in the ED is if they have crushing chest pain, or they have an accident (ranging from cutting their finger, to piling up their car).

That's exactly the work environment to which I'm moving; two hospitals, one the average acuity is 4, the other 4.8. People don't come in unless they're just about dead.

I have no problem seeing wackos, crazies and hypochondriacs, I just expect that they pay for the services they receive.

You want to pay me $100? Sure I'll listen to you ramble about your fibromyalgia pain for 15 minutes.

 

[mojo]

I have no problem seeing wackos, crazies and hypochondriacs, I just expect that they pay for the services they receive.

You want to pay me $100? Sure I'll listen to you ramble about your fibromyalgia pain for 15 minutes.

Man, I think I'd have to charge about $500 for that one.

 

[xaelia]

I had a repeat offender to our main ED and our fast-track seeking narcotics from us for low back pain (despite each of my discharge instructions printing bold that we will not give her narcotics) who is disabled from fibromyalgia. Disabled! Her ~3 year old son was in the room last time; no bright future for him.

 

[MR1]

2) Want a second opinion: It's been months/I've been to five doctors. Why can't you tell me what's wrong?

This one is my favorite and I get called in the ED all the time with this one, I think it stems from watching to much "ER".

On a second note the idea of a "vagina-ER" is great

 

[skiz knot]

Last night was extra heavy on workman's comp/ground level fall. The 86yo with the highly comminuted Colles' fx didn't complain at all. The 42 yo spent an hour arguing with the staff because I wouldn't prescribe one of the "D" narcotics for her trapezius contusion.

As you probably have noticed old and young (pediatric) patients seem to have a much higher threshold for pain in orthopaedic injuries (especially fractures). This may be due to some intrinsic pain threshold of the old and young, or more likely the amount of soft tissue damage to the affected area (which does hurt, even though you can not see it on Xray). Old people and kids often times have horrible looking fractures due more to the quality/composition of their bone than to the amount of energy needed to create such injury. The femur fx in the 85 yr old from a ground level fall just isn't going to hurt as much as the femur fx of the healthy 40 yr old involved in an MVA.

That being said, there is almost always a psych component of the unpleasable

 

[seelee]

Incomming med student who is seriously considering ER. I hear alot of complaints along these lines. But based on my (very limited) experience, these types of patients are typical in the primary clinical setting too. It seems to me that the real complaint is that being trained in emergency medicine makes the routine non-emergent complaints a waste of your specialized training. Is that a fair assesment? If an incomming student/resident expected that 80% of his time was going to be handling these kinds of situations, and was comfortable with it, would he have a better outlook I wonder?

I (once again from my limited perspective) think that the chance to treat the run of the mill primary care-type complaints combined with the opportunity to see really sick people, trauma, etc. would be a nice mix. Is this point of view incredibly naive? I am attracted to EM because it would give me the chance to practice "primary care" medicine, while also treating more "exciting" cases, and making a much more reasonable salary (compared to primary care).

Is this a bad or uncommon way to look at things?

 

[Arcan57]

One of the main issues with chronic PCP type patients (aside from them not being what we trained for) is that the ED is an exceptionally poor place to receive chronic care. We don't test A1c's or lipids, we don't have time for smoking cessation counseling, we won't give a month's worth of pain medication, and we don't have a record of your immunizations, screening exams, etc. We do what we can with the resources and time available. But with the possible exception of asthma the care we provide for chronic conditions does not live up to current guidelines.

 

[docB]

One of the main issues with chronic PCP type patients (aside from them not being what we trained for) is that the ED is an exceptionally poor place to receive chronic care. We don't test A1c's or lipids, we don't have time for smoking cessation counseling, we won't give a month's worth of pain medication, and we don't have a record of your immunizations, screening exams, etc. We do what we can with the resources and time available. But with the possible exception of asthma the care we provide for chronic conditions does not live up to current guidelines.

You are absolutely right of course but the prevailing trend is for us to do more of this crap than less. Smoking cessation is a prime example. We're all doing that now that there's a $amount attached to it. Hell, it's now got its own spot on the Tsheets.

