Overly Pessimistic (IM) Preceptor...are all doctors like this?

[Arkangeloid]

So I do my preceptorship at a community hospital with a hospitalist (not sure what the difference is between a hospitalist and an internist, but whatever). What she does is that she shows me a patient, and tells me about her diagnostic process and stuff. But afterwards, she explains to me how it's pointless to help the patient because he either has some chronic disease, or has a poor lifestyle, or is noncompliant, or whatever. She does this for every single patient.

I mean, her concerns probably have some basis in reality, but do most doctors have a glass half empty perspective similar to her's? How valid is such a perspective?

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[Lavan]

A hospitalist is someone (general medicine, general peds) who only works in the hospital taking care of inpatients, no clinic. An internist historically is the primarily clinic-based practice of internal medicine.

This feeling is extremely common and sad. As a hospitalist, you work only with inpatients. Which means that it's the same people with end-stage or chronic poorly controlled disease who are admitted for heart failure or copd exacerbations dialysis noncompliance volume overload hepatic encephalopathy etc. These patients will not improve. They are stabilized, discharged, and then readmitted at some regular interval until they progress. This is an issue with hospitalist medicine, where you don't see well-controlled or compliant patients who can stay out of the hospital for prolonged periods of time.

Most hospitalists I've worked with have varying degrees of the same attitude, outside of the some of the very youngest ones. There are of course oodles of hospitalists that don't feel that way, but at your local county-type hospital full of the indigent uninsured...probably not so much.

 

[TheWeeIceMan]

You should check out the hospitalist thread by ZDoggMD. He also has some videos in there that are hilarious.

 

[SunsFun]

Some of it could just be a mismatch in values between the doc and his or her patients. I've seen it a couple of times in inner city county hospital. They are never on the same page so the attending eventually gives up.

 

[Anastomoses]

Ehh, sounds like a personality glitch to me. As a doctor...nay, as a person, being non-judgmental and giving others the best available care is all that is demanded of a doctor. I find it a bit selfish when doctors start acting as if they are entitled to delivery and return on patient behavior. Like the personal satisfaction is owed to them. Sure, it's fantastic when things go well and you help someone...but for crying out loud, just do your job excellently and improve on what is in your power. That's it! If the diabetic neuropathy just keeps getting worse with each visit from a patient, feel empathy that this person clearly doesn't have it in his/her power to comply soundly and attempt to reach them...if it's not possible, then it's not. Next. I have a hard time relating to doctors who get emotionally ruffled about these things.

 

[username456789]

Ehh, sounds like a personality glitch to me. As a doctor...nay, as a person, being non-judgmental and giving others the best available care is all that is demanded of a doctor. I find it a bit selfish when doctors start acting as if they are entitled to delivery and return on patient behavior. Like the personal satisfaction is owed to them. Sure, it's fantastic when things go well and you help someone...but for crying out loud, just do your job excellently and improve on what is in your power. That's it! If the diabetic neuropathy just keeps getting worse with each visit from a patient, feel empathy that this person clearly doesn't have it in his/her power to comply soundly and attempt to reach them...if it's not possible, then it's not. Next. I have a hard time relating to doctors who get emotionally ruffled about these things.

Your views may change slightly when your compensation is tied to outcomes rather than interventions.

Or, they may not.

 

[ruralsurg4now]

But afterwards, she explains to me how it's pointless to help the patient because he either has some chronic disease, or has a poor lifestyle, or is noncompliant, or whatever.

That's generally true.

 

[ruralsurg4now]

I find it a bit selfish when doctors start acting as if they are entitled to delivery and return on patient behavior.

What an odd view of medicine you have. You seem to think physicians just trundle around and write random stuff with no concern for whether anyone listens to them or does what they say and only desperately try not to "judge." Guess what? When physicians do that, they get burned out in under one year. You have a typically idealistic and unrealistic view of life held by brainwashed medical students. But it's OK because you'll learn.

 

[FutureInternist]

Ehh, sounds like a personality glitch to me. As a doctor...nay, as a person, being non-judgmental and giving others the best available care is all that is demanded of a doctor. I find it a bit selfish when doctors start acting as if they are entitled to delivery and return on patient behavior. Like the personal satisfaction is owed to them. Sure, it's fantastic when things go well and you help someone...but for crying out loud, just do your job excellently and improve on what is in your power. That's it! If the diabetic neuropathy just keeps getting worse with each visit from a patient, feel empathy that this person clearly doesn't have it in his/her power to comply soundly and attempt to reach them...if it's not possible, then it's not. Next. I have a hard time relating to doctors who get emotionally ruffled about these things.

That sounds well and good until you get into practice and have to deal with these patients & how their non-compliance hurts your well being
If a DMer has high A1c, its your fault
If a CHFer get readmitted within 30 days, its your fault
If a 50 yo pt refuses Cscope, its your fault
And for each of these, your reimbursement if cut by a certain %

The only way to compel compliance is to fire all non-compliant pts from your clinic & when they cannot find someone to help them, perhaps they will wake up & see the light i.e. consequence of their (in)action

 

[Winged Scapula]

Its hard to be sympathetic to the non-compliant patient because they, more often than not, are more likely to sue than the compliant patient.

