A few things hit me yesterday, so I thought I’d share them with you.

1)  We have a new rule in the hospital.  No ultrasounds after 5PM unless it’s for testicular torsion, ovarian torsion or ectopic pregnancy.  (Things which can result in loss of an organ with resultant infertility,  or death in the case of ectopic).  Why?  The ultrasound techs are a scarce commodity and are tired of being called in too often.  Mind you, we can only do very limited ultrasound ourselves, and aren’t allowed to bill for ultrasound as ER docs, because our radiologists ‘have an exclusive contract.’  So, if you need an ultrasound for, say, blood clot in the leg (DVT), you have to wait until morning.

There’s a lesson here, as we ask ‘why aren’t there more doctors!  We need more doctors!’  The lesson is this: scarcity is power.  The techs threatened to quit unless things weren’t more favorable for their work environment.  Hmm.  Is there a lesson here for physicians?

2)  Some patients have recently said to my partners, ‘I will have my way!’  They demanded inappropriate lab tests.  Whatever health-care reform does, one of it’s worst consequences (and also a consequence of our coddling of everyone under the banner of customer satisfaction) is the general belief that the emergency department is a great big medical restaurant where you order what you want and the staff will scurry about bringing you ice, peanut butter and CT scans on demand.  That behavior, as we say, ‘has got to stop.’

3)  Mental health is in a state of crisis.  Many with severe mental illness are going without treatment due to economic constraints.  And many who say that they have mental illness are MANIPULATING THE SYSTEM. One recently told my partner, ‘I’m not suicidal, I just said that to get back in the ER faster.’  I’ve heard the same.  ‘I didn’t mean that, I was just upset.’  You see, upset isn’t a mental illness.  And if you’re unhappy over your job or your family, you  might have reasons to be.  But that doesn’t necessarily constitute mental illness.  And if you feel guilty over scummy things you’ve done, with a few exceptions, you don’t need a pill.  You need to repent, apologize and change.

Good grief, we can’t all have mental illness.  Somebody has to remain sane enough to fill out the forms!

4)  The catchword of the decade is ‘benefits.’  Everyone wants a good job with benefits.  Especially those choice state and federal jobs with great retirements and health insurance.  But make sure to spread the word; those are funded by the evil, money-grubbing private sector.  By people with businesses (physicians for example) who pay their employees’ benefits and who pay taxes to pay those state and federal benefits.

See above:  we can’t all just ‘get benefits.’  Some of us have to keep making  money to pay for them.

Well, I feel better.  Have a great day, dear reader, and keep the faith.


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