 

[Arcan57]

You are absolutely right of course but the prevailing trend is for us to do more of this crap than less. Smoking cessation is a prime example. We're all doing that now that there's a $amount attached to it. Hell, it's now got its own spot on the Tsheets.

The ED as a medical home is a fundamentally flawed concept, but you are right that is the trend. At least we get paid for smoking cessation, then there are ideas like screening everyone that visits the ED for HIV. I wonder how long it will be until these universal screening measures become part of a Joint Commission/Medicare mandate for the ED.

 

[Doctor Bob]

How long until EM is actually considered one of the primary care specialties (along with FP, IM, Peds and ObGyn)?

Then we could get bonuses and scholarships for going into "primary care".

 

[docB]

The ED as a medical home is a fundamentally flawed concept, but you are right that is the trend. At least we get paid for smoking cessation, then there are ideas like screening everyone that visits the ED for HIV. I wonder how long it will be until these universal screening measures become part of a Joint Commission/Medicare mandate for the ED.

I agree. This idea that the AAFP "Medical Home" concept is fundamentally bad for EM as a specialty was discussed at the ACEP general assembly last year.

As far as Joint Comm forcing stuff into the ED that doesn't belong there I ask how many of us are forced by our hospitals to initiate treatments that are required by core measures to be done within 24 hours or on discharge, ie. during the admission by the primary doc? I'd raise my hand but I'm busy writing for an ACE inhibitor, and echo and it's tired from spending years writing for 25mg of Lopressor po (which would meet the B blocker requirement while being so low a dose as to hurt as few people as possible).

 

[docB]

How long until EM is actually considered one of the primary care specialties (along with FP, IM, Peds and ObGyn)?

Then we could get bonuses and scholarships for going into "primary care".

Question is do we really want this? I don't want their money if they are going to try to turn us into PMDs. I'm not trained for that. I'm not good at it and I don't want to do it. If I did I'd have trained in a different specialty.

The fact that I'm the only doctor anyone can get in to see either because of $$ or because the PMDs are all overbooked trying to see 6 patients an hour (which is again due to $$) is not a problem with Emergency Medicine. It's a problem with everyone else. The answer is not to force me into a reluctant and poorly fitting role. That will just make everyone worse off.

 

[dragonfly99]

seelee,
Yes I think you might be a little happier in the specialty if you understand/realize that not everybody will be really sick.
However, the kinds of patients who come to the ER for primary care tend to be a different population than those who show up in a nicer private clinic (though would be similar to those in internal medicine "resident clinics"). They tend to be less responsible, less educated and generally more demanding. Not all, but many of them. This is because most chose to not go see their primary care doc because they couldn't plan ahead, did not want to wait, or think the world revolves around them and that they would somehow get "more advanced/better" care in an ER.

 

[Doctor Bob]

Question is do we really want this? I don't want their money if they are going to try to turn us into PMDs. I'm not trained for that. I'm not good at it and I don't want to do it. If I did I'd have trained in a different specialty.

The fact that I'm the only doctor anyone can get in to see either because of $$ or because the PMDs are all overbooked trying to see 6 patients an hour (which is again due to $$) is not a problem with Emergency Medicine. It's a problem with everyone else. The answer is not to force me into a reluctant and poorly fitting role. That will just make everyone worse off.

Oh I agree that EM docs shouldn't be primary care docs in the traditional sense. But the way things are, plenty of people use the ED that way (sadly) and as long as we have to see them in that regard when they get a sniffle or run out of their meds for chronic back pain (which they probably got from us in the first place) they ought to let people who want to go into EM get things like the national health service scholarships and stuff. The place I'm doing my EM residency at gives a $10,000 signing bonus to the people going into the primary care residencies (IM, FM, ObGyn). EM residents ought to get it also (or maybe I'm just being selfish 🙂 )

I figure, a primary care doc sees maybe 20-40 patients a day. And an EM doc probably sees the same number of people in the ED (or more) who are really only there for nothing more acute than things seen in an FP's clinic.

