Patients

[goodpatients]

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PGY2 here in a surg specialty. I came into medicine thinking I loved patient contact and surgery. Both of those dwindled during rotations, and even more in residency. Outright bored of being in the OR now, and not just the really uninteresting stuff like hip, but everything else too.

I still love patient contact, my issue is with the patients themselves. Most of the patients are one of the following: alcoholics, rude, excessively overweight etc. I don't have anything against those traits personally, but maybe 10% of patients are nice to work with. After residency, is there any way to control the type of patients I work in by the area? Like if I live in an area with high cost of living, or an area without medicare/uninsured patients, will it get better?

And does surgery get better, or do I just learn to keep working without worrying about if it is boring?

 

[Apollyon]

I'm guessing you're ortho. Ipso facto, much of your work comes from trauma. Much trauma is secondary to alcoholics, rude, excessively overweight, etc. People are people, and people suck.

And the "noble poor" are fading away, being replaced by the "entitled poor". And rich folks will lie right to your face, without shame.

 

[goodpatients]

I'm guessing you're ortho. Ipso facto, much of your work comes from trauma. Much trauma is secondary to alcoholics, rude, excessively overweight, etc. People are people, and people suck.

And the "noble poor" are fading away, being replaced by the "entitled poor". And rich folks will lie right to your face, without shame.

While I'm sure rich folks can be rude too, my observation is that the 10% of good patients I have aren't alcoholic, overweight or "poor" (sorry for generalizing), so I was hoping that can be fixed by changing location. Could've been fixed by going into peds too.

 

[DokterMom]

I'm guessing you're ortho. Ipso facto, much of your work comes from trauma. Much trauma is secondary to alcoholics, rude, excessively overweight, etc. People are people, and people suck.

And the "noble poor" are fading away, being replaced by the "entitled poor". And rich folks will lie right to your face, without shame.

No research to back this up -- just gut instinct. But it seems to me that the poor are scorned now more than they were in the past (back when they were "noble") and that this results in a level of preemptive defensiveness that comes across as "entitlement". I guess maybe they do feel entitled to being treated with a basic level of respect and human dignity -- so "entitled"?

 

[doc05]

Are you at a university program in a big city? The northeast?

 

[rokshana]

While I'm sure rich folks can be rude too, my observation is that the 10% of good patients I have aren't alcoholic, overweight or "poor" (sorry for generalizing), so I was hoping that can be fixed by changing location. Could've been fixed by going into peds too.

so do peds ortho.

 

[Apollyon]

No research to back this up -- just gut instinct. But it seems to me that the poor are scorned now more than they were in the past (back when they were "noble") and that this results in a level of preemptive defensiveness that comes across as "entitlement". I guess maybe they do feel entitled to being treated with a basic level of respect and human dignity -- so "entitled"?

The entitlement extends beyond neutral - expecting more than others. Moreover, the respect to which you refer, they do not display.

I am EM, and I see this a lot.

 

[Psai]

Welcome to medicine!

Today we saved a patient from coding. The family didn't see it and probably didn't know but they kept thanking us for taking care of the patient both when they came in and when they left. These moments are surprisingly rare but so nice when it happens.

But now that we know his family is nice, his prognosis is very poor.

 

[LucidSplash]

so do peds ortho.

Yeah but then he has a career where 90% is just trying to make kids sit in wheelchairs more comfortably (hyperbole intended for comedic effect but also grain of truth).

 

[greenleaves]

I'm guessing you're ortho. Ipso facto, much of your work comes from trauma. Much trauma is secondary to alcoholics, rude, excessively overweight, etc. People are people, and people suck.

And the "noble poor" are fading away, being replaced by the "entitled poor". And rich folks will lie right to your face, without shame.

What a concept! If you suffer passively in silence and treat your physician like a god, you're "noble". If you expect a little dignity and express interest in your care, you're "entitled"?

 

[Apollyon]

What a concept! If you suffer passively in silence and treat your physician like a god, you're "noble". If you expect a little dignity and express interest in your care, you're "entitled"?

