Some unique but recognizable insignia to discern an EM PHYSICIAN from the other white-coat wearers.

[RustedFox]

If your patients can't tell there is something different about you than everyone else they've spoken to during their admission to your ER, no garment is going to change that. My guess is that they can, you're just too snake bit to realize it...sorry 'bout that. I think you're going to be OK....

You're right.
I'm pretty snakebitten.
I'm seriously going to take time off early this year.
Like, 4-6 weeks.

I absolutely cannot handle the nonsense anymore.
From the 2 AM: "My baby have a FEVER! and She just come back from her baby-daddy-place! HE be GAVE her a FEVER!"
To the "I'm a BOOMER who can't tell you anything, but I want everything done for me. My wife will tell you everything (except she can't)."

But...

"I never saw a doctor."

I have been sent the message that I "don't look like a doctor", and therefore "cannot be a doctor" by 99% of the dumb@sses out there.
So, I won't be.

We'll see how that works out.

I don't live extravagantly.
95% of my clothes are from WalMart/Target.
I don't own a luxury car, a luxury watch, a luxury suit.
My TV is from 2009. Its all of like, 27 inches diagonal.
I don't really turn it on all that much.
I drive a 2014 Hyundai hatchback. Standard transmission.

A "good day off" for me is going to the park to juggle a soccer ball, then maybe hitting the driving range.
Then, its iced tea until the nightly hockey game comes on. Might catch a nap, first.

That life suits me just fine.

My best buddy works in a greenhouse back in State College, PA.
He raises Christmas trees, and some ornamentals. Nothing illegal, you millennials.
He manages the place. Makes around 70K a year.
He lives just fine.
Neither of us have kids that we need to save $300,000 dollars of tuition for.
Neither of us jet off to Bora Bora for a week because "why the hell not?!"

But the difference between he and I, is that he doesn't worry about needlestick exposures at 3:45AM.
He doesn't put in a chest tube in a flail chest in a BOOMER on Eliquis who has fallen off the toilet and worry about stopping the bleeding.
He doesn't walk into a room with a non-sick kid and is immediately overcome by marijuana smoke while daddy says "Eyy'yo, Can I gets a work note too?" - as he barely bothers to look up from the newest iPhone that I have better sense than to buy.

I made 357K last year. That's a lot of money.
I'll give most of it up, for a lot less stress.


This was seriously my last patient:

14 year old hispanic female. Perfect hemicrania migraine. Conjunctival injection. Everything that Osler wrote about.

"I can help you."

10 mg Decadron.
15 mg Toradol.
10 mg Reglan.

The girl looks at me like I was Jesus Christ after she felt better.

BUT!

Mommy is already on the phone, screaming at whoever will listen.

"Esss un MIGRAINE ! El doctor DICE que ya-ta-ta-ta-ta-TA-ta-ta.",

I stopped her. I seriously said: "STOP!"

I actually didn't "dice que" anything. But; because you love drama, you've already got your pre-written script that you're going to scream to the abuelita on the other end of the phone.

She stopped. Mouth open. Cellphone next to it. Fat face staring back at me. Stupified. Hand didn't move from her ear, because that's the fixed position that its in for so many people.

Silence.

"Hang up. CUELGATE."

I seriously did not say a single thing about the child's condition, prognosis, anything.

Yet. Mommy is already creating a telenovela about her child's headache visit to the ER.


I can't with these people. This is 90% of my day.



AYYYYEEEE-ya-ta-ta-ta-ta-TAAA-teee!

---

Members don't see this ad.

 

[RustedFox]

Second to last patient:

68 year old white female.
Amazingly deconditioned.
Fat wattles caused air currents to be disturbed as she walked into the exam room.
Suitcase is at bedside (Positive Samsonite Sign!)

"Hello. I am Dr. Rustedfox. How can I help you feel better today."
"You can admit me because I might be coming down with a UTI and it always gets bad and I need to be on STRONG anitbiotics."

Okay, madam. Give me a urine sample, we'll get some blood from you. Lets look at the chemistry together.

"NO, no, no. I don't need all of that. I just want you to admit me and I can take it from there."

"Who is your family care doctor?"

"Doctor Higgenbotham in West-by-Southwest-Orange, NJ! Call him NOW and he'll tell YOU what to do since you can't figure it out!"