 

[Rendar5]

The ED as a medical home is a fundamentally flawed concept, but you are right that is the trend. At least we get paid for smoking cessation, then there are ideas like screening everyone that visits the ED for HIV. I wonder how long it will be until these universal screening measures become part of a Joint Commission/Medicare mandate for the ED.

I've heard of smoking cessation in the ED, but I don't really understand how that talk can be fit into the time constraints. HIV testing, at least if the state laws are properly done, really wouldn't take more than a "do you want a rapid cheek swab/finger prick HIV test while you're here?" from a doc or triage nurse, then a DoH call for a result follow-up. Of course, without a proper system or without certain state laws, that also becomes a "WTF why are you making us spend precious time on this ****"

 

[DrMom]

As for smoking cessation, when I go through the social history I try to stop when a patient says they smoke. I explain that I know that they know smoking isn't good for them and that I encourage them to cut back and eventually quit. Sometimes this includes a little bit longer on recommendations of how to do this, implications on their own or their kid's health (ie: asthmatics). Really, the whole thing doesn't take too long and is legit discussion on smoking cessation with the patient.

 

[seelee]

seelee,
Yes I think you might be a little happier in the specialty if you understand/realize that not everybody will be really sick.
However, the kinds of patients who come to the ER for primary care tend to be a different population than those who show up in a nicer private clinic (though would be similar to those in internal medicine "resident clinics"). They tend to be less responsible, less educated and generally more demanding. Not all, but many of them. This is because most chose to not go see their primary care doc because they couldn't plan ahead, did not want to wait, or think the world revolves around them and that they would somehow get "more advanced/better" care in an ER.

Is it wrong to just expect that the people who come in are going to be helpless/selfish etc. and resign yourself to the fact that these are the types of patients we get and to expect otherwise would be like banging your head against the wall and expecting the wall to move?

 

[Arcan57]

As for smoking cessation, when I go through the social history I try to stop when a patient says they smoke. I explain that I know that they know smoking isn't good for them and that I encourage them to cut back and eventually quit. Sometimes this includes a little bit longer on recommendations of how to do this, implications on their own or their kid's health (ie: asthmatics). Really, the whole thing doesn't take too long and is legit discussion on smoking cessation with the patient.

Yes, but the code for smoking cessation counseling specifies a specific amount of time that, unless the task is farmed out to a nurse, no one can honestly bill.

 

[RxnMan]

I agree. This idea that the AAFP "Medical Home" oncept is fundamentally bad for EM as a specialty was discussed at the ACEP general assembly last year...

They were really pushing this during my FP rotation. Had a couple of lectures on it. I asked one speaker how they were going to incentivize people going to PMDs, when they already could see an EMP for free on short notice without an appointment.

He looked at me like I was speaking Greek.

 

[GeneralVeers]

The smoking cessation guideline is a minimum of 5 minutes I think. That's why I never bill for it. I'd rather spend that 5 minutes treating a sore throat and discharging them. Also the people who smoke tend to be uninsured (interesting that they can afford cigarettes but not health insurance), so I won't get reimbursed for smoking cessation anyway.

I disagree with those who think EM should get primary care stipends. I would rather we put that money towards more stipends for actual primary care. If we can increase the number of primary care docs, it should decrease the amount of BS abnormal patients that we see.

 

[BKN]

Actually, the ED population is getting much sicker than 30 years ago when we were first recognized as a specialty. See abstract by Xu and Nelson (me) in 2009 SAEM meeting supplement of Academic EM. All of us who were practicing in the 80s have noticed this. It's gonna get worse as my generation (boomers) hits our 60s and on up. So cheer up, you younger guys can look forward to more emergencies.