You don't sound like you've been out in the real world.

The "noble poor" are people that only have their pride, and would rather suffer than stand the indignity of a handout. They do not take anything from anyone, but earn everything they have.

The "entitled" are those that get something for nothing, without any humility or gratitude, and complain about what they are getting, no strings attached.

Anything worth having is worth working for. If someone had their hand out, and there isn't a shovel or broom in that hand, but only an expectation of someone putting something of value in that hand, due to no effort, the person who IS holding the broom or the shovel (and I've been that person) is going to be disaffected.

And, finally, you get what you give. To expect dignity, without showing the same, is illogical.

 

[smq123]

PGY2 here in a surg specialty. I came into medicine thinking I loved patient contact and surgery. Both of those dwindled during rotations, and even more in residency. Outright bored of being in the OR now, and not just the really uninteresting stuff like hip, but everything else too.

I still love patient contact, my issue is with the patients themselves. Most of the patients are one of the following: alcoholics, rude, excessively overweight etc. I don't have anything against those traits personally, but maybe 10% of patients are nice to work with. After residency, is there any way to control the type of patients I work in by the area? Like if I live in an area with high cost of living, or an area without medicare/uninsured patients, will it get better?

And does it get better, or do I just learn to keep working without worrying about if it is boring?

I did residency in a fairly ritzy part of town (we saw mostly the Medicaid population - i.e. the janitors and waitresses who served the ritzy part of town). But a few of those wealthy patients did make their way to the clinic.

They were nice as long as they got what they wanted. If you dared to disagree with them - tell them that antibiotics weren't necessary, or that they don't need Percocet for their sprained knee, or that their testosterone actually is normal - that's when the fangs came out. Before that, I had never heard of someone calling a lawyer because they didn't get the antibiotic that they wanted for their viral URI.

Some people are just jerks.

 

[Carbocation1]

Switch to Anesthesia.

 

[VA Hopeful Dr]

I did residency in a fairly ritzy part of town (we saw mostly the Medicaid population - i.e. the janitors and waitresses who served the ritzy part of town). But a few of those wealthy patients did make their way to the clinic.

They were nice as long as they got what they wanted. If you dared to disagree with them - tell them that antibiotics weren't necessary, or that they don't need Percocet for their sprained knee, or that their testosterone actually is normal - that's when the fangs came out. Before that, I had never heard of someone calling a lawyer because they didn't get the antibiotic that they wanted for their viral URI.

Some people are just jerks.

I've found that blue collar workers are the best patients. They get that you have an area of knowledge (probably because they're similar - plumbers, electricians, stuff like that) and give advice based on that.

 

[Apollyon]

I've found that blue collar workers are the best patients. They get that you have an area of knowledge (probably because they're similar - plumbers, electricians, stuff like that) and give advice based on that.

Yeah, when someone is in building trades, I can put things into terms they get, such as with Ohm's law; the electricians understand circulation.

 

[smq123]

This discussion is making me think about the two patients I had a few months ago. Two separate women, both had similar cancers.

One patient was fairly well off. Not "rich," but had private insurance and had the means and education to get cancer treatments. The other came to this country as a refugee - no money, no resources.

The first patient whined about everything. The surgery hurt. The radiation burned her skin - "they enjoyed torturing me." Chemo was "terrible, worse than cancer." She went to three different oncologists because she refused to truly believe that she would need chemo. She burst out crying because she lost her hair.

The second patient was clear that whatever treatment she could get, she would take. It didn't matter if she spent ten years making a payment plan, it didn't matter how painful the treatment was - she said that her only goal was to live. She has a husband and two children and the only thing that she wanted was to live.

You take the wins when you find them. There's no way of getting a guaranteed panel of happy, grateful, pleasant patients. You take them when you find them.

 

[Saddleshoes]

PGY2 here in a surg specialty. I came into medicine thinking I loved patient contact and surgery. Both of those dwindled during rotations, and even more in residency. Outright bored of being in the OR now, and not just the really uninteresting stuff like hip, but everything else too.