Okay, if you have no local doctor, I need to admit you to the hospitalist's service if you need to be admitted.

"What do you MEAN by IF?! I need to stay in the hospital!

As it turns out, Mrs. Costanza is only here because she has been displaced from her apartment because they're fumigating it for termites, which are terribly common in Florida. The workup has returned, and its stone-cold negative.

"I'm going to get Dr. Higgenbotham on the phone RIGHT NOW and he will tell you to admit me!"

Sure, madam.

I can hear her, thru the curtain - saying things like "YOU have to TELL this ER doctor to ADMIT me!"

I busted her party.

"Madam. Your workup is negative, and you are being discharged. I have no medical basis to admit you. In fact, what you are asking me to do is to commit medicare fraud. I cannot do that."

I picked up the phone, out of her hand.

"Yes Sir. Doctor RustedFox here. No, sir. Your patient has no medical need for admission. I suggest she finds somewhere comfortable to spend the night. Thank you, sir. Goodnight."


-------------------------------------------------------------------------------------------------------------------------------------------------------------------


This is 90% of what I do. There is no real "medicine", there's just frauds, abusers, psychotics, drunks, and the like.


I really want out.

 

[thegenius]

You're right.
I'm pretty snakebitten.
I'm seriously going to take time off early this year.
Like, 4-6 weeks.

I absolutely cannot handle the nonsense anymore.
From the 2 AM: "My baby have a FEVER! and She just come back from her baby-daddy-place! HE be GAVE her a FEVER!"
To the "I'm a BOOMER who can't tell you anything, but I want everything done for me. My wife will tell you everything (except she can't)."

But...

"I never saw a doctor."

I have been sent the message that I "don't look like a doctor", and therefore "cannot be a doctor" by 99% of the dumb@sses out there.
So, I won't be.

We'll see how that works out.

I don't live extravagantly.
95% of my clothes are from WalMart/Target.
I don't own a luxury car, a luxury watch, a luxury suit.
My TV is from 2009. Its all of like, 27 inches diagonal.
I don't really turn it on all that much.
I drive a 2014 Hyundai hatchback. Standard transmission.

A "good day off" for me is going to the park to juggle a soccer ball, then maybe hitting the driving range.
Then, its iced tea until the nightly hockey game comes on. Might catch a nap, first.

That life suits me just fine.

My best buddy works in a greenhouse back in State College, PA.
He raises Christmas trees, and some ornamentals. Nothing illegal, you millennials.
He manages the place. Makes around 70K a year.
He lives just fine.
Neither of us have kids that we need to save $300,000 dollars of tuition for.
Neither of us jet off to Bora Bora for a week because "why the hell not?!"

But the difference between he and I, is that he doesn't worry about needlestick exposures at 3:45AM.
He doesn't put in a chest tube in a flail chest in a BOOMER on Eliquis who has fallen off the toilet and worry about stopping the bleeding.
He doesn't walk into a room with a non-sick kid and is immediately overcome by marijuana smoke while daddy says "Eyy'yo, Can I gets a work note too?" - as he barely bothers to look up from the newest iPhone that I have better sense than to buy.

I made 357K last year. That's a lot of money.
I'll give most of it up, for a lot less stress.


This was seriously my last patient:

14 year old hispanic female. Perfect hemicrania migraine. Conjunctival injection. Everything that Osler wrote about.

"I can help you."

10 mg Decadron.
15 mg Toradol.
10 mg Reglan.

The girl looks at me like I was Jesus Christ after she felt better.

BUT!

Mommy is already on the phone, screaming at whoever will listen.

"Esss un MIGRAINE ! El doctor DICE que ya-ta-ta-ta-ta-TA-ta-ta.",

I stopped her. I seriously said: "STOP!"

I actually didn't "dice que" anything. But; because you love drama, you've already got your pre-written script that you're going to scream to the abuelita on the other end of the phone.

She stopped. Mouth open. Cellphone next to it. Fat face staring back at me. Stupified. Hand didn't move from her ear, because that's the fixed position that its in for so many people.

Silence.

"Hang up. CUELGATE."

I seriously did not say a single thing about the child's condition, prognosis, anything.

Yet. Mommy is already creating a telenovela about her child's headache visit to the ER.


I can't with these people. This is 90% of my day.



