Not to be inflammatory but... Are we doing society a disservice as doctors?

[JaSam]

So I've just switched to a new rotation in the city hospital and we see tons of unbelievable cases and a lot of times I can't help but come away thinking: Why the hell are we saving these people? These uneducated, drug dealing, uninsured, mean-spirited, indifferent masses of disgust and decay? Now before you go berserk, I do have compassion, but more so for those patients who are sick because of some unfortuneate event or some poor little girl/boy who god has dealt them some congenital defect that threatens their life. But unfortuneately, these cases are quite the minority. I'm just sick and tired of seeing druggies come in with stupid crap like uncontrolled HTN b/c he'd rather spend every last penny on drugs than go to a fking walmart and get his meds for 4 dollars a month.

Not only from a financial standpoint but also from a darwinistic perspective, I'm having a harder and harder time convincing myself that its even worth the bother trying to help these people because in the end, we're only hurting society as a whole. These patients don't have insurance. Yes, you may feel sorry for the uninsured, but let me remind you, theres usually a good reason why most of these people are uninsured. They grow up in bad neighborhoods, have no education, resort to selling drugs instead of getting a good job, care more about having sex at age 13 than any of its consequences, and when things come crashing down, they leech off welfare and never give a rats ass about their health until they come into the ED with some terrible illness. Why are we responsible for even keeping these people alive? I work my tail off as do all of you so why should we be responsible for paying for the food and healthcare for these pathetic creatures? You know how advanced the US would be if we just denied them healthcare to these bums? They'd die off slowly but surely, we'd save tons of resources (time, money, manpower, etc.), and more importantly they won't have a chance to go back and procreate another generation of losers like themselves who contribute nothing but trouble and a severe burden on society.

Honestly, have any of you thought about this? IS this what our dream is by being doctors? This is why we struggle through medical school and residency for? To help some lazy ass, obese, unattractive, uneducated, crackwhore who doesn't even have the slightest insight to realize that maybe if she gets immense CP each time after cocaine use, that the drug use is what's causing her ailment and thus probably its not in her best interest to continue?

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[staphaureus]

So I've just switched to a new rotation in the city hospital and we see tons of unbelievable cases and a lot of times I can't help but come away thinking: Why the hell are we saving these people? These uneducated, drug dealing, uninsured, mean-spirited, indifferent masses of disgust and decay? Now before you go berserk, I do have compassion, but more so for those patients who are sick because of some unfortuneate event or some poor little girl/boy who god has dealt them some congenital defect that threatens their life. But unfortuneately, these cases are quite the minority. I'm just sick and tired of seeing druggies come in with stupid crap like uncontrolled HTN b/c he'd rather spend every last penny on drugs than go to a fking walmart and get his meds for 4 dollars a month.

Not only from a financial standpoint but also from a darwinistic perspective, I'm having a harder and harder time convincing myself that its even worth the bother trying to help these people because in the end, we're only hurting society as a whole. These patients don't have insurance. Yes, you may feel sorry for the uninsured, but let me remind you, theres usually a good reason why most of these people are uninsured. They grow up in bad neighborhoods, have no education, resort to selling drugs instead of getting a good job, care more about having sex at age 13 than any of its consequences, and when things come crashing down, they leech off welfare and never give a rats ass about their health until they come into the ED with some terrible illness. Why are we responsible for even keeping these people alive? I work my tail off as do all of you so why should we be responsible for paying for the food and healthcare for these pathetic creatures? You know how advanced the US would be if we just denied them healthcare to these bums? They'd die off slowly but surely, we'd save tons of resources (time, money, manpower, etc.), and more importantly they won't have a chance to go back and procreate another generation of losers like themselves who contribute nothing but trouble and a severe burden on society.

Honestly, have any of you thought about this? IS this what our dream is by being doctors? This is why we struggle through medical school and residency for? To help some lazy ass, obese, unattractive, uneducated, crackwhore who doesn't even have the slightest insight to realize that maybe if she gets immense CP each time after cocaine use, that the drug use is what's causing her ailment and thus probably its not in her best interest to continue?

Ideally, I'd love for all my patients to be nice and peachy people who had the misfortune of being sick.. and I can help save the day so they can go back to their merry way and spread the love to the people around them. Unfortunately, there are regular people out there who are also sick.. and if doctors are allow to decide who to see/not see (at least at a public institution), then you'd get on a pretty slippery slope. I've met some racist a$sholes who are classmates, some docs who resent old people for being old, crazy people for being crazy, and messed up kid and drugs addicts for being abused and raped. Who's to say the guy walking into your ER with a suit on didn't just fuked his investors over and put a ton in poverty, and who's to say the homeless crackhead isn't a vet with psychiatric issues, self-medicating. I think without some sort of objectivity and professionalism in patient management, quality of care for everyone would decline, certainly for such a decent human being such as yourself.

 

[PeepshowJohnny]

Yes, I've thought about it but I try to rise above it.

It's kind of a complicated thing for me. Like, I am anti-death penalty as a rule, but man when you get a case like this dude (http://www.cnn.com/2008/CRIME/08/22/duncan.verdict.ap/) I still feel the call for blood lust rising up in me. But I try to rise above it.

Why do I bring up the death penalty? Because I'm opposed to it for the same reason I try to give the best care to everyone I can: I'm can't feel good about myself for playing God. All I'm getting is a snapshot of these people at one point in time. I don't know where they came from or where they're going. Based on this limited information, it just feels so egotistical to say "You're a degenerate meth head, you don't deserve my care." I don't know the circumstances that led them to this life and I can't say for sure if I don't fix him up after smashing his car into a light pole he won't get his life together and become a modern day saint.

Now, I'm not dumb. I know the odds. I know the majority of gang bangers and drunk drivers and noncompliant patients are just going to go down the same path time after time, but some don't. And again, I don't know the future so I try to give everybody their best chance.