I still love patient contact, my issue is with the patients themselves. Most of the patients are one of the following: alcoholics, rude, excessively overweight etc. I don't have anything against those traits personally, but maybe 10% of patients are nice to work with. After residency, is there any way to control the type of patients I work in by the area? Like if I live in an area with high cost of living, or an area without medicare/uninsured patients, will it get better?

And does surgery get better, or do I just learn to keep working without worrying about if it is boring?

I think you are having a normal evaluation as a surgical specialist.
1. If the OR is a bore, congratulations! That means you are mastering your profession.
2. As we move deeper into our careers many of us find the "hands on" portion of the work to be boring and repetitive. But the "people interaction" part of the work becomes more and more fun.

 

[Ironheme]

This discussion is making me think about the two patients I had a few months ago. Two separate women, both had similar cancers.

One patient was fairly well off. Not "rich," but had private insurance and had the means and education to get cancer treatments. The other came to this country as a refugee - no money, no resources.

The first patient whined about everything. The surgery hurt. The radiation burned her skin - "they enjoyed torturing me". Chemo was "terrible, worse than cancer." She went to three different oncologists because she refused to truly believe that she would need chemo. She burst out crying because she lost her hair.

The second patient was clear that whatever treatment she could get, she would take. It didn't matter if she spent ten years making a payment plan, it didn't matter how painful the treatment was - she said that her only goal was to live. She has a husband and two children and the only thing that she wanted was to live.

What was their outcomes?

 

[doc05]

Another thought --

If you are bored in the O.R., and you also don't like the patients, then what else is left?

Maybe you should switch specialties. As a pgy2, it's early enough that you don't have much to lose. Think about it.

 

[ThoracicGuy]

I think you are having a normal evaluation as a surgical specialist.
1. If the OR is a bore, congratulations! That means you are mastering your profession.
2. As we move deeper into our careers many of us find the "hands on" portion of the work to be boring and repetitive. But the "people interaction" part of the work becomes more and more fun. .

A PGY 2 is not mastering anything...

 

[smq123]

What was their outcomes?

It's too soon to tell for sure, but I am hopeful that they'll both be fine. The second patient managed to qualify for charity care at one of the local teaching hospitals - they had initially turned her away, but somehow, when she applied again, they took her as a patient. I was really happy for her; it's never good to hear a patient tell you, "I'm going to die, aren't I?," no matter how true it is. To her credit, she was never histrionic or melodramatic, just very aware that she was going to die in a couple of years if she didn't get help.

The first patient did fine through surgery and radiation. She kept trying to negotiate with her oncologist to stop chemo early because "it's too many chemicals" and "such a long course of chemo can't possibly be necessary." 🙄

 

[anonperson]

PGY2 here in a surg specialty. I came into medicine thinking I loved patient contact and surgery. Both of those dwindled during rotations, and even more in residency. Outright bored of being in the OR now, and not just the really uninteresting stuff like hip, but everything else too.

I still love patient contact, my issue is with the patients themselves. Most of the patients are one of the following: alcoholics, rude, excessively overweight etc. I don't have anything against those traits personally, but maybe 10% of patients are nice to work with. After residency, is there any way to control the type of patients I work in by the area? Like if I live in an area with high cost of living, or an area without medicare/uninsured patients, will it get better?

And does surgery get better, or do I just learn to keep working without worrying about if it is boring?

This is typical.
As far as being overweight, 30%-40% of the country is obese. It's only getting worse so get used to it.

Area/payor mix is huge in terms of the types of patients you will see. This is obvious. Go see what types of patients run through your typical county hospital in the inner city and what type go through your local private hospital with the fountains and fancy lobby.

If you want to control what type of patients you will see, you could probably be super selective on the types of insurances you take. The higher end ones tend to have patients who are richer and usually richer people are thinner. But people with money come with their own host of problems, like being extremely demanding and having unrealistic expectations. Some of them are not very nice either. You could also offer services for cash only. All of these things will limit your income and may not be feasible though.