Its all fun and games until they realize, "Oh ****, I might die" and guess who they start to blame? YOU didn't *really* tell them how serious things were. YOU didn't force them to take their medication/have surgery/get the test etc.

 

[alpinism]

So I do my preceptorship at a community hospital with a hospitalist (not sure what the difference is between a hospitalist and an internist, but whatever). What she does is that she shows me a patient, and tells me about her diagnostic process and stuff. But afterwards, she explains to me how it's pointless to help the patient because he either has some chronic disease, or has a poor lifestyle, or is noncompliant, or whatever. She does this for every single patient.

I mean, her concerns probably have some basis in reality, but do most doctors have a glass half empty perspective similar to her's? How valid is such a perspective?

Nearly every older hospitalist i've worked with feels the same way.

Is she being pessimistic? Maybe.

But, in reality the vast majority of medicine patients fit perfectly into those categories.

It gets really frustrating really fast when you can't fix anything and most of your patients either don't care about their health or are too far gone to help.

 

[ruralsurg4now]

Nah. Deleted.

 

[evilbooyaa]

I see where the lines are drawn in opinion: MS1 and MS2 vs anyone who has been in the hospital for an extended period of time (M3 or above).

Anyone M3 or above knows that the hospitalist in the OP is pretty spot on. Because she only sees inpatients, she sees the worst of the worst. Generally patients are re-admitted because they exacerbate their chronic disease.

To answer OP's question: It's not rare. I imagine that anyone who has been a hospitalist for more than a year understands that they are only mildly delaying the inevitably for the majority of their patients. Some patients keep being re-admitted to the hospital b/c of non-compliance. Others are b/c they are too far in their disease process for regular living (even when compliant with drugs/diet/etc.) to not exacerbate their symptoms at some point. It's hard to tell the difference sometimes, b/c a patient who eats a cheeseburger and exacerbates their CHF won't necessarily tell you that they ate said cheeseburger.

 

[Instatewaiter]

Ehh, sounds like a personality glitch to me. As a doctor...nay, as a person, being non-judgmental and giving others the best available care is all that is demanded of a doctor. I find it a bit selfish when doctors start acting as if they are entitled to delivery and return on patient behavior. Like the personal satisfaction is owed to them. Sure, it's fantastic when things go well and you help someone...but for crying out loud, just do your job excellently and improve on what is in your power. That's it! If the diabetic neuropathy just keeps getting worse with each visit from a patient, feel empathy that this person clearly doesn't have it in his/her power to comply soundly and attempt to reach them...if it's not possible, then it's not. Next. I have a hard time relating to doctors who get emotionally ruffled about these things.

Look, I agree with you to some extent but this doctor's feelings are widely held. You'll realize after a few years that much of medicine is beyond your control. What is taught as an appropriate treatment doesnt work or is too hard to do and patients are noncompliant. You realize what is really treatable and it often comes off as jaded.

STEMI... I can treat that.

Non-compliant diabetes... well that will turn into a STEMI and at least I can treat that

 

[circulus vitios]

I see where the lines are drawn in opinion: MS1 and MS2 vs anyone who has been in the hospital for an extended period of time (M3 or above).

Or anyone that's dealt with the 'general public' in any capacity and understands how incorrigibly stupid most people are...

 

[boogaloo]

So I do my preceptorship at a community hospital with a hospitalist (not sure what the difference is between a hospitalist and an internist, but whatever). What she does is that she shows me a patient, and tells me about her diagnostic process and stuff. But afterwards, she explains to me how it's pointless to help the patient because he either has some chronic disease, or has a poor lifestyle, or is noncompliant, or whatever. She does this for every single patient.

I mean, her concerns probably have some basis in reality, but do most doctors have a glass half empty perspective similar to her's? How valid is such a perspective?

The overwhelming majority of hospitalists/internists I've worked with seem to share the same sentiment. My friend met one who smokes, and the guy warned him to never, ever, ever go into IM, no matter what. One of my preceptors also told me the same thing. I can see how it can be a miserable existence, and I can safely say I will never go into IM. Much respect to the guys/gals who will be.

 

[Anastomoses]

ruralsurg4now, post: 14793485, member: 572596"]What an odd view of medicine you have. You seem to think physicians just trundle around and write random stuff with no concern for whether anyone listens to them or does what they say and only desperately try not to "judge." Guess what? When physicians do that, they get burned out in under one year. You have a typically idealistic and unrealistic view of life held bybrainwashed medical students. But it's OK because you'll learn.[/quote]

What an odd view of medicine you have. You seem to think physicians just trundle around and write random stuff with no concern for whether anyone listens to them or does what they say and only desperately try not to "judge." Guess what? When physicians do that, they get burned out in under one year. You have a typically idealistic and unrealistic view of life held by brainwashed medical students. But it's OK because you'll learn.

y

Wrong. Nothing idealistic about my view. My view entails the simple fact that humans just are ****ty. And I've developed enough to accept that fact...some are genetically born ****ty and some evolve into ****ty. And that's fine. My job is to provide them the best. I would feel like less than if I ever did anything less than giving each patient their full information with less than a slightly admonishing smile. I doubt I'll change on that. We all have weaknesses. It's ridiculous for a doctor to get so arrogant about it except in the casebbelow in which there may be a penalty to the doctor for patient outcomes.