AYYYYEEEE-ya-ta-ta-ta-ta-TAAA-teee!

I would consider tattooing “I’m a doctor” in English and Spanish on your forehead.

Worked for me. Patients stare at me for 5 seconds....some of them I can read their lips:

“Eye-uh-mmmm a DACTOR”

Oh yes! Nice to meet you doc!

I never get confused anymore.

 

[RustedFox]

I would consider tattooing “I’m a doctor” in English and Spanish on your forehead.

Worked for me. Patients stare at me for 5 seconds....some of them I can read their lips:

“Eye-uh-mmmm a DACTOR”

Oh yes! Nice to meet you doc!

I never get confused anymore.

I'm just so tired of getting abused by patients.
And then they have their PG survey (always AFTER their bill!)
So they have their righteous indignation.

I am a good doctor.
dchristismi knows me. She hired me.
I trained "Tenk!"

I have been seriously broken by the PG process and an entitled society.

Are you wealthy? Oh, well - don't let the fact that there wasn't a mint on your pillow and a towel folded like a swan in your room dissuade you from giving me a 5/5.

Are you poor? Oh, well - don't let the fact that you're not sober enough to take care of your child dissuade you from giving me a 5/5. Please, the fact that you can't connect to the hospital's WiFi to continue playing your slot machine game on your very expensive cellphone isn't my fault.

The entitledom.

If I would have said any of the things to a physician that my patients have said to me... my dad would have given me a quick pop in the mouth. Not a closed fist, just a quick snap of a backhand. POP. Why? Because you don't say things like that. Especially not to professionals. It would have stung, but it wouldn't have hurt for long.... just long enough for me to learn the lesson. A lesson that so many people need to learn. One way, or the other.

How do I know?

Welp. I've made that mistake. I've tasted that sting.

I didn't lash out against my dad. I recognized that:

"What I said was Wrong! And I won't do IT again! I love you, Dad!"

Thanks, Dad. I love you.

You taught me respect.

 

[TheSingularity]

Bruh. I hear ya.

Two things.

1) Pick up shifts at a place with residents. EM residents. Not like carribbean med school IM off service rotators. One place I work I have the honor and privilege of working with GOOD emergency medicine residents. It's amazing. Even one good resident makes yourself so much nicer. I watched so much football on my shift yesterday.

2) You want out? Let's get out together. I'll be doing fellowship in a few years, if the current political trade winds stay true.. It'll be a pay cut but I'll be happier and doing something I believe in.

I'm just so tired of getting abused by patients.
And then they have their PG survey (always AFTER their bill!)
So they have their righteous indignation.

I am a good doctor.
dchristismi knows me. She hired me.
I trained "Tenk!"

I have been seriously broken by the PG process and an entitled society.

Are you wealthy? Oh, well - don't let the fact that there wasn't a mint on your pillow and a towel folded like a swan in your room dissuade you from giving me a 5/5.

Are you poor? Oh, well - don't let the fact that you're not sober enough to take care of your child dissuade you from giving me a 5/5. Please, the fact that you can't connect to the hospital's WiFi to continue playing your slot machine game on your very expensive cellphone isn't my fault.

The entitledom.

If I would have said any of the things to a physician that my patients have said to me... my dad would have given me a quick pop in the mouth. Not a closed fist, just a quick snap of a backhand. POP. Why? Because you don't say things like that. Especially not to professionals. It would have stung, but it wouldn't have hurt for long.... just long enough for me to learn the lesson. A lesson that so many people need to learn. One way, or the other.

How do I know?

Welp. I've made that mistake. I've tasted that sting.

I didn't lash out against my dad. I recognized that:

"What I said was Wrong! And I won't do IT again! I love you, Dad!"

Thanks, Dad. I love you.

You taught me respect.

Sent from my Pixel 3 using SDN mobile

 

[bravotwozero]

This is 90% of what I do. There is no real "medicine", there's just frauds, abusers, psychotics, drunks, and the like.


I really want out.

Nah, you're EM for life. I think you'll stick around...

 

[RustedFox]

Bruh. I hear ya.

Two things.

1) Pick up shifts at a place with residents. EM residents. Not like carribbean med school IM off service rotators. One place I work I have the honor and privilege of working with GOOD emergency medicine residents. It's amazing. Even one good resident makes yourself so much nicer. I watched so much football on my shift yesterday.