But why is surgery boring for you? Obviously you had exposure to the field you are matched in during medical school so you could match. Is it the procedure itself or are you just not doing a lot in cases other than retracting?

Also, when out in practice, unless you're on call and have to do something urgently/emergent, you don't have to electively operate on anyone. I've told a handful of patients "I don't think I am the doctor who will be able to care for you effectively. I will be more than happy to continue your care for the next month while you search for a new physician."

 

[greenleaves]

You don't sound like you've been out in the real world.

The "noble poor" are people that only have their pride, and would rather suffer than stand the indignity of a handout. They do not take anything from anyone, but earn everything they have.

The "entitled" are those that get something for nothing, without any humility or gratitude, and complain about what they are getting, no strings attached.

Anything worth having is worth working for. If someone had their hand out, and there isn't a shovel or broom in that hand, but only an expectation of someone putting something of value in that hand, due to no effort, the person who IS holding the broom or the shovel (and I've been that person) is going to be disaffected.

And, finally, you get what you give. To expect dignity, without showing the same, is illogical.

"Earn everything they have", you must have been watching a little too many movies with the tired old tropes from the 60s and 70s. It is these so called "noble poor" that you describe that allow the middle and lower classes to be repeatedly be stepped upon and shafted with every successive tax break. "They do not take anything from anyone, but earn everything they have." What is this even supposed to imply? It is noble to ignore life threatening signs of illness because you can't afford health insurance and are too ashamed to seek benefits? No thank you, I'd prefer to be entitled and alive rather than dying an ignominious death.

While I can understand the problem you have with the "entitled", grouping the lower class into two black and white groups isn't the way to go. It reeks of an entitled elitist attitude to begin with.

"The "entitled" are those that get something for nothing, without any humility or gratitude, and complain about what they are getting, no strings attached." By your assessment the medicaid patients should take the treatment they get and shut up about it because it's not their place to complain about the care they are receiving. And what do you mean something for nothing? I'm sure while it's nothing from their pockets, someone somewhere (most likely you and I) are paying for that care.

"Anything worth having is worth working for. If someone had their hand out, and there isn't a shovel or broom in that hand, but only an expectation of someone putting something of value in that hand, due to no effort, the person who IS holding the broom or the shovel (and I've been that person) is going to be disaffected." This could word for word be something out of Bill O'Reilly's mouth.

You get paid to see your patient, whether their subpar insurance reimburses you enough or not is another matter. Provide the minimum standard of care and move on. Enough complaining about not getting a handout of easy and nice patients, which is basically what you and OP are doing.

 

[deleted245139]

"Earn everything they have", you must have been watching a little too many movies with the tired old tropes from the 60s and 70s. It is these so called "noble poor" that you describe that allow the middle and lower classes to be repeatedly be stepped upon and shafted with every successive tax break. "They do not take anything from anyone, but earn everything they have." What is this even supposed to imply? It is noble to ignore life threatening signs of illness because you can't afford health insurance and are too ashamed to seek benefits? No thank you, I'd prefer to be entitled and alive rather than dying an ignominious death.

While I can understand the problem you have with the "entitled", grouping the lower class into two black and white groups isn't the way to go. It reeks of an entitled elitist attitude to begin with.

"The "entitled" are those that get something for nothing, without any humility or gratitude, and complain about what they are getting, no strings attached." By your assessment the medicaid patients should take the treatment they get and shut up about it because it's not their place to complain about the care they are receiving. And what do you mean something for nothing? I'm sure while it's nothing from their pockets, someone somewhere (most likely you and I) are paying for that care.

"Anything worth having is worth working for. If someone had their hand out, and there isn't a shovel or broom in that hand, but only an expectation of someone putting something of value in that hand, due to no effort, the person who IS holding the broom or the shovel (and I've been that person) is going to be disaffected." This could word for word be something out of Bill O'Reilly's mouth.