Its hard to be sympathetic to the non-compliant patient because they, more often than not, are more likely to sue than the compliant patient.

Its all fun and games until they realize, "Oh ****, I might die" and guess who they start to blame? YOU didn't *really* tell them how serious things were. YOU didn't force them to take their medication/have surgery/get the test etc.

Look, I agree with you to some extent but this doctor's feelings are widely held. You'll realize after a few years that much of medicine is beyond your control. What is taught as an appropriate treatment doesnt work or is too hard to do and patients are noncompliant. You realize what is really treatable and it often comes off as jaded.

STEMI... I can treat that.

Non-compliant diabetes... well that will turn into a STEMI and at least I can treat that

that's precisely my point. I don't feel bitter about human nature. I'd be more likely to give an enthusiastic good luck while full well knowing the patient has an impossible task ahead and give a grin when it comes in for exacerbating the disease. I mean...hello! it's not like they are doing it on purpose.

 

[ruralsurg4now]

Wrong. Nothing idealistic about my view. My view entails the simple fact that humans just are ******. And I've developed enough to accept that fact...some are genetically born ****** and some evolve into ******. And that's fine. My job is to provide them the best. I would feel like less than if I ever did anything less than giving each patient their full information with less than a slightly admonishing smile. I doubt I'll change on that. We all have weaknesses. It's ridiculous for a doctor to get so arrogant about it except in the casebbelow in which there may be a penalty to the doctor for patient outcomes.

I honestly have no idea what you just wrote there. What I think you're saying -- but I'm not sure -- is that you think that people who get tired of non-compliant patients are not "providing them the best." That's not necessarily true, although it of course could occur. But if it does, there's nothing to criticize about it since that's completely normal human behavior. In other words, if you're going to accept non-compliance as normal human behavior and try to be open-minded about it, then you're going to have to also accept the provider not caring any more about the patient and be open-minded about that. If you're just going to stand on a soap box and say otherwise, then I'll just remind everyone that you yourself turned your friend with lice into a monster and social pariah for the exact thing you're talking about and add "self-owned."

 

[FutureInternist]

Non-compliant diabetes... well that will turn into a STEMI and at least I can treat that

That's a good one
I'm going to use this from now on !!

 

[Mad Jack]

Ehh, sounds like a personality glitch to me. As a doctor...nay, as a person, being non-judgmental and giving others the best available care is all that is demanded of a doctor. I find it a bit selfish when doctors start acting as if they are entitled to delivery and return on patient behavior. Like the personal satisfaction is owed to them. Sure, it's fantastic when things go well and you help someone...but for crying out loud, just do your job excellently and improve on what is in your power. That's it! If the diabetic neuropathy just keeps getting worse with each visit from a patient, feel empathy that this person clearly doesn't have it in his/her power to comply soundly and attempt to reach them...if it's not possible, then it's not. Next. I have a hard time relating to doctors who get emotionally ruffled about these things.

Spend five years working at an inner city hospital, seeing the same people come in for the same things, week after week, and get back to me. You have to be superhuman to not sometimes be overwhelmed by the futility of it.

Patient: "I don't understand why I am feeling this way. I felt fine yesterday!"
Me: "Well, you and I have met a few times before, so just tell me straight. Did you smoke crack again this morning?"
Patient: "Yes. But I felt fine yesterday!"
Me: "And then you smoked crack. It's your biggest trigger. You should really quit or pick a new drug of choice or something before this kills you. Every time you come in, your exacerbations are worse."
Patient: "Okay. I'll try."

Two days after discharge, Ms. Crack is back. Same diagnosis, same trigger. For the 30th time this year. Wasting our Medicaid tax dollars. And I feel bad, I really do. Addiction is a powerful thing. But you just bash your head up against a wall sometimes.

And don't even get me started on the half dozen people that come in a couple times a year because they light their nasal cannulas on fire while smoking. Your smoking put you where you're at. It wrecked your lungs. It put you on oxygen. It made your sex life nonexistent. AND THEN IT LIT YOUR FACE ON FIRE. And yet, here we are again.

I can't even imagine how bad it is on the physician side of things if just the respiratory side is this frustrating. This is exactly why I want to go into a specialty with shortterm patient-provider relationships like anesthesia, rads, or EM.

 

[Anastomoses]

IWhat I think you're saying -- but I'm not sure -- is that you think that people who get tired of non-compliant patients are not "providing them the best." That's not necessarily true, although it of course could occur. But if it does, there's nothing to criticize about it since that's completely normal human behavior. In other words, if you're going to accept non-compliance as normal human behavior and try to be open-minded about it, then you're going to have to also accept the provider not caring any more about the patient and be open-minded about that. If you're just going to stand on a soap box and say otherwise, then I'll just remind everyone that you yourself turned your friend with lice into a monster and social pariah for the exact thing you're talking about and add "self-owned."

