What's the single worst thing about our job? (Pick only one)

[Boatswain2PA]

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Me: What can we do for you today?
Pt: fix me
Me: tell me what's going in.
Pt: I'm sick
Me: how are you sick?
Pt: I don't feel well
Me: how do you not feel well?
Pt: I don't know.

Wag your tail or growl at me, but give me SOMETHING to start with here....

 

[allantois]

Me: What can we do for you today?
Pt: fix me
Me: tell me what's going in.
Pt: I'm sick
Me: how are you sick?
Pt: I don't feel well
Me: how do you not feel well?
Pt: I don't know.

Wag your tail or growl at me, but give me SOMETHING to start with here....

Aren't you supposed to figure this out? You are the expert!!

 

[EmergentMagician]

Aren't you supposed to figure this out? You are the expert!!

What medical problems do you have?

"You have that. It's in the computer"

Or

"Glaucoma, seborrheic dermatitis"

*Does not mention their massive sternotomy scar or warfarin rx*

Old people seem to only be able to articulate their eye or skin pathology

 

[bky3c]

What medical problems do you have?

"You have that. It's in the computer"

Or

"Glaucoma, seborrheic dermatitis"

*Does not mention their massive sternotomy scar or warfarin rx*

Old people seem to only be able to articulate their eye or skin pathology

"Well, I don't know what they did there <points to scar>. I was asleep!"
"Oh, no, honey, I don't have <insert HTN, HPL, etc. here>. I take medicine for that."

 

[DOswag]

There has been total medicalization of every aspect of American life: constant commercials that tell you to consult your doctor or go to the nearest ED for any trivial issue. People show up expecting that all of their life's issues can be solved, they can be provided with a note to get them out of their troubles and that somehow insurance is supposed to cover any and every expense, procedure or intervention most of which are only done for medicolegal reasons anyway

This is something we see in psychiatry as well. Seems everything is pathologized these days as something that can and should be "fixed" by doctors. Social media has ruined people into thinking they have adhd because they suddenly can't focus as an adult though made it fine through undergrad and their 2 master's programs. People thinking they have autism as increased as well despite no history of issues and suddenly in there 20's want to "see if I have it". Gender dysphoria has grown at an exponential rate in the past 5-10 years. Reading this thread solidifies all the more my decision to go into psychiatry instead of EM though.

 

[WhatJobDoIPick]

This is something we see in psychiatry as well. Seems everything is pathologized these days as something that can and should be "fixed" by doctors. Social media has ruined people into thinking they have adhd because they suddenly can't focus as an adult though made it fine through undergrad and their 2 master's programs. People thinking they have autism as increased as well despite no history of issues and suddenly in there 20's want to "see if I have it". Gender dysphoria has grown at an exponential rate in the past 5-10 years. Reading this thread solidifies all the more my decision to go into psychiatry instead of EM though.

Americans love to have a label to attach all of their woes to. Even better if it has a pill you can take for it. Anything to avoid the personal responsibility of ascribing their dysfunction to their obesity, diet, lack of exercise, sleep routine, substance abuse, personal relationships, etc etc.

 

[xaelia]

There has been total medicalization of every aspect of American life: constant commercials that tell you to consult your doctor or go to the nearest ED for any trivial issue. People show up expecting that all of their life's issues can be solved, they can be provided with a note to get them out of their troubles and that somehow insurance is supposed to cover any and every expense, procedure or intervention most of which are only done for medicolegal reasons anyway

Yes – this, which is somewhat supported by ACEP and it's "Our amazing ED docs are always there for you 24/7!", combined with the actual operational realities/cost pressures of hospitals and ED, plus the well-meaning social justice aspirations of some of our academic colleagues, combined with *having to do it with a smile* because PG/HCAHPS etc.

 

[deleted1183938]

It's not all sunshine and roses in the ED in NZ, but this entire category of issues is dramatically curtailed.