You get paid to see your patient, whether their subpar insurance reimburses you enough or not is another matter. Provide the minimum standard of care and move on. Enough complaining about not getting a handout of easy and nice patients, which is basically what you and OP are doing.

Not disagreeing with the gist of your post, but I think the point is that the sense of entitlement in an emergency dept (apollyon and my wheelhouse), and medicine at large, is that it drains time and resources to bend to that. That affects care of others. People who are more agreeable during the course of care are likely to allow the care to happen. You speak of 'minimum standard and move on'... Yep. People get that. Then they get pissed you don't have ham, and only have turkey.
Everyone deserves and should get adequate care... It becomes a excessive when a patient pokes their head into a room with a cardiac arrest and gets pissy that you forgot their 12th packet of Graham crackers.

 

[greenleaves]

Not disagreeing with the gist of your post, but I think the point is that the sense of entitlement in an emergency dept (apollyon and my wheelhouse), and medicine at large, is that it drains time and resources to bend to that. That affects care of others. People who are more agreeable during the course of care are likely to allow the care to happen. You speak of 'minimum standard and move on'... Yep. People get that. Then they get pissed you don't have ham, and only have turkey.
Everyone deserves and should get adequate care... It becomes a excessive when a patient pokes their head into a room with a cardiac arrest and gets pissy that you forgot their 12th packet of Graham crackers.

I am in agreement with what you're saying. Unfortunately I have not had enough exposure to know that such patients are the norm and not the exception. I don't think I'm pragmatic enough to deal with such patients, it's going to be a few painful years of residency to start adjusting!

 

[DrSnips]

Going peds surg will not solve your problem, as you'll still have to deal with irate parents--I believe this is even worse than dealing with disagreeable patients.

 

[Apollyon]

"Earn everything they have", you must have been watching a little too many movies with the tired old tropes from the 60s and 70s. It is these so called "noble poor" that you describe that allow the middle and lower classes to be repeatedly be stepped upon and shafted with every successive tax break. "They do not take anything from anyone, but earn everything they have." What is this even supposed to imply? It is noble to ignore life threatening signs of illness because you can't afford health insurance and are too ashamed to seek benefits? No thank you, I'd prefer to be entitled and alive rather than dying an ignominious death.

While I can understand the problem you have with the "entitled", grouping the lower class into two black and white groups isn't the way to go. It reeks of an entitled elitist attitude to begin with.

"The "entitled" are those that get something for nothing, without any humility or gratitude, and complain about what they are getting, no strings attached." By your assessment the medicaid patients should take the treatment they get and shut up about it because it's not their place to complain about the care they are receiving. And what do you mean something for nothing? I'm sure while it's nothing from their pockets, someone somewhere (most likely you and I) are paying for that care.

"Anything worth having is worth working for. If someone had their hand out, and there isn't a shovel or broom in that hand, but only an expectation of someone putting something of value in that hand, due to no effort, the person who IS holding the broom or the shovel (and I've been that person) is going to be disaffected." This could word for word be something out of Bill O'Reilly's mouth.

You get paid to see your patient, whether their subpar insurance reimburses you enough or not is another matter. Provide the minimum standard of care and move on. Enough complaining about not getting a handout of easy and nice patients, which is basically what you and OP are doing.

You still sound like you haven't been out in the real world. You really make a huge jump from people not taking a handout to ignoring "life threatening signs of illness" and "dying an ignominious death". When I was in South Carolina, I saw a patient that had had CABG x2 (second was a redo) to the tune of $170K. This guy was paying $100/month to pay it back. Of course, he never will. However, he is making a good faith effort, and he got well beyond "the minimum standard of care".

