It seems that every day I work in the emergency department, I’m amazed by yet another hard reality of modern medicine.  One of the most striking is that a great many physicians don’t want to be physicians anymore.  I mean, they want the title and the money, but the hard work of being with people, caring for the sick, touching them, investing in them…well that’s a little too far off their radar.

Examples?  Primary care doctors who do a cursory exam and then send the patient to the ER for the ‘pre-admission’ physical by the ER doctor.  Read:  ‘I’m too busy to do this, so someone else needs to do the evaluation for me.’  Physical exam and history, connection, once the mainstay and high glory of primary care, too often considered an inconvenience.

Specialist?  How about surgeons for whom operating was once the greatest thrill of all, but who now put off the appendectomy for 12 hours to finish the office.  Surgeons who try to find every reason to transfer the trauma, or the kid, or the complicated anything, and who want to admit to internists and only consult.  Surgeons who want me to evaluate post-op complications.  In years past, a surgeon would chew your arm off if you removed the dressing he placed on his patient!

Cardiologists?  Cardiologists in smaller hospitals who find acute myocardial infarction, heart attack, to be a really annoying interruption to their day of diagnostic cardiac caths and stress tests, and who say of resuscitations:  ‘I’m too far away to make a difference.  do your best.’

Neurologists who don’t want to admit or treat strokes acutely, but want them admitted to someone else, or transferred out of town to ‘stroke centers.’

Pediatricians who don’t want to take call.  ER doctors who only want to order tests and call an admitting doctor, without actually evaluating the problem.

Neurosurgeons who would rather berate than operate.

I could go on and on.
But there are the patients, you see.  Patients who refuse to take any responsibility for themselves.  Who won’t buy the $4 prescription you make pains to write, so that they can get it at WalMart.  Patients who smoke two packs a day years after their expensive bypass surgery.  Pregnant children whose parents smile about the new grand-baby, then raise it themselves while their daughters become pregnant by yet another pimply faced teen or street thug; parents who raise those pimply-faced teens and thugs, and say ‘boys will be boys.’  All of them who say, ‘don’t you got nothing to give me for pain?  Lortab don’t do nothing for me!’  All of them who see the gift of free care given to them, not as a kindness, but as an entitlement which the government, or the rich, owe them.
College students addicted to ADHD drugs, and who sell them at finals.  Colleges who tell their students to keep having sex with whomever they want, irrespective of the explosion of STD’s that plague health departments, ER’s and student health clinics.

Young men and women desparate to get the magic golden ticket…disability!  High holy grail of all things.  Drunk drivers arrested and arrested and arrested, who cuss and fume and threaten the staff, but who don’t understand why they aren’t treated with mints on the pillow.

Even the insured, who in their insured comfort feel that all insurance has to do with a giant pot of money, and that anything they want should be ordered, because they want it. Generation after generation of men and women, boys and girls allowed to think that pills and procedures, X-rays and CT scans are the answer to their inner emptiness, and who seek those things like men once sought God.

And let’s not leave out the well-meaning administrators, politicians, policy-makers and social researchers, those separated from reality by a vast gulf filled with a thick, politically-correct, self-deceiving fog.  They  pontificate in board-rooms about equal access, and patient satisfaction; about through-put times and access, non-discrimination and sensitivity.  These people who go home at 5PM when the ER is still overwhelmed and trying to find places to put people against walls, so they can be watched with the barest margin of safety.  These administrators who can’t fathom how anyone might snap, lash-out, be unkind, abrupt or (Saints preserve us!) candid with their abusive fellow staff and patients.

See, it’s all melting down.  We have, indeed, some of the very best medical care in the entire world. But we’re destroying it.  Doctors abused by insurers and government rules, doctors spoiled and sometimes cold-hearted from a cold, mechanistic education.  Doctors who are so burnt out from the volume and demands of the current incarnation of socialism that they see patients not as suffering humans, not even as customers, but as assailants.

Patients refusing to be any part of their own well-being; patients wanting all the best of everything, all the time, with little to now investment of their own money.  ‘What, my own money for health?  Are you crazy?’

And a system of government madness, regulatory ineptitude, insurer abuse and administrative neglect and distance that glues it all together in a macabre collage of inefficiency.

Most of the doctors aren’t the problem.  Most of the patients aren’t the problem.  But there are significant numbers of both.  It doesn’t take much to bring down a system teetering like ours.

What will we do when the patients want to much, the doctors want to much, and no one has anything else to give?

I just don’t know.  I hope we figure it out before-hand.

Pray, hard, now that we keep having doctors, and health-care, in our country.

Edwin

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