That's not my problem…really?

Mankind is my business...but I'm not on call

Ebenezer:  But it was only that you were an honest man of business!

Jacob Marley:  BUSINESS?  Mankind was my business!  Their common welfare was my business!

In ‘A Christmas Carol,’ Marley is overwhelmed with remorse that he died without doing as much as he could for others, and that as a spirit, he is unable to comfort the suffering.  Subsequently, Ebenezer is launched on a search for a heart of compassion.

I wish that some physicians would have a midnight apparition that would shock them into reality.  Like the psychiatrist who, when asked for a consultation on a possibly suicidal patient, informed me that it was not his problem.  This despite his being on our staff.  ‘Why?’ I asked.  ‘Because then it will become a habit,’ his philosophic response.

It brings back my partner’s conversation with a regional ENT about a child’s throat abscess (a potentially airway-threatening event).  ‘That’s not my problem.’

Or the attempts to transfer patients when I didn’t have other particular specialists on call, when the predictable response was,  ‘Tell me how that’s my problem!’

Technically, it was true. A particular doctor may not have a direct (legally binding) duty to a particular patient; that doctor may not be on call for my facility.  But sometimes, we need help; sometimes our patients need help.  And the last thing anyone needs to hear, or say, is ‘that’s not my problem.’

Surely there is a more diplomatic, compassionate way to get the point across.  ‘I’m sorry, but I don’t think I should see that patient and here’s why.  But let me make some suggestions.’  Or even better, ‘I understand the problem, let me go ahead and help the patient; because humanity is my problem too!’

Maybe my perspective is perilously skewed.  After all, I can’t really avoid anything.  No matter what the problem, all anyone has to do is send ‘the problem’ to the emergency room and ‘Ouila!’, it’s my problem. From suicidal behavior to complicated evaluations that will run past the 5 PM office closing; from incidental high blood pressure in the free clinic to pre-litigation physicals (after rear-end accidents), to ‘pre-ICU stabilization,’  there’s not much that can’t be construed as the problem of the emergency department.

Fair enough.  I enjoy solving problems; I like being the guy with the answer.  I suspect it’s why many of us went into emergency care.  All I want is for everyone to take a bigger view, a more expansive view, of the problems of humanity.  Medicine will fall into ruin if we focus on a very narrow sense of our problems.

I’m not talking socialism here.  I’m talking about it’s remedy; it’s antithesis.  Socialism says that we really can’t trust individuals to do the right thing for the right reasons, so we should have the state assume the role of benevolence and do the ‘right thing’ all around (using, of course, the money and ability of everyone it can press into service).  Then, politicians who actually do very little can claim to have solved the problems that were actually solved by individuals coerced to do things ( things which they usually do poorly when coerced, by the way).

It reminds me of the time my partner received a call from a tiny hospital in Northeast Georgia.  They had a patient with a bad rattlesnake envenomation.  They had no antivenin; on the other hand, our small hospital in the boondocks of Upstate South Carolina had a bunch.  So, they sent their patient by air to our facility for treatment.  Did we have a legal, codified duty?  Was it my partner’s problem?  Hardly.  But he did the right thing and there was a good outcome.

No ‘Interstate Envenomation Commission’ was necessary.  No ‘Georgia-Carolina Snake-bite Consortium’ was established.  One doc and one hospital just did the right thing and said, ‘sure, I’ll make that my problem too!’

Many problems ‘aren’t my problem.’  And many problems, strictly speaking, aren’t yours.  But if we could work on them together, we might ease a lot of suffering and keep government at bay.

Those two goals are certainly on my own ‘problem list.’

Edwin