Have you ever studied the Bhagavad Gita? I'm not a Hindu, but it's really fascinating philosophy. Wikipedia actually does a pretty decent job explaining it, so take a peak. Anyway, to play the "For Dummies" version, one of the great lessons is that because we don't have a godly awareness of things in this life, the best we can do is fulfill our duty. For example, if a soldier is called to fight and he does that, it does not matter if the war was not just or was unwinnable, as long as he does his duty there's something sacred about that.

I feel the same way about medicine. The job to decide who we should treat and who should not receive treatment in the grand scheme of things is not our decision to make. Our job is to help people to the best of our ability who need it. Let the politicians and the public health people sort out if it's worth to get a replacement heart valve for the IV drug user.

Now, that's not to say we don't get decision power. I feel comfortable stopping CPR on someone who's already gone or denying somebody a surgery because it's not indicated because that's a medical decision. Deciding not to treat a patient because they'll just get sick again or not help society isn't a medical decision.

 

[JaSam]

Ideally, I'd love for all my patients to be nice and peachy people who had the misfortune of being sick.. and I can help save the day so they can go back to their merry way and spread the love to the people around them. Unfortunately, there are regular people out there who are also sick.. and if doctors are allow to decide who to see/not see (at least at a public institution), then you'd get on a pretty slippery slope. I've met some racist a$sholes who are classmates, some docs who resent old people for being old, crazy people for being crazy, and messed up kid and drugs addicts for being abused and raped. Who's to say the guy walking into your ER with a suit on didn't just fuked his investors over and put a ton in poverty, and who's to say the homeless crackhead isn't a vet with psychiatric issues, self-medicating. I think without some sort of objectivity and professionalism in patient management, quality of care for everyone would decline, certainly for such a decent human being such as yourself.

Yea you make some good points there but its hard coming to work and giving it my best effort when I really have a hard time convincing myself that these are truly "good" people per say that I'm helping. A lot of them, I just can't even come to respect because of the way they've lived or treated themselves and/or others and its like the more they talk about how they got to their current situation, the more I shake my head. I'm often tempted to blurt out see ya next week or see ya next month if you make it when I see them before discharge b/c honestly, there's little we can do to fix them at this point. The greatest problem lies not in medically curing them but in mentally getting through to them but what are the odds of that right? If you grew up with an abusive, alcoholic father and a mother who ran off to let you try and take care of your 7 siblings, you'd probably wouldn't care what hte hell I have to say either so that's what I'm saying: Sometimes I feel like why bother? Like last week my attending advised some drug addict with 3 months to live to quit his drugs. And in my mind I'm thinking, if I were him, that would mean DO MORE DRUGS instead of less cuz to him that's probably the best way to go out.

 

[staphaureus]

Yea you make some good points there but its hard coming to work and giving it my best effort when I really have a hard time convincing myself that these are truly "good" people per say that I'm helping. A lot of them, I just can't even come to respect because of the way they've lived or treated themselves and/or others.

I agree with you. There are days when I hated some of the patients I followed, some are manipulative, nasty to everyone, entitled, and just live an extremely selfish lifestyle. I don't pretend that how I feel doesn't in someway compromise my care (whatever I can do). But I try to recognize this, and proceed with what I think is appropriate... doesn't mean I have to smile though. I just pretend that a reasonable person wouldn't behave the way that they do, and therefore they're at least have some sort of psychiatric issues . Occasionally, its nice to see that some actually turn themselves around.

 

[simpler2]

This is why we struggle through medical school and residency for? To help some lazy ass, obese, unattractive, uneducated, crackwhore who doesn't even have the slightest insight to realize that maybe if she gets immense CP each time after cocaine use, that the drug use is what's causing her ailment and thus probably its not in her best interest to continue?

I thought that we were all in this so that we can drive luxury cars and feel smarter than the neighbors in our gated suburban communities. It's not like we have any responsibility to society or anything.

Also, I agree that we (as highly educated professionals) should simply decide who should live or die. We should probably eliminate the inferior races and people whose opinions differ from ours as well.

 

[JaSam]

Yes, I've thought about it but I try to rise above it.

It's kind of a complicated thing for me. Like, I am anti-death penalty as a rule, but man when you get a case like this dude (http://www.cnn.com/2008/CRIME/08/22/duncan.verdict.ap/) I still feel the call for blood lust rising up in me. But I try to rise above it.

Why do I bring up the death penalty? Because I'm opposed to it for the same reason I try to give the best care to everyone I can: I'm can't feel good about myself for playing God. All I'm getting is a snapshot of these people at one point in time. I don't know where they came from or where they're going. Based on this limited information, it just feels so egotistical to say "You're a degenerate meth head, you don't deserve my care." I don't know the circumstances that led them to this life and I can't say for sure if I don't fix him up after smashing his car into a light pole he won't get his life together and become a modern day saint.

Now, I'm not dumb. I know the odds. I know the majority of gang bangers and drunk drivers and noncompliant patients are just going to go down the same path time after time, but some don't. And again, I don't know the future so I try to give everybody their best chance.

Have you ever studied the Bhagavad Gita? I'm not a Hindu, but it's really fascinating philosophy. Wikipedia actually does a pretty decent job explaining it, so take a peak. Anyway, to play the "For Dummies" version, one of the great lessons is that because we don't have a godly awareness of things in this life, the best we can do is fulfill our duty. For example, if a soldier is called to fight and he does that, it does not matter if the war was not just or was unwinnable, as long as he does his duty there's something sacred about that.

I feel the same way about medicine. The job to decide who we should treat and who should not receive treatment in the grand scheme of things is not our decision to make. Our job is to help people to the best of our ability who need it. Let the politicians and the public health people sort out if it's worth to get a replacement heart valve for the IV drug user.

Now, that's not to say we don't get decision power. I feel comfortable stopping CPR on someone who's already gone or denying somebody a surgery because it's not indicated because that's a medical decision. Deciding not to treat a patient because they'll just get sick again or not help society isn't a medical decision.