Are you on crack? There is absolutely no correlation between what I expect from a friend (not putting me an in injurious position) or from a patient (owes me nothing other than to pay their fee and behave politely) or what I believe is expected of a medical professional (absolute best in treatment of which the individual is capable). How did you mix all that up in your little brain?

A person with lice is not a criminal. A person with DM or HTN or HIV is not a criminal. If a person with a condition passes it along to others haphazardly (in the case of lice or HIV), that person is a social pariah. If you aren't good with logic, just abstain. And FYI: She and I are closer than ever. Maybe I do better than you'd expect.

 

[Anastomoses]

Spend five years working at an inner city hospital, seeing the same people come in for the same things, week after week, and get back to me. You have to be superhuman to not sometimes be overwhelmed by the futility of it.

Two days after discharge, Ms. Crack is back. Same diagnosis, same trigger. For the 30th time this year. Wasting our Medicaid tax dollars. And I feel bad, I really do. Addiction is a powerful thing. But you just bash your head up against a wall sometimes.

And don't even get me started on the half dozen people that come in a couple times a year because they light their nasal cannulas on fire while smoking. Your smoking put you where you're at. It wrecked your lungs. It put you on oxygen. It made your sex life nonexistent. AND THEN IT LIT YOUR FACE ON FIRE. And yet, here we are again.

I can't even imagine how bad it is on the physician side of things if just the respiratory side is this frustrating. This is exactly why I want to go into a specialty with shortterm patient-provider relationships like anesthesia, rads, or EM.

I will definitely try to get back to you on this.
1. I'm already fully aware this thing happens. I've been in a clinic now for a couple months in the evenings and every third patient has "non-compliant" in their computer notes.
2. I just don't feel exasperation or incredulity that people may find it nearly impossible to give up the things which lead to their demise (smoking, greasy foods, too lazy to implement exercise, sweets). Sorry if that's bizarre or phasing for some of you. I just don't even see it the same way and it's not that I'm a bleeding heart liberal. Human nature is what it is and you don't get to choose patient behavior. It's not like choosing friends or choosing a marriage partner.
3. I think many of us have some really poor things we do but aren't being judged for it because it doesn't have to be exposed to a medical professional. These people just need patience and at least fake warmth; they don't need tough love or frustration. We just aren't entitled to that from my perspective.

 

[ruralsurg4now]

Are you on crack? There is absolutely no correlation between what I expect from a friend (not putting me an in injurious position) or from a patient (owes me nothing other than to pay their fee and behave politely) or what I believe is expected of a medical professional (absolute best in treatment of which the individual is capable). How did you mix all that up in your little brain?

A person with lice is not a criminal. A person with DM or HTN or HIV is not a criminal. If a person with a condition passes it along to others haphazardly (in the case of lice or HIV), that person is a social pariah. If you aren't good with logic, just abstain. And FYI: She and I are closer than ever. Maybe I do better than you'd expect.

I like how you say a person with lice is not a criminal. I'm pretty sure everyone who read your thread about it believes you.

 

[circulus vitios]

Spend five years working at an inner city hospital, seeing the same people come in for the same things, week after week, and get back to me. You have to be superhuman to not sometimes be overwhelmed by the futility of it.

While shadowing, I heard a story about an obese diabetic who would eat six full size pies every Thanksgiving. It would **** him up to the point of being admitted to the hospital, every year.

I'm interested in EM/rads/gas for somewhat similar reasons. The stupidity wouldn't bother me, but I would like to avoid it.

 

[ruralsurg4now]

While shadowing, I heard a story about an obese diabetic who would eat six full size pies every Thanksgiving. It would **** him up to the point of being admitted to the hospital, every year.

See, they should just let him die the second time. I'm not joking, btw.

 

[Porfirio]

Spend five years working at an inner city hospital, seeing the same people come in for the same things, week after week, and get back to me. You have to be superhuman to not sometimes be overwhelmed by the futility of it.

Patient: "I don't understand why I am feeling this way. I felt fine yesterday!"
Me: "Well, you and I have met a few times before, so just tell me straight. Did you smoke crack again this morning?"
Patient: "Yes. But I felt fine yesterday!"
Me: "And then you smoked crack. It's your biggest trigger. You should really quit or pick a new drug of choice or something before this kills you. Every time you come in, your exacerbations are worse."
Patient: "Okay. I'll try."

Two days after discharge, Ms. Crack is back. Same diagnosis, same trigger. For the 30th time this year. Wasting our Medicaid tax dollars. And I feel bad, I really do. Addiction is a powerful thing. But you just bash your head up against a wall sometimes.

And don't even get me started on the half dozen people that come in a couple times a year because they light their nasal cannulas on fire while smoking. Your smoking put you where you're at. It wrecked your lungs. It put you on oxygen. It made your sex life nonexistent. AND THEN IT LIT YOUR FACE ON FIRE. And yet, here we are again.