2) You want out? Let's get out together. I'll be doing fellowship in a few years, if the current political trade winds stay true.. It'll be a pay cut but I'll be happier and doing something I believe in.

Sent from my Pixel 3 using SDN mobile

The complete lack of respect and downright direct abuse has smothered the desire that I had to get out there and be a good doctor. And it's generally amongst certain subgroups of people.

You want someone to take care of you? Find someone else. I'm toasted. I'd rather go rogueman than serve these Philistines for them to turn around and complain about things that I have zero control over.

These adult-children have no idea how good they have it. They want their cake, and they want to eat it....and then complain about it.

Right now, I'm just a smoldering ember in the ashtray of EM, and I want to just jump out of the ashtray and onto the floor.

 

[Birdstrike]

If your patients can't tell there is something different about you than everyone else they've spoken to during their admission to your ER, no garment is going to change that. My guess is that they can, you're just too snake bit to realize it...sorry 'bout that. I think you're going to be OK....

For the first ten years of being a doctor I constantly got, “You’re too young to be a Doctor.” Not anymore. Get old enough and they’ll start knowing who the doctor is.

Try putting some flour in your hair, shaving the hair off the top of your head, or putting some bifocals on your nose. Either that or just be patient.

“Father Time waits for ——ing no one.” -David Goggins

 

[Birdstrike]

The complete lack of disrespect and downright direct abuse has smothered the desire that I had to get out there and be a good doctor. And it's generally amongst certain subgroups of people.

You want someone to take care of you? Find someone else. I'm toasted. I'd rather go rogueman than serve these Philistines for them to turn around and complain about things that I have zero control over.

Right now, I'm just a smoldering ember in the ashtray of EM.

Talk to me, dude.

 

[GeneralVeers]

I have similar frustrations to Fox, but for $300/hr I just treat them like widgets. How can I get this lump of flesh either upstairs or out of the ER the fastest way possible? All of the dirtbags who come in get minimal attention from me and minimal workup. No scripts for Tylenol/Motrin. If they complain IDGAF. I don't even look at my Press-Ganey scores, because frankly they are irrelevant and I can't change my practice and personality at this point in time.

 

[Fox800]

I have similar frustrations to Fox, but for $300/hr I just treat them like widgets. How can I get this lump of flesh either upstairs or out of the ER the fastest way possible? All of the dirtbags who come in get minimal attention from me and minimal workup. No scripts for Tylenol/Motrin. If they complain IDGAF. I don't even look at my Press-Ganey scores, because frankly they are irrelevant and I can't change my practice and personality at this point in time.

You're the hero we deserve...I think.

 

[TheSingularity]

How do you deal with the nurses squaking about this or that noisy widget wanting attention tho?

I have similar frustrations to Fox, but for $300/hr I just treat them like widgets. How can I get this lump of flesh either upstairs or out of the ER the fastest way possible? All of the dirtbags who come in get minimal attention from me and minimal workup. No scripts for Tylenol/Motrin. If they complain IDGAF. I don't even look at my Press-Ganey scores, because frankly they are irrelevant and I can't change my practice and personality at this point in time.

Sent from my Pixel 3 using SDN mobile

 

[dchristismi]

Talk to me, dude.

Yeah Foxy, you sound extra crispy. Talk to us, either here or pm. You don't sound ok. (Or maybe you're just superventing...)

 

[Dr Mantis Toboggan]

I work in the rural SE and see tons of elderly patients. I am lucky that here they are by and large extremely nice folks. But it’s also not a wealthy area and our payor mix is not lit.

The complete lack of disrespect and downright direct abuse has smothered the desire that I had to get out there and be a good doctor. And it's generally amongst certain subgroups of people.

You want someone to take care of you? Find someone else. I'm toasted. I'd rather go rogueman than serve these Philistines for them to turn around and complain about things that I have zero control over.

These adult-children have no idea how good they have it. They want their cake, and they want to eat it....and then complain about it.

Right now, I'm just a smoldering ember in the ashtray of EM, and I want to just jump out of the ashtray and onto the floor.

 

[deleted109597]

Pick up shifts at a place with residents. EM residents. Not like carribbean med school IM off service rotators. One place I work I have the honor and privilege of working with GOOD emergency medicine residents. It's amazing. Even one good resident makes yourself so much nicer. I watched so much football on my shift yesterday.