Interesting, those are some noble standards you hold yourself to. But I'd be interested to see if you'd still oppose the death penalty if that guy killed your son instead. I'd bet it'd be much different, perhaps not.

Same applies here in many ways. Because the pain and burden that these patients inflict on society is divided a million fold over so sure it may be easy for you to sleep at night knowing well that tens of millions of other tax payers and hard working Americans are helping support these people. But if you take time to think about it, that's not really the case. For as many good Americans out their making their living and trying to raise a good family out there, theres also an increasing number of people like the one's i've alluded to who unfairly live off of us. And to a certain extent, (I don't know the numbers) but it's gotta seem like we're each in part supporting a huge chunk of that burden on our shoulders when in fairness theres no way we should be forced to.

And to take this one step further. Another reason why I'm so pissed. You ever watch the 11pm news of some random shooting or robbery of some innocent youth or woman or child? The perpetrators more often than not come from these same subset of disgusting people I've mentioned. Now if it was one of your loved ones that was killed I would like to see how you respond and react when you see a similar carbon copy of the killer in the ED the next day you go to work.

 

[JaSam]

I thought that we were all in this so that we can drive luxury cars and feel smarter than the neighbors in our gated suburban communities. It's not like we have any responsibility to society or anything.

Also, I agree that we (as highly educated professionals) should simply decide who should live or die. We should probably eliminate the inferior races and people whose opinions differ from ours as well.

Ha, appreciate your sarcasm. But that last line actually if you think in the best interest of the entire human race as a whole, is exactly what we should do. Darwin would agree, survival of the fittest, smartest, richest, prettiest, healthiest.

Its like when you're in a rowing competition and theres a fat dude on your team who just can't produce the strokes per minute per body weight to help your team succeed, but you guys feel sorry for him and just take him for the ride instead of kicking him off the team. In the end, everyone on the team loses just so the fat dude doesn't feel bad. Because heaven forbid, that would be wrong to throw him overboard, and your mama would frown upon your actions.

 

[DarthNeurology]

Honestly, have any of you thought about this? IS this what our dream is by being doctors?

I haven't met any patient that I didn't think wasn't worth "saving." I think we all hope that the drug abuser will get off crack and be able to have more happier years. In the end, you will see a lot of patient whom you really love die and you will see some patient who are very obese with poor coronary status live for years. One patient I knew had abused cocaine and had a devastating health consequence and we knew he might go back to abusing cocaine as he had for over 20 years, but we we're all pulling for him and felt it was a trajedy.

Those extra years for the prostitute who is addicted to whatever drug mean just as much to her as they do to you, so the giving the gift of extra years of life I don't think can ever do a diservice to society.

What about say an anesthesiologist who say retires when they are relatively young, i.e. 55 to 60 years old and just want to sail the world and spend time reading books. His/her productive life, i.e. giving back to society has ended! (Especially if they say that they don't want to do medicine again.) Now say I have this doctor in the ER and they are having an MI . . . if we "save" him/her does this hurt society? Overall yes as the doctor won't be doing anything productive just using resources for maybe another 30 years . . .

Now say we "save" the prostitute addicted to cocaine, well, what if she has a two and five year old to take care of and she gets to do this and they become productive members of society, otherwise they go into the orphanage and the state pays for them. So you can see how using the good to society argument it might be worth it to save the verbally abusive cocaine addicted prostitute over a pleasant retired anesthesiologist.

Face it, everybody beyond their reproductive years contribute NOTHING to the evolution of the human species, so helping a 60 year obese woman be normotensive will help her a lot but wouldn't screw us evolutionarily. Heck, I don't think hypertension or diabetes have a big effect on evolution as they most affect health after reproductive years (this may change as kids are getting diabetes at big rates).

In the end it is just one interesting case after another. A non-adherent patient on antihypertensives IS interesting and fun to take care as is the anesthesiologist with an MI. In the end it is too fun to try to "save" everybody that you wouldn't want to play God.

Medicine is my dream as you CAN help people live healthier lives and have more years or at least more higher quality years, and the whole diagnosis and treatment is what is fun. I.e. managing say a cirrhotic with end-stage-liver failure is stimulating and fun (can be heartbreaking too) but you don't really focus on the poor mortality or that you may only save them a couple months.

 

[The Angriest Bird]

Oh well my friend, you have made many good points. I have to give you credit.

I was a social psychology major for undergrad. One of the biggest question in social psychology is "is it the person or the situation."

Apparently you are a well educated, smart and moral medical student. If I could play the role of god, rewind time back to about 20 years ago, letting you be born in a family in the ghetto of the city. Your father was shot dead when you were 5. Your mom worked as a prostitute and was on drugs. 70% of the neighbors in your communities were once in jail. Your uncle sexually abused you when you were 7. Would you still be a medical student? Is your mind tough enough to sustain all these burdens, which were put on you without your "informed consent?"

P.S. I'm NOT speaking for the "social outcasts." I agree that a lot of them chose their path purely based on the content of their characters.

 

[HarryRosenMD]

A physician answers to a calling... being at heart, one of wanting to help and educate others.
Obviously everyone has problems... but help should not be restricted to certain 'moraly approved' patient populations. From a purely societal point of view, helping one potentially helps many, as the drug addict you refuse to help, may now:
-No longer be able to care for a child, parent, or other loved one(s)
-Infect others
-Commit a crime to to get the needed money for medical help

The thoughts you share go through every physicians mind from time to time. Just try to focus on the potential of the interaction. The potential to make a difference. You simply offer up that potential... again and again if need be. That's how you answer your calling to all of us.

 

[45408]

At the bedside, it's not your role to make these decisions. As a policy maker, I think you should be lower on the list for a liver transplant if you're an alcoholic than if you had an autoimmune disease. Sorry. My wife's co-worker saw one of her patients (who had received a liver transplant) at the liquor store. No small surprise that she's having complications with the transplant.

 

[Ypo.]