As to the "low quality" patients. I don't think they are much different in their world view than the rest of the population. After all 10% of the general population are addicts, 10% have major psychiatric illness. And when you say they wouldn't wait to see their doctors, well how many have access? But we are in the top 5% of responsibility and drive, and we don't relate well to the average. Suggest "empathy" injection. ;-)

 

[GeneralVeers]

As to the "low quality" patients. I don't think they are much different in their world view than the rest of the population. After all 10% of the general population are addicts, 10% have major psychiatric illness. And when you say they wouldn't wait to see their doctors, well how many have access? But we are in the top 5% of responsibility and drive, and we don't relate well to the average. Suggest "empathy" injection. ;-)

EMPATHY???? Hold on there, it's not like we're trying to be supreme court justices......

 

[xaelia]

It's gonna get worse as my generation (boomers) hits our 60s and on up.

More like "gonna get worse when the obese, hypertensive, diabetics in their 20s get up into their 40s on dialysis with multiple stents" down 'round these parts.

 

[Tiger26]

EMPATHY???? Hold on there, it's not like we're trying to be supreme court justices......

Sounds like somebody's just a little jealous that he isn't as good of a decision maker because he doesn't have the rich life experiences of a latina woman . . .

 

[Rendar5]

🙄 god, I hate politics sometimes. (hell the dems pulled the same **** back when bush was picking guys). let's pick random quotes from 10 year old speeches, start arguing about meaningless buzz words like empathy and judicial modesty, and pick 1-2 cases with standard legal rules that we odn't like out of hundreds and hundreds cases with full and meaningful interpretations as a whole and not even ask one's opinion on constitutional interpretation and landmark decisions.

/end rant (don't worry, next time I'll actually join in on the political humor...)

 

[seelee]

Sounds like somebody's just a little jealous that he isn't as good of a decision maker because he doesn't have the rich life experiences of a latina woman . . .

👍

 

[GeneralVeers]

Sounds like somebody's just a little jealous that he isn't as good of a decision maker because he doesn't have the rich life experiences of a latina woman . . .

You're right. I can't possibly make life-threatening decisions about patients because I didn't have an underprivileged upbringing, and didn't have to fight against a white-male-dominated chauvinist world that wouldn't allow me to express my empathy,

 

[GeneralVeers]

🙄 god, I hate politics sometimes. (hell the dems pulled the same **** back when bush was picking guys). let's pick random quotes from 10 year old speeches, start arguing about meaningless buzz words like empathy and judicial modesty, and pick 1-2 cases with standard legal rules that we odn't like out of hundreds and hundreds cases with full and meaningful interpretations as a whole and not even ask one's opinion on constitutional interpretation and landmark decisions.

/end rant (don't worry, next time I'll actually join in on the political humor...)

Actually the "empathy" quote was from Barack Obama about 2 months ago. Hardly "10 year old speech".

Kudos to those who picked up my carefully placed political reference.

 

[Rendar5]

Actually the "empathy" quote was from Barack Obama about 2 months ago. Hardly "10 year old speech".

Kudos to those who picked up my carefully placed political reference.

I'm aware of where the empathy quote is from. 10 year old speech was referring to the rich experiences of a latina woman quote (though now that i think about it i think that one was a bit more recent) and also some remark about policy set from the bench that really makes 0 sense out of context. I'm just kinda annoyed that every news article or soundbite on this woman is about one of 4 things, none of which really relates to her qualifications.

EDIT: just in case someone gets the wrong idea, I'm not complaining about anyone's remarks here, just the media and the politicians/pundits. Now back on topic...

 

[BKN]

I have successfully hijacked the thread with a single sentence. . .wooop!

 

[jbar]

As much as I want a stipend, the point of giving bonuses to primary care is to encourage people to enter that field. Since I think as of a few years ago EM filled something like 95% of the open residency spots primary care needs that incentive more.

If we can get paid for telling people to stop smoking how much do we get for the "smoking crack when you have asthma is really bad for you" conversation?

 

[Dwindlin]

I had a question that is along the lines of the original thread topic. On the rare occasions you do see a "normal" patient, do you notice that they actually tend to be sick more often than the normal clientele? Its a trend I've noticed at the ER I transport to as a medic and observe in, was curious if anyone else sees this.