1) Generally, the only senior doctors on the floor are the ED docs – so most of our calls for admission/consultation are being taken by a registrar, and the hierarchy of medicine in the British system means it's drilled into them to at least see the patient first before declining/complaining.
2) In a situation where it's between a couple different services, this can obviously get messy and need to get escalated up the tree to the senior doctors for the consulting services – but the ED is mostly outside the process, and these other services negotiate the next steps in care for the patient between themselves, without troubling us (other than the patient taking up a bed space for an eternity).

I never, ever dread going to work.

This makes me want to leave America. American healthcare is trash. But hey, we make good money. Hahaha

 

[alpinism]

It's not all sunshine and roses in the ED in NZ, but this entire category of issues is dramatically curtailed.

1) Generally, the only senior doctors on the floor are the ED docs – so most of our calls for admission/consultation are being taken by a registrar, and the hierarchy of medicine in the British system means it's drilled into them to at least see the patient first before declining/complaining.
2) In a situation where it's between a couple different services, this can obviously get messy and need to get escalated up the tree to the senior doctors for the consulting services – but the ED is mostly outside the process, and these other services negotiate the next steps in care for the patient between themselves, without troubling us (other than the patient taking up a bed space for an eternity).

I never, ever dread going to work.

It's the same in South African EDs with specialist physicians.

I think it comes down to 2 main reasons:

1. Generally speaking we only admit people that legitimately need admission and not all these grey zone medicolegal admits that dominate the reason for admission at most community Hospitals. Because of this other physicians trust us since they know we dont call for stupid things and will often be happy to take our patients with a quick call that lasts maybe at the most a minute.

2. The consultants are much better staffed with better hours and so they typically don't mind the extra work unlike here where they already have fully packed OR schedules with 10+ cases with another 10+ consults. Its amazing how more willing people are to see patients when it does not result in them staying in the hospital till 8pm when they were supposed to be done at 4pm to have dinner with their families.


The other huge problem with US medicine is that most docs never work in the ED and have no clue how it functions. In most other countries docs are usually required after medical school to work as medical officers where they spend at least 6+ months in the ED actually working shifts and seeing patients before applying for residency. Not surprisingly this leads to more understanding of the difficulties we face on shifts and docs typically are more willing to help care for more patients since they already know how crazy it gets on shifts.

 

[namethatsmell]

Im starting to fantasize about turning my w2 job into a PRN gig in 2-3 years and being credentialed at 3-4 places where i only work prn as i choose.

For awhile I was essentially PRN at a few different places. There were some mutual guardrails in place to ensure I worked enough at each shop to stay up to date with their operational changes etc and at the same time they had to give me enough hours to ensure a salary floor was there. The key to this was pre-negotiating how scheduling would work. It'd send them my availability a few months in advance and then they could pick from what I sent them. That way I could plan ahead for life stuff while also making sure the various gigs wouldn't conflict. It was glorious.

 

[TooMuchResearch]

This is something we see in psychiatry as well. Seems everything is pathologized these days as something that can and should be "fixed" by doctors. Social media has ruined people into thinking they have adhd because they suddenly can't focus as an adult though made it fine through undergrad and their 2 master's programs. People thinking they have autism as increased as well despite no history of issues and suddenly in there 20's want to "see if I have it". Gender dysphoria has grown at an exponential rate in the past 5-10 years. Reading this thread solidifies all the more my decision to go into psychiatry instead of EM though.

Hey, the medical system now requires me to call every 45 year old schizoaffective sex offender male a female just because they decided a week ago they are female...

 

[NYEMMED]

Lawyers…

 

[wendalltwolf]

 

[Dred Pirate]

Dead children.

Sorry but nothing even comes close.

this x100 - I am not a physician, but the first death I ever witnessed in person was a 6 month old at a tiny 10 bed rural hospital, 50 miles from anything resembling an appropriate pediatric facility.

 

[miacomet]

Administrators who practice medicine without a license