These patients don't have insurance. Yes, you may feel sorry for the uninsured, but let me remind you, theres usually a good reason why most of these people are uninsured. They grow up in bad neighborhoods, have no education, resort to selling drugs instead of getting a good job, care more about having sex at age 13 than any of its consequences, and when things come crashing down, they leech off welfare and never give a rats ass about their health until they come into the ED with some terrible illness. Why are we responsible for even keeping these people alive? I work my tail off as do all of you so why should we be responsible for paying for the food and healthcare for these pathetic creatures? You know how advanced the US would be if we just denied them healthcare to these bums? They'd die off slowly but surely, we'd save tons of resources (time, money, manpower, etc.), and more importantly they won't have a chance to go back and procreate another generation of losers like themselves who contribute nothing but trouble and a severe burden on society.

It's not your job to judge patients in this manner. Your job is to suspend moral judgment and to think objectively towards treating the patient. I'm not saying that you can't use some of the observations you make (toothless, unkempt, track marks on arms=likely homeless heroin addict), but there is nothing in your training as a medical student that makes you an expert in sociology or anthropology or even psychology. And you are most likely not an expert in health care policy, either.

You will make your life a lot easier when you decide to adopt a policy of nonjudgment and think about the most efficient way to get these people in and out the door.

Just realize that the more jaded and quick to jump to conclusions you allow yourself to become, the poorer physician you'll make yourself. Believe it or not, first impressions are not as accurate as we lead ourselves to believe, and it can be all too easy to think that we've got our patients pegged when in fact we are just stereotyping them inaccurately.

 

[lipstikisntfood]

As someone already mentioned, I think the thoughts and anger of the poster affect almost every medical student and doctor at times, perhaps especially when we're tired, hungry, in need of a bathroom, and haven't had time for ourselves or our families in weeks. One little mental game I play that is often effective is this: every single patient I see is one more chance for me to practice my skills and solidify my knowledge. If seeing an alcoholic drug addict Hep. C infected rude obnoxious pt w/end-stage liver disease helps me help someone else in the future (someone who is a good, kind, contributing member of society), then the obnoxious pt actually has contributed to society as well. Therefore, I can convince myself to treat that pt w/the respect and kindness he deserves (unless, of course, he is blatantly rude to me).

 

[BigRedBeta]

It is disheartening. I certainly don't take the same extreme course as you do, but it's frustrating and I definitely had plenty of times when I wondered was it really a good idea, or socially just to be taking care of these patients.

My feeling is this - my job is to promote health and well being. I'm essentially the messenger, and there's only so much I can do. If people are willing to take my advice, follow the treatments I've put forth, then great, they'll see the benefits. But I can only do so much. People have to help themselves.

In July, I did a general medicine sub-i with an internist who works in a more affluent part of town, and it was down right astounding to see what happens when people actually take their meds, try to make a little effort to improve their health and so on. Probably 80% of his diabetic patients had A1C's below 7%. A majority on a statin were below their lipid goals...including a huge number of diabetics who were below that 70 benchmark for LDL. Blood pressures were controlled. People checked their sugars multiple times a day and brought their logs with them. So it does work. You can make a difference when people want to change.

Further, there are fields (like peds or plastics) where this sort of cynicism is far less rampant. Take this anger you have, and keep it in mind when you're looking for your future field.

 

[45408]

When I feel like I'm doing a disservice is when it's a patient whose family is not acting in the patient's best interest, but the patient is no longer capable of telling us much of anything at all. I'm a huge proponent of patient autonomy, and I doubt that many of them really want to have a G-tube, a rectal tube, a Foley, and numerous pressure ulcers for the rest of their life.

 

[radslooking]

We do a disservice when we overtreat, overdiagnose, just as much as when we undertreat and underdiagnose. We do both in our current crappy system of medical care. It's up to you to use your good judgment to decide when we do either.

Even if you wanted to, you just can't make clear judgments on someone's character seeing them 15 minutes a day in their room.

 

[MrBurns10]

The vast majority of medical students were raised in middle class+ families and thus don't know what it's like to be raised in a bad neighborhood where drugs and violence run rampant. And honestly, when we see a drug addict or a 14 year old pregnant girl with a "party pelvis" (the residents' term for someone who has GC, chlamydia, and trich), we're not supposed to know what their life is like. But I think where you can have compassion is by acknowledging that you can't possibly understand their situation and commit to helping them as best you can, even when it can be frustrating and demoralizing.

This is a great article a classmate of mine sent to the class. It's long, but definitely worth the read.

http://www.theamericanscholar.org/su08/elite-deresiewicz.html

 

[Droopy Snoopy]

What about say an anesthesiologist who say retires when they are relatively young, i.e. 55 to 60 years old and just want to sail the world and spend time reading books. His/her productive life, i.e. giving back to society has ended! (Especially if they say that they don't want to do medicine again.) Now say I have this doctor in the ER and they are having an MI . . . if we "save" him/her does this hurt society? Overall yes as the doctor won't be doing anything productive just using resources for maybe another 30 years . . .

Your analogy is flawed. Maybe if the anesthesiologist was traveling the world defacing national monuments and works of art, or spreading drug-resistant tuberculosis... The patients in question don't simply not contribute to society, they actively work to the detriment of it.

 

[mrantarctica]

Perhaps you are highlighting some of the pervasive futility in medical treatments offered by hospitals.

However, your role as a doctor is more than just about writing that script for penicillin. Indeed, the word Doctor comes from 'docere' meaning to "teach". With all your patients, you should take the opportunity to teach them a little bit about their illness, or about aspects of their care, or why you do the things you do.

I know that sounds all idealistic and full of **** - but you might be the ONLY person that's ever explained to that patient that they should stop smoking and for what reasons. THat might just make the difference. You never know until you actually try.

Most of your questions are why the field of public health exists. Everyone in our society has choices to make. The choices you make or not the same as anyone else. You might be dreaming about that Gold Rolex 'one day', while Bill Gates just has to go out and say 'Ill take it, got a silver and bronze one too?". Similarly, healthy choices are not always the easiest choices for everyone. Good to be aware of that when dealing with some people that have more than just acute medical problems.