The noble poor to whom I refer are, prototypically, black farmers in northern Mississippi and Alabama. However, people like them are all over this country, but, as I say, dwindling. You, again, belie your lack of real world experience. You see the noble Medicaid patient "take their treatment and shut up because it's not their place to complain about the care they are receiving". Yet, you haven't seen rampant Medicaid abuse. Someone who says, "I'm hungry. Oh, that's not enough? I have chest pain and I'm hungry" burns goodwill quickly. They don't get "the minimum standard of care"; they get well and above. You are painting me with your preconceived notions of poor people not having a malicious or lazy bone in their bodies; you seem to believe that there is no internal reason, but it is all the "bourgeois white man" keeping these people down. It's more nuanced than that, but it is your reckoning that I divide the working class into black and white groups. That is you, splitting. I say that it is morphing from one to the other, which is not black and white, but shades of grey.

My elitist attitude would be me to say, "let them eat cake". I am not. I can't believe you rail against people working. And, you know what? I have never seen Bill O'Reilly on any show (but you seem to have), and I don't even know what network he is on. But you, again, belie your sentiments by bringing that up.

And, finally, "something for nothing" is the individual. It is disingenuous to say that "someone, somewhere" are paying for that care. Of COURSE, someone is, but it isn't that person who is making use of the system that gives them "something for nothing". When I worked in Hawai'i, the Medicaid program was called "Quest", and they required all insurers to provide a percentage of their subscribers to be the Medicaid population. People that got "Kaiser Quest" hit the jackpot. I couldn't afford Kaiser, and I was a doctor, and these folks got it for free.

So, before you vilify me, get a "work callus" (experience) and see who is following your treatment plan, and who isn't. When I tell you that your problem needs to see a specialist, and I make that appointment for you, and you blow it off, and you get worse, how is that my fault?

 

[Apollyon]

Going peds surg will not solve your problem, as you'll still have to deal with irate parents--I believe this is even worse than dealing with disagreeable patients.

Worst part of peds? The parents. Worst part of being a vet? The pet owners.

 

[greenleaves]

You still sound like you haven't been out in the real world. You really make a huge jump from people not taking a handout to ignoring "life threatening signs of illness" and "dying an ignominious death". When I was in South Carolina, I saw a patient that had had CABG x2 (second was a redo) to the tune of $170K. This guy was paying $100/month to pay it back. Of course, he never will. However, he is making a good faith effort, and he got well beyond "the minimum standard of care".

The noble poor to whom I refer are, prototypically, black farmers in northern Mississippi and Alabama. However, people like them are all over this country, but, as I say, dwindling. You, again, belie your lack of real world experience. You see the noble Medicaid patient "take their treatment and shut up because it's not their place to complain about the care they are receiving". Yet, you haven't seen rampant Medicaid abuse. Someone who says, "I'm hungry. Oh, that's not enough? I have chest pain and I'm hungry" burns goodwill quickly. They don't get "the minimum standard of care"; they get well and above. You are painting me with your preconceived notions of poor people not having a malicious or lazy bone in their bodies; you seem to believe that there is no internal reason, but it is all the "bourgeois white man" keeping these people down. It's more nuanced than that, but it is your reckoning that I divide the working class into black and white groups. That is you, splitting. I say that it is morphing from one to the other, which is not black and white, but shades of grey.

My elitist attitude would be me to say, "let them eat cake". I am not. I can't believe you rail against people working. And, you know what? I have never seen Bill O'Reilly on any show (but you seem to have), and I don't even know what network he is on. But you, again, belie your sentiments by bringing that up.

And, finally, "something for nothing" is the individual. It is disingenuous to say that "someone, somewhere" are paying for that care. Of COURSE, someone is, but it isn't that person who is making use of the system that gives them "something for nothing". When I worked in Hawai'i, the Medicaid program was called "Quest", and they required all insurers to provide a percentage of their subscribers to be the Medicaid population. People that got "Kaiser Quest" hit the jackpot. I couldn't afford Kaiser, and I was a doctor, and these folks got it for free.

So, before you vilify me, get a "work callus" (experience) and see who is following your treatment plan, and who isn't. When I tell you that your problem needs to see a specialist, and I make that appointment for you, and you blow it off, and you get worse, how is that my fault?

It isn't your fault if someone blows off appointments you made for them. That's what lawyers are for.

