This is my column in October’s Emergency Medicine News.  I posted the link earlier, but here’s the text.

I’m certainly no Martin Luther, though I think he was a very cool guy. And in medicine, there’s now place to nail my theses, as Luther did in Wittenberg, and so spark a reformation. But if there were, here are a few of the things I’d say.

Physicians and nurses are weary of being the victims of assault and abuse at work, all the while perceiving that their hospitals and employers are more concerned with the rights and safety of the assailants. Shame on you, if you allowed your staff to be abused while you worried about the criminal who attacked them!

Thesis: Medical providers are under attack and need protection more than their attackers.

In all likelihood, physicians practicing full time emergency medicine don’t need to be recertified by board exams or anything else. And they may not even need documented CME. Actually practicing is its own education, day in, day out and year after year. They actually look things up and learn on the job.

Thesis: We practice medicine on real patients, and learn as we go. No more tests, no more hoops.

The pain scale, and the entire pain management culture, is (to quote my children) an ‘Epic Fail.’ It has led to addiction, abuse, dysfunction, disability, staggering cost in confabulated complaints and worst of all, unnecessary deaths from prescription medications. Regulatory panels and advisory groups need to stop wringing their hands and listen to the reality of people like us, who are asked, on every shift, ‘can I have more pain pills?’

Thesis: Narcotic abuse and addiction can start in the ED. The pain scale is worthless. The age of the ‘candy man’ must end.

The rest of medicine cannot abdicate its responsibilities, expecting emergency medicine to stand in the gap like Atlas, holding it up, so that they can avoid call, avoid poor patients, avoid drunks and have a comfortable life. Remember when they thought our speciality was inferior? Odd that we can now do anything.

Thesis: We cannot be all specialties to all people, and we cannot carry medicine for the convenience and economic prosperity of others.

EMTALA must be reformed. It has cost lives, jobs and entire facilities. And it has, like all entitlements, bred dependency, irresponsibility and abuse. Whatever benefits it accrued have been washed away by a tidal wave of reckless, uncaring misuse of the great gift the government gave the public…the gift of our productivity.

Thesis: EMTALA results in theft and abuse. It has to be reformed, or medicine as we know it will be finished in America.

Customer service has a place, but must be re-defined. A person who steals from you, abuses you and/or assaults you, knowingly, must cease to be a customer. Their satisfaction surveys should be stapled to them as they are escorted to the door.

Thesis: Customer service is for customers; or at least those in actual need who conduct themselves in a civilized manner.

We cannot continue to be ‘too important to be valuable.’ Emergency departments have a critical mission, and if we are to continue that mission, we must have the support of the government, academia, administrators and our own specialty organizations. We need good PR and fast. And we need to be encouraged to do the right thing, despite what the satisfaction surveys say.

Thesis: Stand beside us, leaders, not behind us. We need help now more than ever!

On that topic, rather than telling physicians and nurses not to write/post/blog about their workplace experiences, administrators and employers would be wise to scan those writings for kernals of truth, and for trends that need to be addressed. Think of it as data gathered by spies…who live in the real world.

Thesis: Social media can serve as a useful weather-vain. Leaders should use it, not suppress it.

We should have protection against malpractice litigation when we see a patient for free. Or at least, we should be covered by the government who mandated that we do it in the first place.

Thesis: It’s no fair to be sued by someone you treated for free.

If not that, we should be allowed a tax credit for some percentage of the value of uncompensated care, at the end of each year.

Thesis: To the government: pay us, or give us tax breaks. It was your rule, now pay up!

Medicine is being crushed into the dust by the opinions of those who refuse to see the reality. Physicians cannot afford practices. ER’s cannot afford the staff they are mandated to have. Psychiatric patients flood our hallways, and their antics (real or contrived) diminish the quality of care we are able to give. Patients desiring disability, or feigning it, are draining our resources like leeches. Critical specialties and drugs are absent. And in the midst, we are told to do more with less. The end is truly in sight.

Thesis: Please listen! What we are saying isn’t burn-out, bitterness, greed or conservatism. It’s called reality, and it’s scary out their in the fox-holes of medicine!

Ingratitude is epidemic as we are expected to help everyone, at anytime, for nothing. A ‘right’ becomes an expectation which becomes a duty and then enslavement.

Thesis: No matter how hard you work for free, it’s rare to hear a ‘thank you’ when everyone feels entitled.

Too many agencies have access to our practices: state medical boards, specialty boards, Joint Commission, Institute of Medicine, CMS and various private consultants, all recommending things we know won’t work, but which we are powerless to resist.

Thesis: How about this agency: Commission to Defend Doctors against Agencies and Industry Consultants!! The CDDAAIC.

Physicians must stick together, in and across specialties. We must be kind and gracious to one another. And if we are not going to form a union, we should at least help one another out when it comes to rules and laws. They control us because they divide us like tribes.

Thesis: Physicians must help one another; because no one else thinks we need it.

Just because we complain, doesn’t mean we’re burnt out. If that were the case, reformers as divergent as Martin Luther and Martin Luther King, Jr. would have been merely burned out rabble rousers. Complaints, and dissatisfaction, mean something is wrong; badly wrong. We love our patients and our jobs, but things are spiraling out of control, and nowhere more than in America’s emergency departments.

Thesis: Telling the truth, even if it’s uncomfortable, isn’t burnout. And ignoring the truth isn’t tolerance; it’s cruel, hopeless apathy.

Feel free to post these around your hospital, for all to see. The Reformation of Medicine has to start sometime. Now is as good as any!

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