I can't even imagine how bad it is on the physician side of things if just the respiratory side is this frustrating. This is exactly why I want to go into a specialty with shortterm patient-provider relationships like anesthesia, rads, or EM.

I read stories like these, and they just make me laugh. I love the crazy stories.

Ultimately, it is the patient that decides medical treatment. I am only there to provide advice, treatment, and a non-judgmental ear to listen to their stories. To have an expectation to "change" a patient is not realistic. Some people just want to smoke crack.

As for the waste of Medicaid tax dollars, that is a different issue and one that is not addressed by my actions/beliefs, but by society's actions/beliefs. If there are no resources to treat Ms. Crack Smoker then there is no treatment for Ms. Crack Smoker, but society dictates that - not me.

 

[michaelrack]

If there are no resources to treat Ms. Crack Smoker then there is no treatment for Ms. Crack Smoker, but society dictates that - not me.

I have a feeling that society is going to soon mandate treatment for Ms. Crack Smoker without providing resources- you are right about society doing the dictating

 

[Mad Jack]

I read stories like these, and they just make me laugh. I love the crazy stories.

Ultimately, it is the patient that decides medical treatment. I am only there to provide advice, treatment, and a non-judgmental ear to listen to their stories. To have an expectation to "change" a patient is not realistic. Some people just want to smoke crack.

As for the waste of Medicaid tax dollars, that is a different issue and one that is not addressed by my actions/beliefs, but by society's actions/beliefs. If there are no resources to treat Ms. Crack Smoker then there is no treatment for Ms. Crack Smoker, but society dictates that - not me.

I just wish that our patients recognized they were a part of society and that their care is not, in fact, free. We had a drunk that came in to the ED over 300 times one year. Even at 1k a visit, which is on the loooow side for an ambulance ride and a night in the ED, he cost the taxpayers 300k. For that amount of money, we could have put him up in a cheap apartment, provided him with Dubra and food, and let him drink himself to death for ten years, or put him up in top-notch rehab for a year straight. He would be happier. We would save money. But instead, we just burn money, to the benefit of no one.


It doesn't really get to me too much. But it can be frustrating. It's sort of like my commute. Yeah, it could be better. Sure it is frustrating some days. But it doesn't ruin my day, nor do I really dwell on it outside of the moment. It's just an irritating fact of life that you learn to live with.

 

[username456789]

I have a feeling that society is going to soon mandate treatment for Ms. Crack Smoker without providing resources- you are right about society doing the dictating

Precisely.

Society has a way of demanding unreasonable things from physicians, and then ensuring that all possible hurdles are set up between the physician and that goal. We're then met with incredulity (why can't us powerful doctors with our Brobdignagian paychecks figure out a way?) while they continue to snipe at our reimbursement and force us to do much much more with much much less.

 

[username456789]

I have a feeling that society is going to soon mandate treatment for Ms. Crack Smoker without providing resources- you are right about society doing the dictating

Precisely.

Society has a way of demanding unreasonable things from physicians, and then ensuring that all possible hurdles are set up between the physician and that goal. We're then met with incredulity (why can't us powerful doctors with our Brobdignagian paychecks figure out a way?) while they continue to snipe at our reimbursement and force us to do much much more with much much less.

 

[ruralsurg4now]

Ultimately, it is the patient that decides medical treatment. I am only there to provide advice, treatment, and a non-judgmental ear to listen to their stories. To have an expectation to "change" a patient is not realistic. Some people just want to smoke crack.

As for the waste of Medicaid tax dollars, that is a different issue and one that is not addressed by my actions/beliefs, but by society's actions/beliefs. If there are no resources to treat Ms. Crack Smoker then there is no treatment for Ms. Crack Smoker, but society dictates that - not me.

That's an inane way of thinking and the reason we're broke as a nation. You personally are like "hey, whatever, she shows up and I do whatevs and then she ignores me and I get paid." That would be fine if SHE was paying you for each visit, but she's not paying anything. She's spending, for example, my money and so are you.

Then you think you have that covered by expressing an indifferent "whatever society wants" statement followed by "I have nothing to do with that." Except that society is kept separated from it, too, which is why people vote the way they do. In other words, if voters were given bills and statements saying "you owe $35 as your part to pay for Ms. Crackhead's 50th ER visit this year, we expect payment within 60 days," they'd all rebel. Currently, nobody actually feels any impact at all because we just go into debt as much as we want. Therefore, you're free to vote for your "feeelings" and go "awwww, everyone deserves free healthcare, awwww." Similarly, that's why we have tax withholding, so most people don't realize how much they pay in taxes because they never see the money. If we forced people to, on April 15th, write a lump-sum check of $15,000 or even $100,000 or $3 million to the government, people would immediately rebel against liberalism.