This makes me bristle. I don't mind Veers and running widgets. I don't mind leaving entirely.
I do mind the mindset of "work somewhere where you make the other poor schmucks do all the bull**** work and all you do is sit there and surf facebook at work."
F that. I tried to make residency teaching work. Both at CMG and traditional med school places. All it is doing is bailing water or moving deck chairs.
Spend less save more. Pay down debt. I would do some jobs for $70-100k a year. This isn't one of them.

 

[TheSingularity]

Ok obviously I'm joking.

I do think it's protective to work with residents. They can buffer you from having to deal with the nitty gritty so that you can focus on the big picture.

This makes me bristle. I don't mind Veers and running widgets. I don't mind leaving entirely.
I do mind the mindset of "work somewhere where you make the other poor schmucks do all the bull**** work and all you do is sit there and surf facebook at work."
F that. I tried to make residency teaching work. Both at CMG and traditional med school places. All it is doing is bailing water or moving deck chairs.
Spend less save more. Pay down debt. I would do some jobs for $70-100k a year. This isn't one of them.

Sent from my Pixel 3 using SDN mobile

 

[Birdstrike]

I was exactly where @RustedFox is, 10 years ago. Something snapped in me and I decided I didn't deserve the daily beat downs and finally refused to take the abuse anymore, from patients and even more so, from administration. From that moment in time, I was done, leaving, and just had to find the right key to the exit door. That's when I instituted plan, Get-Out-Before-Ya-Stroke-Out. I now feel like I have a new life, and didn't really even know it, until I was actually out. I thank God every day for the sunlight I can now see. I strongly feel God called me into EM, but that it was a time-limited mission. I felt equally called and assisted, on the way out.

ACEP and ABEM won't save you. You've got to save yourself. Or maybe it takes saying a prayer and asking for help, from a higher power. I don't know. I do know that it won't hurt and it'll cost you nothin'.

 

[Fox800]

This thread is inspiring me to pay off my debt and eff off to New Zealand in a few years.

 

[deleted109597]

Ok obviously I'm joking.

I do think it's protective to work with residents. They can buffer you from having to deal with the nitty gritty so that you can focus on the big picture.

Sent from my Pixel 3 using SDN mobile

Of course it's protective. You don't actually have to argue with the stupid BS patients. You don't get yelled at by the annoying consultants. It's like being a middle manager. But it's also crap to do it the way you're saying.
As faculty you need to actively seek out the crap patients to help protect the residents. Model appropriate behavior for them to the prick consultants.
Not watch football ffs.

 

[TooMuchResearch]

Really? My best attendings watched us struggle, then we discussed how to do it better next time. And some of them were actually watching sports and YouTube videos half the shift. They also worked their share of resident-free shifts, so they seemed more... credible.

Of course it's protective. You don't actually have to argue with the stupid BS patients. You don't get yelled at by the annoying consultants. It's like being a middle manager. But it's also crap to do it the way you're saying.
As faculty you need to actively seek out the crap patients to help protect the residents. Model appropriate behavior for them to the prick consultants.
Not watch football ffs.

 

[TheSingularity]

Dude get off your high ****ing horse. My residents don't write a single note (I write all of them) so that they can do doctor stuff. May god strike me down if I watch 15 mins of football on a shift.

Of course it's protective. You don't actually have to argue with the stupid BS patients. You don't get yelled at by the annoying consultants. It's like being a middle manager. But it's also crap to do it the way you're saying.
As faculty you need to actively seek out the crap patients to help protect the residents. Model appropriate behavior for them to the prick consultants.
Not watch football ffs.

Sent from my Pixel 3 using SDN mobile

 

[KGflyboy]

Dude get off your high ****ing horse. My residents don't write a single note (I write all of them) so that they can do doctor stuff. May god strike me down if I watch 15 mins of football on a shift.

Sent from my Pixel 3 using SDN mobile

Wow... Your residents don't write notes? If word gets out where you work, there will be a line of applicants 5,000 deep wanting to match to your program.

 

[ShockIndex]

The complete lack of disrespect and downright direct abuse has smothered the desire that I had to get out there and be a good doctor. And it's generally amongst certain subgroups of people.

