Monday, December 3, 2007

You Don't Have Cancer

During my 3rd year surgery rotation I was allowed to work in our “ED” for 2 weeks. While it was called an Emergency Room it was really nothing more than an urgent care clinic for the homeless and stupid, but it’s what we had. I had some thoughts of entering this field, but had been wavering since beginning my clinical rotations. The cases regularly seen by our department and the nature of the work soon wore on me and forever soured me against this specialty.

However, despite the absurd complaints, the runny noses, the drunks, and the pride-swallowing displays I saw on a regular basis there was one encounter that made me realize that EM was truly not suited for me.

I arrived, late one day due to a morning conference, and found the usually cheerful chairman in a very foul mood. Thinking that his anger was due to our tardiness I tried to explain where we’d been. He quickly told me he didn’t care, told me to see patients, and walked into an exam room.

A few minutes later, while talking to an EMT student, I heard this doctor and a patient yelling at one another in a room. The chair left the room, clearly upset, followed by a strung out, gaunt, crazy-looking woman crying afoul.

“You’re heartless! I have cancer! I have cancer and you’re not doing anything for me! I always get this for my pain! You’re an asshole. I’m calling your supervisor and getting you fired!”

Chair, turning around quickly, pointing his finger at her: “No you don’t! You do not have cancer, there is not a shred of proof you have (certain type of) cancer, and I don’t care anymore. Go ahead and complain, I’m the highest you’ll get in this department and I’m done listening to you!”

With that he turned, finishing her discharge. When she tried to yell at him further he threw his hand up, like a teen-aged girl expressing her worldly wisdom with a quick “talk to the hand” and summarily dismissed this woman. She, furious, stormed away, paper in hand, cursing loudly and threatening to sue the “whole fucking bunch of you assholes!”

I was slack jawed - amazed at this seeming display of physician cynicism and the fact that he had actually thrown up his hand to shut her up. An hour later, as he predicted after she left, an administrator came down to the ED with the patient and confronted him.

Admin: “Why didn’t you take this patient seriously? How can you be so certain that she doesn’t have cancer? I want you to take care of her and do as she requests.”

This was all said to the chairman of the ED, with the patient acting like a spoiled child, arms folded over he chest and displaying a most distasteful “I told you so look”, while the staff stood around, trying to look busy, but clearly watching to see what would transpire.

The chair didn’t budge. He called out the administrator, asked what degree he had that conferred upon him the power to diagnose this woman with cancer when several physicians agreed that there was no evidence, and told him to write the script himself because he would not – he was not a drug dealer. He then added that, if this was the type of support they could expect from the administration and CEO they’d been promised during their monthly meeting, this would be his last shift.

Of course the administrator, trying to remain calm but clearly unnerved, relented and informed the woman that, unfortunately, they would not be able to help her at this time. They walked away and a nurse said he was inviting her to fill out a survey in order to help “increase efficiency”.

Aside from the humorous and tragic aspect of this case, this settled any desire to enter emerg for me. There was no way that I would tolerate that kind of abuse, by people who held MBAs or MPHs and knew nothing of actual medicine and only cared about customer service and maintaining a "hotel" image. There was no way I could stand up to that form of degradation regularly and feel that my sacrifices had been worth it. Medicine is not in the business of letting people "have it their way" only to get sued for complications. While it's not for me, I applaud anyone who can look at that on a daily basis and come back for more.


Ladyk73 said...

hey.....I was one of those mba/mph types at a clinic....I never did that, and I reamed our ceo a new one if she did. As the head of finance, me and the clinic boss always had each others back. I did not try to practice med, my clinicians supported our crazy chart billing audits

MedStudentGod (MSG) said...

Nothing against MBA or MPH, as long as you stick to what you're trained to do. I think a lot of hospital doctors are finding these administrators less than restricted about where they tread and what they request. In all honesty, what do I know about running a business and what do they know about practicing medicine (actual medicine and not the business aspect)?

It's always good when each party recognizes where the other has authority and doesn't try to intervene. It makes for a better work environment.

Anonymous said...

Sounds like a typical ER doc to me - uncaring and just mean. How could he know that she wasn't in pain? How did they know she didn't have cancer that might be in remission? If you were anything like this then I'm glad you got out of the ER.

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