 

[username456789]

I just wish that our patients recognized they were a part of society and that their care is not, in fact, free. We had a drunk that came in to the ED over 300 times one year. Even at 1k a visit, which is on the loooow side for an ambulance ride and a night in the ED, he cost the taxpayers 300k. For that amount of money, we could have put him up in a cheap apartment, provided him with Dubra and food, and let him drink himself to death for ten years, or put him up in top-notch rehab for a year straight. He would be happier. We would save money. But instead, we just burn money, to the benefit of no one.


It doesn't really get to me too much. But it can be frustrating. It's sort of like my commute. Yeah, it could be better. Sure it is frustrating some days. But it doesn't ruin my day, nor do I really dwell on it outside of the moment. It's just an irritating fact of life that you learn to live with.

Many patients do realize it's not free, they just realize it's also not them that has to foot the bill.

Even in my field, I get perfectly well-to-do patients on a daily basis who demand prescriptions for over the counter products (benzoyl peroxide wash, telfa nonstick bandages, hydroquinone) because "then I can stick it to my insurance company who will have to pay for it!"

 

[ruralsurg4now]

Many patients do realize it's not free, they just realize it's also not them that has to foot the bill.

Right. As long as someone is spending someone else's money, they're very comfortable. That's why I'm for "fee for service" medical care and a flat tax. But, of course, the majority of Americans have been conditioned to abhor that kind of intelligence, so we'll financially collapse soon.

 

[ruralsurg4now]

For that amount of money, we could have put him up in a cheap apartment, provided him with Dubra and food, and let him drink himself to death for ten years, or put him up in top-notch rehab for a year straight.

Or you could do something mind-blowing like ...not bring him to the hospital. OMG NO!! I'm all crying and need Kleenex now!!

 

[Mad Jack]

Many patients do realize it's not free, they just realize it's also not them that has to foot the bill.

Even in my field, I get perfectly well-to-do patients on a daily basis who demand prescriptions for over the counter products (benzoyl peroxide wash, telfa nonstick bandages, hydroquinone) because "then I can stick it to my insurance company who will have to pay for it!"

Yeah. I would say the attitude of entitlement is spread pretty evenly among the social classes. There are plenty of well off people that will throw an employee under the bus or file a lawsuit to keep or make a few bucks, because they don't care about who else has to pay, so long as they get theirs.

Right. As long as someone is spending someone else's money, they're very comfortable. That's why I'm for "fee for service" medical care and a flat tax. But, of course, the majority of Americans have been conditioned to abhor that kind of intelligence, so we'll financially collapse soon.

Trouble is, we used to send them to the police for public intoxication, but police can't tell the difference between a drunk, a diabetic in DKA, and a drunk diabetic in DKA, so they would end up with a lot of people dying under their care. The families would then sue the police departments for millions, so the taxpayer would still pay. There really isn't a good solution that doesn't involve *gasp* treating addiction as a medical condition rather than stigmatizing it, then providing people with treatment that reforms them into productive members of society that pay taxes instead of drain them. But, ya know, that'll never happen in bootstrappy 'murrica. Despite its proven effectiveness in several other countries.

People would rather piss away money to inefficency than look for a solution to the problem that does not conform to conventional social mores and values.

 

[ruralsurg4now]

Trouble is, we used to send them to the police for public intoxication, but police can't tell the difference between a drunk, a diabetic in DKA, and a drunk diabetic in DKA, so they would end up with a lot of people dying under their care.

First of all, that's silly. We didn't have thousands or even hundreds or probably even tens of people annually dying in police stations. We might have had "one." Also, people can generally differentiate between drunks and diabetics and, in fact, you are usually told on arrival that you're getting a guy who was drinking. If you're being honest, just say that you're uncomfortable letting that guy lay out on the street and then accept our current ******ed healthcare system that was developed to assuage such fears.

 

[Anastomoses]

That's an inane way of thinking and the reason we're broke as a nation. You personally are like "hey, whatever, she shows up and I do whatevs and then she ignores me and I get paid." That would be fine if SHE was paying you for each visit, but she's not paying anything. She's spending, for example, my money and so are you.

Then you think you have that covered by expressing an indifferent "whatever society wants" statement followed by "I have nothing to do with that." Except that society is kept separated from it, too, which is why people vote the way they do. In other words, if voters were given bills and statements saying "you owe $35 as your part to pay for Ms. Crackhead's 50th ER visit this year, we expect payment within 60 days," they'd all rebel. Currently, nobody actually feels any impact at all because we just go into debt as much as we want. Therefore, you're free to vote for your "feeelings" and go "awwww, everyone deserves free healthcare, awwww." Similarly, that's why we have tax withholding, so most people don't realize how much they pay in taxes because they never see the money. If we forced people to, on April 15th, write a lump-sum check of $15,000 or even $100,000 or $3 million to the government, people would immediately rebel against liberalism.

You really know how to lump things into a nonsense stew. The poster you're quoting made two clearly separate points.
Said 1. I will do my job well and as effectively as possible without growing frustrated by those I can't control; 2. Taxpayers/society needs to decide exactly how they want that done more effectively...I'm not in a position to affect that as I'm not the policymaker.