I'm sure there are both the types of patients coming to the ER but I'm struggling with believing that majority of them are trying to abuse medicaid. I've seen more instances of unethical billing in Home Health Agencies than from patients themselves. There is rampant Medicare abuse because the system allows for it. It's not the physician's fault but squaring all blame on the patient who has been conditioned to push particular buttons to get attention they want isn't 100% on them. There are undeserving entitled patients but the solution isn't to avoid them or keep treating them as they wish. The change needs to be institutional and much more wide reaching than any one sector of healthcare.

An elitist attitude is one, which says handouts are undeserved and vastly unneeded. It's the attitude, which questions why people don't get jobs while assuming the main cause as laziness. It is basically saying let them eat cake while knowing there is no cake.I don't rail against people able bodied people working, I'm just shocked how much empathy one can lose after working as a physician. I know of Bill O'Reilly because of my family, he's a geriatric fart who makes the idiotic argument that handouts are evil and prevent people from working hard.

As for the Kaiser Quest jackpot you mentioned, I think it's fair. What entitles you to receive Kaiser more so than these medicaid abusers? They got it for free, so what? Did they consider it their birthright after they got it?

I sure have a lot of growing to do but I hope I'll feel empathy and understanding for my patients even if they don't deserve it. I see that you are disillusioned by the things you've witnessed. Maybe you had different views and just got beat down by the constant medicaid abusers and people taking advantage of the system. But instead of lamenting on the dwindling noble poor, we might be better served by trying to change policies and attitudes about what constitutes as entitlement and what doesn't.

Going back to the OP, alcoholics, obese, and rude don't equate as being entitled. They might not show improvement or progress as you want them but hey Medicine hasn't been easy this far, why have expectations that everything will be hunky dory in residency. I'd call it character building.

 

[Apollyon]

It isn't your fault if someone blows off appointments you made for them. That's what lawyers are for.

I'm sure there are both the types of patients coming to the ER but I'm struggling with believing that majority of them are trying to abuse medicaid. I've seen more instances of unethical billing in Home Health Agencies than from patients themselves. There is rampant Medicare abuse because the system allows for it. It's not the physician's fault but squaring all blame on the patient who has been conditioned to push particular buttons to get attention they want isn't 100% on them. There are undeserving entitled patients but the solution isn't to avoid them or keep treating them as they wish. The change needs to be institutional and much more wide reaching than any one sector of healthcare.

An elitist attitude is one, which says handouts are undeserved and vastly unneeded. It's the attitude, which questions why people don't get jobs while assuming the main cause as laziness. It is basically saying let them eat cake while knowing there is no cake.I don't rail against people able bodied people working, I'm just shocked how much empathy one can lose after working as a physician. I know of Bill O'Reilly because of my family, he's a geriatric fart who makes the idiotic argument that handouts are evil and prevent people from working hard.

As for the Kaiser Quest jackpot you mentioned, I think it's fair. What entitles you to receive Kaiser more so than these medicaid abusers? They got it for free, so what? Did they consider it their birthright after they got it?

I sure have a lot of growing to do but I hope I'll feel empathy and understanding for my patients even if they don't deserve it. I see that you are disillusioned by the things you've witnessed. Maybe you had different views and just got beat down by the constant medicaid abusers and people taking advantage of the system. But instead of lamenting on the dwindling noble poor, we might be better served by trying to change policies and attitudes about what constitutes as entitlement and what doesn't.

Going back to the OP, alcoholics, obese, and rude don't equate as being entitled. They might not show improvement or progress as you want them but hey Medicine hasn't been easy this far, why have expectations that everything will be hunky dory in residency. I'd call it character building.

I have never been so idealistic as to be disillusioned. To be honest, the patients are the best part of my job. Shake the hand of every veteran, and thank them for their service. Thank the patients for coming to see you. Don't be afraid to laugh with the patients, to show emotion, and be sincere with them. Enjoy the well child that comes in "throwing up every five minutes", who eats Goldfish crackers the entire time. There's nothing better than a laughing 3 year old, or a smiling neonate.