Because you are unable to put yourself in their shoes (don't worry, noone can) - carrying over pre-formed ideas or judgements about their way of life, and their 'worth' for medical practice is ethically unsound.

It's funny how this pseudo religious (pseudo christian?) life ideas and judgements - based on personal merit (if you do good, youll go to heaven. bad will send you to hell!) filters down into the things we do. Should it really? Does it have any bearing?

 

[LadyWolverine]

It's funny how this pseudo religious (pseudo christian?) life ideas and judgements - based on personal merit (if you do good, youll go to heaven. bad will send you to hell!) filters down into the things we do. Should it really? Does it have any bearing?

Absolutely. Personal merit is all that we really have. It defines our character. And there's nothing pseudo-religious about it. It lies at the root of most religions...and I'd like to think that it lies at the root of humanity in general. Most of us decide to go into medicine because we believe that it is a positive and productive way to apply such merits. And please note that I am not referring to any particular endpoint like Christian "Heaven" here - simply that we feel good when we do something that benefits mankind. Call it what you will - heaven, zen, fulfillment - it doesn't matter.


As to the OP's point - for me, personally, it is very difficult to separate my POV as a clinician from my POV as a taxpayer and citizen. I sympathize with the OP's plight, but I also re-emphasize what other posters have stated above - as clinicians, it is not our role to decide who is "worthy." However, as taxpayers and US citizens (and not to mention as responsible members of society), we have the right to change policy as it is needed. You have a voice - air your concerns where and to whom it matters.

 

[mrantarctica]

I think what you're getting at is a philosophical discussion - very aristotlean - regarding the purpose of our lives. And I agree with the general idea of what you have said. A very interesting topic, but not what I was meaning initially.

What I was getting at was whether should everyone have a 'merit' score so that we can say "oh well done! you deserve this", or "bad boy, you go to jail!" etc.

I feel our ideas of worth of other beings are based on what they contribute in a material way, or a physical way (i.e. taxes, doing a job, acquiring a degree). To the extent that everyone has to a pass a 'legitimacy' test, whether they're worth our undivided attention or feelings. It would follow that those that have the least to offer physically i.e. drug abusers, psychiatric illness, criminals, those with debilitating disease, the elderly and infirm - often receive the poorest treatment, and perhaps suffer the most 'hidden' abuse. I think this filters down into the way we organise our society, the provisions we have for these groups, and also medical care. Should it necessarily be this way? Is our society simply a productivity line?

I question whether many people have looked at some people and thought - hmm that person influenced my understanding of the world in some way, I'm really glad I met him/her.

That's sort of more what I was thinking about. Probably doesn't make much sense in writing I guess...

 

[78222]

As a medical professional I realize that a lot of my patients are dirtbags but that it's not my place to let that change the care I offer them. Some of my patients probably don't deserve medical care or even the air they breath but there is no way I would be so arrogant as to assume I know which ones are deserving and which are not. And as for the uninsured, well there are a lot of them that could buy insurance if they quit spending their money on new iphones or spinners but there are also a lot of them that can't afford it because they have kids to take care of or a preexisting medical condition which makes it hard to find affordable insurance.

 

[crazylegs]

So I've just switched to a new rotation in the city hospital and we see tons of unbelievable cases and a lot of times I can't help but come away thinking: Why the hell are we saving these people? These uneducated, drug dealing, uninsured, mean-spirited, indifferent masses of disgust and decay? Now before you go berserk, I do have compassion, but more so for those patients who are sick because of some unfortuneate event or some poor little girl/boy who god has dealt them some congenital defect that threatens their life. But unfortuneately, these cases are quite the minority. I'm just sick and tired of seeing druggies come in with stupid crap like uncontrolled HTN b/c he'd rather spend every last penny on drugs than go to a fking walmart and get his meds for 4 dollars a month.

Not only from a financial standpoint but also from a darwinistic perspective, I'm having a harder and harder time convincing myself that its even worth the bother trying to help these people because in the end, we're only hurting society as a whole. These patients don't have insurance. Yes, you may feel sorry for the uninsured, but let me remind you, theres usually a good reason why most of these people are uninsured. They grow up in bad neighborhoods, have no education, resort to selling drugs instead of getting a good job, care more about having sex at age 13 than any of its consequences, and when things come crashing down, they leech off welfare and never give a rats ass about their health until they come into the ED with some terrible illness. Why are we responsible for even keeping these people alive? I work my tail off as do all of you so why should we be responsible for paying for the food and healthcare for these pathetic creatures? You know how advanced the US would be if we just denied them healthcare to these bums? They'd die off slowly but surely, we'd save tons of resources (time, money, manpower, etc.), and more importantly they won't have a chance to go back and procreate another generation of losers like themselves who contribute nothing but trouble and a severe burden on society.

Honestly, have any of you thought about this? IS this what our dream is by being doctors? This is why we struggle through medical school and residency for? To help some lazy ass, obese, unattractive, uneducated, crackwhore who doesn't even have the slightest insight to realize that maybe if she gets immense CP each time after cocaine use, that the drug use is what's causing her ailment and thus probably its not in her best interest to continue?

I can assure you that a great majority of doctors have thought these thoughts before, most of them being interns/residents who work in county hospital settings or other institutions who serve the uninsured as well. As for myself, they most definitely surface when I am up at 4am admitting yet another "refractory HTN, chest pain, r/o MI" patient who refuses to buy his $4 BP meds because he'd rather spend his welfare money on another hit of cocaine and only cares to shoo me away during my H&P so that he can sleep cozily in his nice comfortable hospital bed after downing a triple portion dinner in the ER.