And yet you still have a gripe and begin accusing him of being the reason the nation is broke...and extrapolating all sorts of insane things. Are you familiar with the concept of "logical fallacies"...because you're one of the worst perpetrators I've seen not only on these forums but in years. You attempt to appeal to emotion, to probability, to vague forms of disambiguation. You commit one almost every time you post. http://en.wikipedia.org/wiki/List_of_fallacies

I'm the least bleeding heart liberal person I know. Don't confuse my (and the poster you quoted) unwillingness to get emotional over patient futility with an unwillingness to change policy and even allow repeat offenders to die outside the hospital door. Not that I'm suggesting that, as you do.

And no, I'm not one of the people who reported you - obnoxious as you are.

Many patients do realize it's not free, they just realize it's also not them that has to foot the bill.

Even in my field, I get perfectly well-to-do patients on a daily basis who demand prescriptions for over the counter products (benzoyl peroxide wash, telfa nonstick bandages, hydroquinone) because "then I can stick it to my insurance company who will have to pay for it!"

What you're now talking about is policy, is it not? That we/the geniuses in Washington haven't been able to create a proper incentive program that discourages abuse and motivates fiscal responsibility.

 

[ruralsurg4now]

You really know how to lump things into a nonsense stew. The poster you're quoting made two clearly separate points.
Said 1. I will do my job well and as effectively as possible without growing frustrated by those I can't control; 2. Taxpayers/society needs to decide exactly how they want that done more effectively...I'm not in a position to affect that as I'm not the policymaker.

That's right because he also doesn't care that he's spending someone else's money. And neither do you, Lice Head.

 

[ruralsurg4now]

I like how everyone is like "I'm not liberal but ..." and then proceeds to throw up liberalism like "we can't tell who is using drugs (if they're poor) without utilizing mass spectroscopy" or "even if someone ignores your advice, it is your duty to be enthusiastic and caring for them."

 

[Anastomoses]

That's right because he also doesn't care that he's spending someone else's money. And neither do you, Lice Head.

I like how everyone is like "I'm not liberal but ..." and then proceeds to throw up liberalism like "we can't tell who is using drugs (if they're poor) without utilizing mass spectroscopy" or "even if someone ignores your advice, it is your duty to be enthusiastic and caring for them."

Your talk suggests you're dangerous. They need to put a camera on you.

 

[ruralsurg4now]

Your talk suggests you're dangerous. They need to put a camera on you.

I'm sure they'll do that right after they check your hair for eggs.

 

[Anastomoses]

Not only am I lice-free but so is she after apparently suffering for over a year with it and thanking me. My indignation has made her more cautious with the health of others. Swallow that.

 

[ruralsurg4now]

Not only am I lice-free but so is she after apparently suffering for over a year with it and thanking me. Swallow that.

She thanked you? Someone should show her what you wrote about her. That would be hilarious.

 

[ruralsurg4now]

By the way, you see how this works again. Just like with voter ID or urine drug screens, any time we DON'T want a liberal idea, it is set up as "OK, but then you have to satisfy my ridiculous demands first." Like, OK, you can have voter ID as long as you agree to spend billions driving equipment door-to-door for every house, shack, apartment, or illegal alien hideout in America. OMG! Or we could just make it a law that you need it to vote! Wow, that was easy!

Here, it's like "well, you may not like treating drunks repeatedly, but you MUST because what if they're drunk AND in DKA? Or drunk AND have had a CVA? Or drunk AND have a ruptured AAA?" OMG! You're right! Get that drunk guy in here and start doing the non-contrast head CT!!! And repeat every time he's drunk. Wouldn't want to assume, right? Or you could just go "he's drunk? OK, leave him in the alleyway. At some point he'll figure it out. Or not."

 

[Mad Jack]

First of all, that's silly. We didn't have thousands or even hundreds or probably even tens of people annually dying in police stations. We might have had "one." Also, people can generally differentiate between drunks and diabetics and, in fact, you are usually told on arrival that you're getting a guy who was drinking. If you're being honest, just say that you're uncomfortable letting that guy lay out on the street and then accept our current ******ed healthcare system that was developed to assuage such fears.

In my state, in the 90s, there were mutliple medical deaths and emergencies (diabetic comas, etc) every year. It led to large legislative efforts that resulted in the law as it exists today. Or so the ED attendings told me when I asked why the hell this cluster**** exists because I was sick of watching drunks every day instead of doing something useful like working in the trauma room. The police get a guy that is altered, they assume they are drunk or on drugs. Take it from a guy with epilepsy that they didn't exactly know how to handle in my postictal state. They thought I was on PCP lol. If you think the police know what to do when someone isn't in a conventional frame of mind, you clearly know little about how they operate.

