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I.  In no particular order:

Physicians have a kind of Stockholm Syndrome.  We’re now so beaten into submission by metrics and satisfaction scores that we have forgotten how important the brutal truth can be.  We were educated to believe our patients. Then our patients were educated to deceive us for selfish, psychosocial ends.  But if we were honest, for their good, we’d say things like:

‘You don’t have seizures.  You have drama.’

‘If you stop having unprotected sex you’ll stop getting Chlamydia.’

‘Every time you come to the ER for your blood pressure  medicine, you incur thousands of dollars in bills.’

‘Sometimes, officer, drunk is just drunk.  That’s my medical clearance.’

‘If the psych patient has 1) hit someone with a ball-bat within the week and 2) now is being evaluated because he wants to kill people, then 3) it might be better for his evaluation to happen in jail rather than in a room while a female nurse ‘watches’ him.

II. ‘I don’t work nights very often.  But when I do, it feels like I drank oh, say, a case of Dos Equis.’  Nights are hard.  Hard because every year they’re physically more demanding.  Hard because my brain at 4 am with a full tracking board of patients is NOT my brain at 9 am.  No matter how the medical establishment wants to deceive itself.  Nights are hard because specialists and other staff docs are not the least bit interested in helping you.  After all, that’s the ER’s job. Nights are also hard because they bring out the dramatic, the addicted, the drunk, the violent.  Sure, the occasional MI or sick baby.  But lots of dysfunction.  Sorting through it all is hard in the best of circumstances.  Doing so with a foggy brain barely fueled by caffeine, chocolate and pistachios?  Bad idea.

III.  America has utterly failed to teach people anything substantive about their health. It has also failed to make them economically engaged in their healthcare.  With all due respect to those truly in need of government assistance (and there are lots), vast numbers of patients on Medicaid truly abuse the system and use the ED as a family medicine office.  This is costly to the system. But worse, it makes them bad stewards of their care and later will likely make them bad stewards if they have private insurance.  If it costs nothing, it’s worth nothing as it were.  Case in point:  3 am.  ‘My ankle has hurt for three year and pops. Today it popped worse and got stuck and hurts more.’  Or ‘You just got a prescription for this infection three days ago.’ ‘It’s not better.’  ‘Did you get the medicine?’  ‘No.’ ‘Why?’ ‘I don’t know.’  I’m talking $4.00 antibiotics here.  No ownership of personal health or life.

IV.  Not entirely sure how I found my way home to my bed…

That is all for now….

PS  I really do like my job!