You want someone to take care of you? Find someone else. I'm toasted. I'd rather go rogueman than serve these Philistines for them to turn around and complain about things that I have zero control over.

These adult-children have no idea how good they have it. They want their cake, and they want to eat it....and then complain about it.

Right now, I'm just a smoldering ember in the ashtray of EM, and I want to just jump out of the ashtray and onto the floor.

I finished EM residency in 2006 and left the speciality this year for CCM at age 46. The biggest impediment to getting out is the overcoming the negative inertia from the “point of no return” fallacy. People think that they have too much invested in their lifestyles and families to make such a radical change in standard of living. Truth be told, families are generally better off when the primary breadwinner isn’t miserable.

 

[Dred Pirate]

where I work - nobody from the ED wears white coats- the only time you see a white coat is when the hospitalist walks in with one one. Even the ICU docs don't.

Everybody has color coded scrubs, except the md's so - they sort of stick out that way,

But ya - I think it is ridiculous everybody wears them now days - just seems silly (FYI- I am a pharmacist and I have owned one coat in the 13 years I have been at my hospital and it still looks brand new - I avoid it at all costs, just never really liked to wear one.

 

[deleted720339]

How about an arm patch with a turkey sandwich on it?

 

[AlmostAnMD]

@RustedFox , my hero @Tenk thinks highly of you, so as a sign of respect to both of you I have set out on a quest to find the perfect insignia. I think I have a good contribution:

This is just a rough sketch, someone who is better can do better, but you get the idea:

It is modeled and inspired by:

Seems appropriate. Thoughts?

 

[RustedFox]

Pretty much how I felt before I took this LOA, which was sorely needed.

My soul has healed a bit, but still burns.

 

[GeneralVeers]

Pretty much how I felt before I took this LOA, which was sorely needed.

My soul has healed a bit, but still burns.

Did you travel at all or just stay home and keep busy?

 

[RustedFox]

Did you travel at all or just stay home and keep busy?

Staying at home.
Healing.

 

[docB]

Yet, the "satisfaction surveys" largely determine a lot of things for me.

Same here. Frighteningly I have seen clinical policy created based on Yelp reviews. More than once.

 

[thegenius]

Pretty much how I felt before I took this LOA, which was sorely needed.

My soul has healed a bit, but still burns.

Maybe you should take a LOA from this message board. It is true there’s lots of ranting and venting that doesn’t happen in real life.

Please don’t take that wrongly either, I like your posts here.

 

[thegenius]

Same here. Frighteningly I have seen clinical policy created based on Yelp reviews. More than once.

Like what? Do u have an example?

 

[deleted859535]

Maybe you should take a LOA from this message board. It is true there’s lots of ranting and venting that doesn’t happen in real life.

Please don’t take that wrongly either, I like your posts here.

Actually agree with this unless it's truly therapeutic. This subforum unfortunately has a tendency to be skewed strongly towards the negative with little mention or appreciation of the positive. I tend to come away from it feeling worse than I started.

 

[Listen2Savage]

Biceps and traps can tell you that I'm in the gym

lol

Suitcase is at bedside (Positive Samsonite Sign!)

damn lol

 

[gutonc]

Same here. Frighteningly I have seen clinical policy created based on Yelp reviews. More than once.

Holy crap! @docB is back!

 

[deleted109597]

Holy crap! @docB is back!

I nominate him for mod!

 

[GeneralVeers]

Actually agree with this unless it's truly therapeutic. This subforum unfortunately has a tendency to be skewed strongly towards the negative with little mention or appreciation of the positive. I tend to come away from it feeling worse than I started.

I enjoy the opportunity to vent a bit about the ridiculousness of our jobs and the nonsense we have to deal with. I do have a few like-minded colleagues at work, but usually I try to keep the complaints and concerns away from the my medical directors and admin.

 

[docB]

Like what? Do u have an example?

I do but I can't state them overtly in a public forum.

I will say that I have seen instances where patients were appropriately denied requested therapies (not controlled substances). They went to other centers and were given what they wanted and then posted about the perceived superiority of the other facilities. Several of those have resulted in revisions of facility or group guidelines or, more commonly, an arm around the shoulder with a "next time give 'em what they want."