On one hand, I chastise myself for deviating from the mostly-humanly-impossible altruistic mindset that society requires of its physicians 100% of the time all of the time ... and on the other hand, I truly thank you for verbalizing these thoughts that so many of us are too afraid to voice for fear of retribution from ourselves, our peers, all of society, etc. I don't care how you choose to philosophically explain why I am wrong for thinking and having these detrimental thoughts and feelings on this subject - there are many lazy good-for-nothing human dirtbag scumbuckets out there, and they have plagued society ever since humans made their appearance on this planet. It's my job as a physician to suck it up and treat them like it's my privilege to be of service to them and their self-perpetuating shattered state of health, regardless of how I feel about it. That's what we get paid the (proverbial) big bucks to do.

 

[45408]

As for myself, they most definitely surface when I am up at 4am admitting yet another "refractory HTN, chest pain, r/o MI" patient who refuses to buy his $4 BP meds because he'd rather spend his welfare money on another hit of cocaine and only cares to shoo me away during my H&P so that he can sleep cozily in his nice comfortable hospital bed after downing a triple portion dinner in the ER.

He came and saw you too? That story sounds surprisingly familiar!

 

[LadyWolverine]

He came and saw you too? That story sounds surprisingly familiar!

You guys must live in Baltimore.

 

[Fishy-Cracker]

although I think I understand some of your frustration.....I can't help but be disgusted by the elitist attitude that is apparent in a few of your statements.

1. Being "uneducated" does not mean a person is not intelligent, just as having a college degree does not make somebody intelligent (do you know any *******es that graduated from your college? I sure do). An "uneducated" person can still be a valuable member of a community, make good money (or not), and raise a good family. In fact, people such as this are some of the most honorable, hard working people and the most enjoyable to be around.

2. Being unattractive makes you worthless to society and not worthy of your efforts? what the hell? you must be really attractive!!, but someday you will become ugly, just like the rest of the pathetic ugly people.

perhaps you should learn about the life of, for example, an ugly manual laborer (you know what manual labor is right?) who has worked physically harder than you could EVER imagine..... so that the next time someone comes to see you that doesn't belong in your educated, beautiful presence, you might think twice before discarding them as part of the 'indifferent masses of disgust and decay'.

I hope your post was just your way of coping with a stressful week because your attitude will be very crippling to you in the relationships with your patients and a more humble attitude will help your relationships to me more beneficial and therapeutic for the patient

everybody has a story and you would do well to learn it.

 

[dilated]

Much more interesting than debating whether or not we should let Darwin have his way with white trash is how quickly we become acclimated to modern medicine's love of zombifying and torturing the elderly. I can't count the number of people I see in medicine who have zero quality of life or even awareness, but are getting a G-tube or a PICC or whatever other torture will allow the family to pretend they're being a good child and the team to get them off the service so they can go back to rotting in storage. This is literally like 20%+ of hospital admits I've seen.

That's the disservice we do society as doctors.

 

[Electrophile]

Much more interesting than debating whether or not we should let Darwin have his way with white trash is how quickly we become acclimated to modern medicine's love of zombifying and torturing the elderly. I can't count the number of people I see in medicine who have zero quality of life or even awareness, but are getting a G-tube or a PICC or whatever other torture will allow the family to pretend they're being a good child and the team to get them off the service so they can go back to rotting in storage. This is literally like 20%+ of hospital admits I've seen.

That's the disservice we do society as doctors.

Agreed. One of several reasons I'm in vet medicine instead. If I'm 70+ years old and terminal with no quality of life, give me the pink juice. Please.

 

[45408]

Much more interesting than debating whether or not we should let Darwin have his way with white trash is how quickly we become acclimated to modern medicine's love of zombifying and torturing the elderly. I can't count the number of people I see in medicine who have zero quality of life or even awareness, but are getting a G-tube or a PICC or whatever other torture will allow the family to pretend they're being a good child and the team to get them off the service so they can go back to rotting in storage. This is literally like 20%+ of hospital admits I've seen.

That's the disservice we do society as doctors.

NO KIDDING. Medicare must absolutely institute advanced directives as a mandatory thing before you get a single penny. This is beyond ridiculous. This is costing us an absolute fortune as well as being brutal to someone who is, for all practical purposes, already dead.

 

[crazylegs]

You guys must live in Baltimore.

Nope, Oklahoma City... it's all too rampant everywhere in the U.S. it seems

 

[crazylegs]

Much more interesting than debating whether or not we should let Darwin have his way with white trash is how quickly we become acclimated to modern medicine's love of zombifying and torturing the elderly. I can't count the number of people I see in medicine who have zero quality of life or even awareness, but are getting a G-tube or a PICC or whatever other torture will allow the family to pretend they're being a good child and the team to get them off the service so they can go back to rotting in storage. This is literally like 20%+ of hospital admits I've seen.

That's the disservice we do society as doctors.

Amen to that one.


My grandpa died when I was a freshman in college. He had battled colon cancer with mets to the liver for a couple of years and had undergone several bouts of chemo plus a total colectomy with an outside colostomy and 2 surgeries to cut out the portions of his liver that had the mets (can't remember the medical term for it - hepatectomy?? eh, anyways)... 2 years from the date of his diagnosis, his oncologist told him that there was nothing else that medicine could do for him. His cancer was unresponsive to the chemo and still spread after the surgeries. I can't remember what his transplant status was, but I think he opted out of it. He decided at that time to let the cancer run its course and to just enjoy what was left of his life.

My mom and grandmother went berserk when they found out about this, of course. I was horrified to see them plead, cry, and even yell at him for not looking at 'alternative' therapies (like hyperbaric O2 and whatnot)... telling him that he was being selfish and not thinking about the family that he was leaving behind. They even tried to call his doctor and get ahold of his medical records so that they could self-refer to other doctors for him to see. I felt really bad for him - he was just tired of it all, and battling cancer for 2 years had made him absolutely miserable - but nobody was supporting his decision and instead insisted that he keep pushing himself to get better for their sake, not necessarily his own. How awful is that?!?!

