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View Diary: How ACA can save lives: let’s visit my Emergency Room on Thanksgiving morning (158 comments)

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  •  Comments from a diary I wrote (3+ / 0-)

    a few days ago about health care professionals working themselves to death.

    This is a comment in reply to a front page story I wrote on the Jonathan Turley Blog

       ER doc
        November 17, 2013 at 7:58 am  

        The issue of sleep deprived docs and nurses is not a new problem, and the new rules governing how much time trainees are allowed/forced to spend at the hospital were meant to address that. Unfortunately, once you are no longer in training, those rules no longer apply to you.

        Then, a whole new set of rules come into play.
        The rules of the marketplace.
        Yeah, here’s that glamorous/dedicated/respected life in medicine we all dreamed about.
        What a load.

        What you find in the ‘real world’ is that for the most part, if you work in the ER, you work for a staffing company. The days of independent group practices in the ER are pretty much over. Now, the staffing company tracks every metric you can possibly imagine. How many patients you see per hour, the acuity of each patient, the level of each patient encounter you have, how much ‘critical care’ you provide, what your documentation levels are, your patient complaint levels, and most importantly (no, not how many lives you save) what your DOWNCODES are. A downcode is when you inadvertently don’t document enough ‘crap’ in the chart, and the staffing company can’t bill for the highest conceivable level of charge for whatever complaint the patient has This has absolutely nothing to do with what kind of care you provide, nor whether the patient got the correct treatment, or even whether they left the ER happy. It’s all about the money. You get measured against an imaginary national standard ER doctor/patient encounter, and you are expected to hit that mark. Every time.

        The hours you work is a whole other issue. In the bigger cities, (and in say, resort areas) it’s not really that much of an issue, because none of the new residents want to have to hie themselves out into the hinterlands to work, so mostly the larger hospitals are fully staffed, and also they try to keep you fresh, so you can see more people per hour, so usually in the cities and at larger med centers, you get restricted to 10 hour shifts, and 16 or so shifts a month.

        Out in the heartland, it’s a whole different ballgame.

        Out here, on the perimeter, to borrow from Jim Morrison, emergency medicine has a whole different face. That face has sagging jowls and red, bloodshot eyes. We are mostly older, and we work all the time, because there simply is no one else. Where I am, we are over an hour from one large city and over two and a half hours from the nearest other large city. We cannot recruit new grads to come here. We pay better than the cities, but still, they won’t come.

        Signing bonuses are offered, but the millennial doctors are not like us…they are far more concerned with their quality of life, no matter what the money is. Hell, maybe they are smarter than we were.

        The upshot of this is, we work. A lot. This month, I will put in twenty 12 hour shifts. In fact, I am typing this in the ER call room, while I wait for lab and xrays. Typically, I will work 6-9 days and then have a handful of days off, then come back and do it again. And I am no longer a spring chicken, to say the least.

        I may be getting some help though…this week we interviewed a guy from a much smaller ER…he is in the real backwoods, in a small 3 bed ER in a tiny town, and he and another guy work 6 day stretches without ever going home. 144 hours in a row. At places like this…and I have worked at them too…usually there are periods where you can catch some sleep. But it’s intermittent, and you really don’t know how much or long. He was relating to me about a recent period where he went 26 hours without sleep. I could totally relate. It happens.

        What’s the solution?

        Hell, I don’t know. You can’t force people to work where they don’t want to. And don’t tell me about passing legislation restricting doctor’s hours. Where do they expect they will get the replacements to fill in the gaps when we all hit the end of our mandated time, and have to go home?
        Right now…and for the foreseeable future…we are what passes for the medical safety net in this country.
        People who don’t or can’t get medical care anywhere else come to us. People who CAN get medical care elsewhere come to us.

        Other than closing half the ER’s in this country, and making people drive longer distances to get to the emergency room, so all the ER’s in this country are fully staffed, I have no ideas. And that’s not a workable one, because people who are having MI’s or strokes, or trauma will die, because there is no care within a reasonable distance, And people get sick in inconvenient places.

        In the meantime, when you go to an ER you may well be seen by a doctor or nurse that is bone tired. We will try to do our best. We will try to be nice, and attentive, and give you the best care we possibly can. Because, tired or not, we are professionals, This is what we do.

        This is who we are. .

    Someone replied to that comment I blockquoted, and the reply irritated an ER doc enough for him to create an account and reply. This reply made Top Comments that night. You can read on down the thread.

    Rudeness is a weak imitation of strength. - Eric Hoffer

    by Otteray Scribe on Thu Nov 28, 2013 at 04:35:06 PM PST

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