Other instances include things like using good practices that some patient's don't understand like doing wound care with clean, non-sterile gloves or irrigating with tap water. One facility purposefully quit using imaging decision rules (NEXUS, Ottawa knee and ankle) opting to have nursing "protocol" those studies based on patient complaints (not Yelp but the same idea) that all pretty much read "I went to the ER for my X-ray and they didn't do it."

 

[docB]

I nominate him for mod!

I nominate him for mod!

Thank you. No.
I can't be trusted not to say inappropriate things.

 

[ShockIndex]

I think taking an LOA from a job to heal from a particularly troubling event can be great. Things like a family tragedy, lawsuit, birth of a child, etc. can be incredibly stressful life events that take a toll, and suspending a major moving part in one’s life (i.e. stressful job) makes perfect sense.

However, I’ve found that LOAs are most useful when there will be some meaningful change in the person or environment that caused the need for a LOA. It might be as simple as the baby is now sleeping through the night or complex as adjudication of a lawsuit. In other words, the LOA gives the environment a chance to change for the better, or allows the individual a chance to develop new skills to adapt to the insufferable environment.

The problem comes when a person returns from a LOA to the same oppressive environment with the same skill sets. Things are good for a while but then old patterns of thinking, behaving, and maladapting return to the surface.

@RustedFox, I once felt a lot like you. I’d spend several weeks working in civilian EM feeling like my day was dominated by “not sick at all” patients and people with an agenda. Then, I’d get plucked out of that environment by Uncle Sam for a few months to go have a blast doing meaningful things with awesome people (most of which had nothing to do with medicine). Although it was stressful for my family to be away, these breaks were my LOAs from EM. Unfortunately, my return to EM would start off great but eventually my old patterns would re-emerge and the system had gotten worse. If anything, the deployments made the dichotomy between mindless BS and something meaningful even more stark.

Several years ago, I came to the realization that I had to change the doctor or change the system. My first inclination was to radically change the doctor by leaving medicine completely - my family vetoed that pretty quick. So, I decided that I needed a less radical change that my family could accept because, no matter what, the EM system was a train that was not going to change for the better. Things like fellowship, business school, or law school in your late 40s is the kind of change that few will understand or think is possible because so many are stuck in the Matrix. They will talk to you about more hours, lost salary, etc. Unless they are your family, don’t listen to them - only you and your family know if the red pill is right for you. If you take it, you quickly feel like you know kung fu. The weight that lifts off your shoulders as you prepare and execute your family’s next life is indescribable and better than anything that our patients are injecting.

As for a special insignia for EM, I’m not sure one is really needed. In some professions, pipe hitters take off their patches and insignia before going to work.

 

[docB]

However, I’ve found that LOAs are most useful when there will be some meaningful change in the person or environment that caused the need for a LOA.

This is a great point. It should really be the mission statement for an HR seminar.
Regrettably it is absolutely not the industry practice. Current industry practice is to scapegoat the individuals present when systems break down (or have bad outcomes due to completely predictable shortcomings) and then prescribe "action plans" such as LOAs, counseling or termination to those individuals without changing the system. Perceived improvements are due to others seeing what happened to the scapegoats and avoiding those situations rather than actual system improvements.

 

[ShockIndex]

This is a great point. It should really be the mission statement for an HR seminar.
Regrettably it is absolutely not the industry practice. Current industry practice is to scapegoat the individuals present when systems break down (or have bad outcomes due to completely predictable shortcomings) and then prescribe "action plans" such as LOAs, counseling or termination to those individuals without changing the system. Perceived improvements are due to others seeing what happened to the scapegoats and avoiding those situations rather than actual system improvements.

Every system is perfectly designed for the results that it gets - particularly when averaged over prolonged periods of time.

 

[GeneralVeers]

This is a great point. It should really be the mission statement for an HR seminar.
Regrettably it is absolutely not the industry practice. Current industry practice is to scapegoat the individuals present when systems break down (or have bad outcomes due to completely predictable shortcomings) and then prescribe "action plans" such as LOAs, counseling or termination to those individuals without changing the system. Perceived improvements are due to others seeing what happened to the scapegoats and avoiding those situations rather than actual system improvements.

The system doesn't want to change. The system is optimized for hospital administrators and nurse managers. Patient care is but a tertiary goal to be merely accommodated. To them EM physicians are replaceable cogs, to be thrown out once no longer useful. Why would they bother to change the system when it's far easier, and more cost-effective just to get a new doctor?