Anyways, long story short, a month after he was told there was nothing left to do, he died peacefully at home in a morphine-induced coma with my grandma, my mom, and me all at his side. I was understandably upset by this at the time - it was the first time I had ever watched someone die, and it killed me to see my grandpa go.. but at the same time I was SO happy for him, that he would never have to deal with the cancer or the pain again. In my mind, it wasn't fair for my grandpa to have to continue to suffer just because I wanted him around. He was ready to die, and who were we to stop him?

Looking back on all of this, I am so glad that my grandpa stood fast in his decisions and did not let my mom or grandma coerce him into going through more pain and suffering than he wanted to. He would have wound up like many of these geri patients that we see on the wards every day who spend most of their time rotting in nursing homes with the occasional holiday to the hospital for their plethora of feeding tubes, foleys, and tracheostomies. I am appalled at how hostile and selfish these patients' families are and even more disgusted that my own family harbors these attitudes too

To this day, my mom still insists that alternative medicine would have cured my grandpa's cancer, and he would still be here today if he had just tried it. She also believes that the morphine, not the cancer, is what killed him and that we should have never given it to him in the first place. I don't even know where to start with that - I gave up trying to educate her on modern medicine a long time ago.

 

[highyield]

Much more interesting than debating whether or not we should let Darwin have his way with white trash is how quickly we become acclimated to modern medicine's love of zombifying and torturing the elderly. I can't count the number of people I see in medicine who have zero quality of life or even awareness, but are getting a G-tube or a PICC or whatever other torture will allow the family to pretend they're being a good child and the team to get them off the service so they can go back to rotting in storage. This is literally like 20%+ of hospital admits I've seen.

That's the disservice we do society as doctors.

right on man, i think about this daily.

 

[Tired]

We practice on the worthless so we do better on the worthy.

 

[45408]

To this day, my mom still insists that alternative medicine would have cured my grandpa's cancer, and he would still be here today if he had just tried it. She also believes that the morphine, not the cancer, is what killed him and that we should have never given it to him in the first place. I don't even know where to start with that - I gave up trying to educate her on modern medicine a long time ago.

Damn, that's tough. My aunt was pushing harder than anyone else in my family to try to be more aggressive with my grandpa's care right before he died, but thankfully, although he was a bit slowed down, he had all his mental faculties up until the day he died. He went out on his own terms, which is how I think it should be, and it's how I don't think it usually is with these demented patients with a tube in every orifice and a half dozen drips as they fade into oblivion, years after their mind had left them.

 

[PeepshowJohnny]

We practice on the worthless so we do better on the worthy.

Can't argue with this. Look at how the post graduate education is built on "free resident" clinics and such. Don't see many millionaires strolling into them.

 

[killerleaf]

so is there a way to say to the doctor, "just let them die?" without being thrown in jail?

my mom has alzheimers, getting worse everyday. I can't even visit her, because she gets violent. otherwise she is pretty tractable with the nursing home staff. of course, for some reason, to her, I am her most hated aunt...
she is incontinent, and due to the stroke, no longer able to walk.

what a world. if I had a pet in this condition, no one would say a word if the decision was made to put them "to sleep". but a human!! horrors......

 

[vtucci]

Wow- I suggest you don't remain this judgmental or you will hate the practice of medicine.

Until you have walked a mile in someone's else shoes, I would avoid judging them and their actions. It is easy to say that drug addicts, alcoholics and non-compliant patients suck because the test our patience and abilities. Why not strive to be that one person that finally breaks through and makes them understand their medical problems on their level (e.g., your high BP is making your hemorrhoids worse, your BP will make you have a stroke, go blind, go into kidney failure, your touch of sugar will make you go blind, have a heart attack etc). Sure you may fail 99/100 times but it is that one time you win that really matters. Maybe you save someone's mother, daughter, father, son. As physicians we have the ability to make a real difference in someone's life.

To OP, if you think it is too frustrating to deal with these patients, maybe you should look into a specialty that minimizes your time with patient care (i.e., path, anesthesia) or perhaps you should seek a more rural environment (although I promise you drug addicts, non-compliant patients will exist in the "sticks" too)? I think it goes without saying that EM is not the field for you and probably primary care, cardiology, GI are out too.

Also consider that if you deny healthcare to these "bums", how many other contributing members of society are they going to get sick with infectious diseases or how many will they kill by having a heart attack while driving?

 

[BlueAvenue]

I honestly can't believe that someone like you went into medicine. I know most of the people on this forum are from middle class families so it can be hard to understand why people act the way they do, but that gives you no right to want to deny people healthcare based on class. I'm from baltimore myself, do you not understand that when you're born impoverished in an uneducated family that it's hard to escape that cycle? not everyone is born with equal opportunities which you need to understand. all because someone is a drug addict doesn't mean they don't have parents who love them and shame on you for not wanting to provide them with the best care possible. Im sorry if you forgot but these are human beings. unbunch your panties and get over yourself

 

[veenut]

I honestly can't believe that someone like you went into medicine. I know most of the people on this forum are from middle class families so it can be hard to understand why people act the way they do, but that gives you no right to want to deny people healthcare based on class. I'm from baltimore myself, do you not understand that when you're born impoverished in an uneducated family that it's hard to escape that cycle? not everyone is born with equal opportunities which you need to understand. all because someone is a drug addict doesn't mean they don't have parents who love them and shame on you for not wanting to provide them with the best care possible. Im sorry if you forgot but these are human beings. unbunch your panties and get over yourself

pot, meet kettle

 

[digitlnoize]

Everyone: Just go watch "Idiocracy" and accept that THAT is the future of our world.

 

[psipsina]

There's no way in the brief meetings that we have with a patient that we can understand and judge their worth as people. Why people are the way they are is way too deep a topic to cover in a single H&P. And that's not our job as physicians. Its hard not to make snap judgements but there really is nothing gained by categorizing your patients into "worthy" or "unworthy" and your judgment may actually hamper the quality of their care. If they read that judgment they can become defensive and even more uncooperative. If you're pre-occupied with your dislike of a patient you might not do your best for them. Its best to leave your own emotional baggage at the door when you enter a room. If you find that you can't do this you can certainly pick a specialty and then practice type where you won't have daily encounters with the unwashed masses. Its not like medicine is a life sentence in the ED of an inner city public hospital.