Here's just a few cases of police thinking someone with AMS is drunk/high, most of them diabetes because it's relevant, but one is a stroke because that case was particularly awful:

http://translate.google.com/transla...a-carcel-portena-141543.html&biw=1350&bih=908
http://www.tampabay.com/news/courts...ke-results-in-1-million-settlement-by/2130278
http://www.dailymail.co.uk/news/art...rested-locked-cells-police-thought-drunk.html
http://www.courthousenews.com/2011/09/07/39601.htm
http://www.nj.com/news/index.ssf/2012/10/nj_state_police_diabetes_train.html
http://www.dailymail.co.uk/news/art...tml?ITO=1490&ns_mchannel=rss&ns_campaign=1490


Even if they KNOW you have diabetes you will often not get proper care:

http://www.texasmonthly.com/daily-p...f-didnt-give-her-insulin-they-knew-she-needed
http://www.cbsatlanta.com/story/24255514/family-of-diabetic-man-who-died-in-jail-wants-answers

The police are completely incompetent when it comes to medicine and medical care. They are out to arrest anyone who is "difficult" or resists them at all in any way. The public is the enemy, rather than the body that they were sworn to protect. They exist to enforce the legal framework of this country, regardless of whether what passes for law is just. To believe otherwise is completely foolish, and shows that you have not personally, nor known through proxy, the often wonderfully incompetent people that operate on the front lines of the criminal "justice" system. This isn't to say they are all bad, but a great number of them are.

Leaving a person to die on the streets is not how a society should function. It would be far better for us, as a society, to rehabilitate whomever we can, and would be far less expensive than most of the alternatives available that don't involve having safety nets akin to a third world country. You also neglect that when you leave people like this in the streets with zero social support or safety nets, they often turn to desperate measures in order to stay alive, thus causing harm to society as a whole. Look to any number of South American countries for examples of what happens when society does nothing and provides no assistance to deal with its population of homeless, alcoholics, and drug addicts.

 

[ruralsurg4now]

Leaving a person to die on the streets is not how a society should function. It would be far better for us, as a society, to rehabilitate whomever we can, and would be far less expensive than most of the alternatives available that don't involve having safety nets akin to a third world country. You also neglect that when you leave people like this in the streets with zero social support or safety nets, they often turn to desperate measures in order to stay alive, thus causing harm to society as a whole. Look to any number of South American countries for examples of what happens when society does nothing and provides no assistance to deal with its population of homeless, alcoholics, and drug addicts.

Or look to any number of South American countries with permissive attitudes towards alcoholism and drug use for examples of what happens.

It's like I said, your problem is not that we're spending all this money, you just dislike that it's being spent in a way different than how YOU'D spend it. And let me guess, "but I'm not liberal," right?

 

[ruralsurg4now]

The argument for liberalism is always "that not how a society should function." That's the justification for welfare, food stamps, subsidized housing, healthcare, unemployment benefits, pensions, and so on. Wow, you have to earn money or be poor? Not in my America!! If you get drunk you might die after aspirating on your own vomit? No, sir, I will make it safe for you to repeatedly get drunk! That's the America I live in! Now pay up, I need some money for my asinine plans.

Oh, bonus points for his discussion on how the police are the enemy of the people. Why can't they just leave us alone to get high?? Fight the police!

 

[Mad Jack]

Or look to any number of South American countries with permissive attitudes towards alcoholism and drug use for examples of what happens.

It's like I said, your problem is not that we're spending all this money, you just dislike that it's being spent in a way different than how YOU'D spend it. And let me guess, "but I'm not liberal," right?

Permissive? Their criminal penalties are as stiff or moreso than ours.

My problem is that we are spending too much money, and in the wrong places. I'm a utilitarian, I don't believe in left or right. I believe in doing what is best for the greatest number of people in the most efficient way possible. Letting people suffer in the streets is not a good solution, as they turn to desperate measures and lower the quality of life in society as a whole. Spending insane amounts of money providing futile treatment is inneficient, and does nothing to improve overall societal well being. We should spend the least money possible to obtain the best outcomes available for our homeless, mentally ill, and addicted populations. You are a typical "I've got mine, **** all the rest" guy who has it made and doesn't give a damn for anyone else. Individualism and capitalism taken to an extreme such as that is a vice.

Just one or two lawsuits for inappropriate care under police custody can completely devastate a city budget. That's another side of things. Even if only one person dies from poor care in police custody, that is 1) an innocent life lost, and 2) a city budget that is short seven figures for the next operating year, which is enough to pay the salaries and benefits of 15 officers. The responsibility fell on hospitals because city governments in my state didn't want to keep playing Russian roulette every time the police brought in a patient with AMS.

 

[ruralsurg4now]

Permissive? Their criminal penalties are as stiff or moreso than ours.

Yeah, that's why people go down to Mexico and Brazil to party. Because they're so harsh. Now we're hitting the depths of silliness in argumentation.

I'm a utilitarian, I don't believe in left or right. I believe in doing what is best for the greatest number of people in the most efficient way possible.

Good, as a utilitarian, you should ignore drunks and drug-users. That saves money. And they will likely die, which also saves money. And if they attack the innocent, we can shoot them, which also saves money. It's also efficient.

 

[ruralsurg4now]

See, the problem is you are NOT a utilitarian. You're a utilitarian with bleeding heart requirements. In other words, you say "I demand drunks be taken care of ...so with that in mind, NOW I'm a utilitarian." That's not being a utilitarian, that's being a liberal.