I do not know who is insured or not when I see them. I can find out, but it's more effort than it is worth. As I tell everyone, "there is only one class of service". It's too tiring to not be genuine, honest, and diligent. Sunshine is the best disinfectant. I can't fake it. What you see is what you get, and, as I tell the patients, "I can't give you everything, but, what I got, you get it all".

 

[cbrons]

It isn't your fault if someone blows off appointments you made for them. That's what lawyers are for.

I'm sure there are both the types of patients coming to the ER but I'm struggling with believing that majority of them are trying to abuse medicaid. I've seen more instances of unethical billing in Home Health Agencies than from patients themselves. There is rampant Medicare abuse because the system allows for it. It's not the physician's fault but squaring all blame on the patient who has been conditioned to push particular buttons to get attention they want isn't 100% on them. There are undeserving entitled patients but the solution isn't to avoid them or keep treating them as they wish. The change needs to be institutional and much more wide reaching than any one sector of healthcare.

An elitist attitude is one, which says handouts are undeserved and vastly unneeded. It's the attitude, which questions why people don't get jobs while assuming the main cause as laziness. It is basically saying let them eat cake while knowing there is no cake.I don't rail against people able bodied people working, I'm just shocked how much empathy one can lose after working as a physician. I know of Bill O'Reilly because of my family, he's a geriatric fart who makes the idiotic argument that handouts are evil and prevent people from working hard.

As for the Kaiser Quest jackpot you mentioned, I think it's fair. What entitles you to receive Kaiser more so than these medicaid abusers? They got it for free, so what? Did they consider it their birthright after they got it?

I sure have a lot of growing to do but I hope I'll feel empathy and understanding for my patients even if they don't deserve it. I see that you are disillusioned by the things you've witnessed. Maybe you had different views and just got beat down by the constant medicaid abusers and people taking advantage of the system. But instead of lamenting on the dwindling noble poor, we might be better served by trying to change policies and attitudes about what constitutes as entitlement and what doesn't.

Going back to the OP, alcoholics, obese, and rude don't equate as being entitled. They might not show improvement or progress as you want them but hey Medicine hasn't been easy this far, why have expectations that everything will be hunky dory in residency. I'd call it character building.

Wait until you are actually in residency and witness this stuff first-hand. Trust me, it’s eye-opening.

 

[Doctor Christmas]

PGY2 here in a surg specialty. I came into medicine thinking I loved patient contact and surgery. Both of those dwindled during rotations, and even more in residency. Outright bored of being in the OR now, and not just the really uninteresting stuff like hip, but everything else too.

I still love patient contact, my issue is with the patients themselves. Most of the patients are one of the following: alcoholics, rude, excessively overweight etc. I don't have anything against those traits personally, but maybe 10% of patients are nice to work with. After residency, is there any way to control the type of patients I work in by the area? Like if I live in an area with high cost of living, or an area without medicare/uninsured patients, will it get better?

And does surgery get better, or do I just learn to keep working without worrying about if it is boring?

If you work at high end institutions you will find rich entitled patients who are insured and have high expectations. Think MGH type places (I met an embassy for during one of my rotations there). At county type places you will find the poor uninsured who are typically also entitled, will likely not pay, may or may not be grateful, and may or may not speak English. My strategy had been to look for institutions where you find middle class working type people who are generally insured and seem to have reasonable expectations, do a reasonable job of taking care of themselves, and expectations are inbetween the 2 cases above.

 

[Psai]

If you work at high end institutions you will find rich entitled patients who are insured and have high expectations. Think MGH type places (I met an embassy for during one of my rotations there). At county type places you will find the poor uninsured who are typically also entitled, will likely not pay, may or may not be grateful, and may or may not speak English. My strategy had been to look for institutions where you find middle class working type people who are generally insured and seem to have reasonable expectations, do a reasonable job of taking care of themselves, and expectations are inbetween the 2 cases above.

It's funny how universal this is