 

[SouthernSurgeon]

I honestly can't believe that someone like you went into medicine. I know most of the people on this forum are from middle class families so it can be hard to understand why people act the way they do, but that gives you no right to want to deny people healthcare based on class. I'm from baltimore myself, do you not understand that when you're born impoverished in an uneducated family that it's hard to escape that cycle? not everyone is born with equal opportunities which you need to understand. all because someone is a drug addict doesn't mean they don't have parents who love them and shame on you for not wanting to provide them with the best care possible. Im sorry if you forgot but these are human beings. unbunch your panties and get over yourself

Way to resurrect a year old thread for a pre-med soapbox moment.

 

[rachmoninov3]

In a world where God speaks through all people, how can we not feel like we are in the lowest class in elementary school?---Dag Hammarskjold

We all get frustrated with the patients that we feel do it to themselves. My biggest gripe is with border-line personalities who want "their ativan" while completely ignoring their children's lives that they f*cked up.

Yet who is to say that I couldn't have been that person?
Had I been born to different parents?
Had something happened and I wasn't able to go to college?
Been in a car wreck and got PTSD?

The important thing is to realize our biases, and under what circumstances we are most likely to experience them. Then, hopefully through philosphy, study, or religion, we've found a bottom line that can allow us to give the benefit of the doubt, and treat our fellow human humanely.

For it is always the strong who are to blame
--Dag Hammarskjold

 

[Substance]

I honestly can't believe that someone like you went into medicine. I know most of the people on this forum are from middle class families so it can be hard to understand why people act the way they do, but that gives you no right to want to deny people healthcare based on class. I'm from baltimore myself, do you not understand that when you're born impoverished in an uneducated family that it's hard to escape that cycle? not everyone is born with equal opportunities which you need to understand. all because someone is a drug addict doesn't mean they don't have parents who love them and shame on you for not wanting to provide them with the best care possible. Im sorry if you forgot but these are human beings. unbunch your panties and get over yourself

MCAT 23 first attempt?

 

[jdh71]

I honestly can't believe that someone like you went into medicine. I know most of the people on this forum are from middle class families so it can be hard to understand why people act the way they do, but that gives you no right to want to deny people healthcare based on class. I'm from baltimore myself, do you not understand that when you're born impoverished in an uneducated family that it's hard to escape that cycle? not everyone is born with equal opportunities which you need to understand. all because someone is a drug addict doesn't mean they don't have parents who love them and shame on you for not wanting to provide them with the best care possible. Im sorry if you forgot but these are human beings. unbunch your panties and get over yourself

As awesome as bumping year old threads to only to get flamed by your butthurt indignity is . . . you'll just have to wait and witness these things for yourself.

What you have here is someone blowing off steam. Just yesterday I admitted a "chest pain" drug seeker - he's got a history of real dz, and knows all of the buzz-words to make sure he gets admitted and gets his IV morphine. He's a dirtbag. He's just one guy yesterday and my 2nd dirtbag this week.

Now, I appreciate the douchbag elitist attitude displayed by the OP - eugenics is never very pretty anytime it rears it's ugly head. There were a bunch of guys 60 or so year ago who took this line of thinking to it's logical end and tried to destroy a whole group of people . . . it's slippery slope, and being a doc isn't always easy.

Remember that, and don't be so judgemental.

 

[Rendar5]

just remember, if you treat or think about people (and trust me if you think about people that way, it comes across in your tone of voice and demeanor) like they're ****, they're just gonna treat you like you're **** in return. It's hard with malignant personalities or people who've wrecked their lives or people trying to take advantage of the system because they relish their role as a sick patient or enjoy getting IV meds. But if you treat them with respect like they're not that type of patient, they'll at least be nice and pleasant to you most of the time.

 

[KeyzerSoze]

so is there a way to say to the doctor, "just let them die?" without being thrown in jail?

my mom has alzheimers, getting worse everyday. I can't even visit her, because she gets violent. otherwise she is pretty tractable with the nursing home staff. of course, for some reason, to her, I am her most hated aunt...
she is incontinent, and due to the stroke, no longer able to walk.

what a world. if I had a pet in this condition, no one would say a word if the decision was made to put them "to sleep". but a human!! horrors......

I'm sorry, did you mean "just let them die" or "just kill them"?

 

[scube]

Damn, that's tough. My aunt was pushing harder than anyone else in my family to try to be more aggressive with my grandpa's care right before he died, but thankfully, although he was a bit slowed down, he had all his mental faculties up until the day he died. He went out on his own terms, which is how I think it should be, and it's how I don't think it usually is with these demented patients with a tube in every orifice and a half dozen drips as they fade into oblivion, years after their mind had left them.

This is exactly why PCP should ask the end of life questions as soon as its prudent, which is very early in getting to know a patient. that way you can tell the family what the patients wishes were and help them thru death. well back to the world of butterflies and puppy dogs for me.

 

[45408]

This is exactly why PCP should ask the end of life questions as soon as its prudent, which is very early in getting to know a patient. that way you can tell the family what the patients wishes were and help them thru death. well back to the world of butterflies and puppy dogs for me.

I think it's an area that doctors fail in, quite regularly. The ICU doctor doesn't want to say anything, because he just met the family a week ago, the PCP isn't even involved because he doesn't see patients in the hospital, the surgeon agrees to do a Hail Mary procedure, and nobody puts on the brakes. I've seen a few cases where someone took the family aside and said "No way no how," and the family appreciated the honesty and agreed to call it quits. I think it's more respectful to the patient to allow them to die with dignity (again, always assuming that this is what they wanted), it allows the family not to stretch out a painful death with tons of interventions, and it keeps us from wasting obscene amounts of money.