Sorry for the rant that is about to occur but some recent events at our hospital have pushed me over the edge. The case the White Coat describes of being talked down to by an internist who doesn’t know his ass from a hole in the ground as to how to manage SVT/Rapid Afib helps emphasise my point. Now, before all you consultants start yelling at me for generalising, I will open by saying the there are MANY GREAT SPECIALISTS OUT THERE. I am personal friends with a number (ie we are friend outside of work) of them so I know there are good orthopods, plastic surgeons, general surgeons, etc practising in this country - this post is not directed towards you. However, there are plenty of crappy ones. Crappy in what way? Well, not necessarily because they don’t know what they are doing - but because they are either too lazy, greedy, or arrogant to DO THE RIGHT THING. Some guys (and for some reason, it is almost always male MD’s) will give about any excuse to not see a patient - be it insured or not. They simply could not be bothered (never mind they were either on call for unassigned patients or were specifically requested by a primary MD for a consult). Here are three cases in point that make my blood boil.
A. An extremely arrogant neurosurgeon overtly tells the ER attending AND the assistant director of the Dept or Medicine that he refuses to get off his lazy ass at 5 pm on a Sunday and help us tap a Ventricular/Intrathecal port (an access catheter in the skull that goes into the sac where the cerebrospinal fluid collects in the spinal canal - used in the delivery of drugs/chemotherapy) in an 45 year old insured patient (not that it should matter) with fever and altered mental status. Why? He just doesn’t want to come a do it, even though his group routinely inserts them. We should just figure out how to do it ourselves. (thankfully an passing-by oncologist previously uninvolved with the case was familiar with the catheter and helped us to tap it (take a CSF sample from it) - the patient wound up having meningitis). He was reported to the CEO of the hospital - but I sure nothing will happen since he is a big shot brain surgeon who generates a lot of dough for the hospital. Oh yeah, don’t forget he is GIVEN 2000 bucks to do a night of call by the hospital even if he never has to come in and see a patient (not that we have to call him very often thank God)!
B. An on-call oral surgeon comes in to see a patient with Ludwig’s Angina - a serious dental infection that spreads under the jaw and can cause loss of the airway, and upon seeing that the patient is “self pay”, says we should transfer him since he is “penniless” and could never afford to follow up with him in the office! When told by the ER doc that he cannot transfer a patient for that reason, he then turfs the case to ENT - who is understandably disgusted as well, but agrees to see the patient. By the time this happens 6 hours later, his infection has worsened and he has to go the ICU, get intubated and trached due to loss of his airway. FINALLY at this point the oral surgeon takes him to the OR - he is still trached and in the ICU three weeks later - this might have been avoided if he were operated on sooner.
C. A general surgeon refuses to see a patient who suffers abdominal trauma and a broken wrist after falling two stories onto the ground. The abdominal CT that was done by the ER showed some fluid (blood) in his pelvis and a clot-filled bladder but no “obvious” intra-abdominal injury”. He states over the phone that it is a case for urology and refuses to see the patient because there is “No surgical issue”. WTF!!! - the urologist eventually comes in and admits him - however the general surgeon finally sees the patient after being called by the Chief of the Dept of Surgery who we had to wake up at 4 am and make a report to. Why? Maybe because the patient was uninsured and was running from the police at the time of the fall.
Indeed, some disgusting examples of doctors not doing the right thing.
Canadian Pharmacy
I sure do hope that each of these surgeons were written up for quality screens…I don’t care if these patients were insured or not…each patient deserves to be seen and treated equally by the surgeon on-call…I don’t blame you one bit for being angry! I’m angry just reading your post!
KARMA, it will eventually get those doctors who feel they are better than the rest of the medical profession.
If you are the On-Call Doctor for your particular specialty in that particular ED then stop pissing and moaning and DO YOUR JOB. You were the one who went into this specialty and you knew what it in tales. That is early morning phones calls because someone needs your services.
Remember this is still a service base industry, don’t forget it!
I’ve been a doc for 35 years and I am sorry to say that I am completely disgusted with this kind of you-know-what. The “prima donna” lazy specialists should be disciplined, but they generally are not.
I understand your frustration with things on your end of things… but as a patient? The phrase “standard of care” springs to mind. As in “breach” of standard of care! I am thinking, in particular, of the trached, intubated man now taking up residence in the ICU. It is probably in the oral surgeon’s best interest that he NOT recover his vitality…
Unfortunately, this is the s#$t I deal with from docs and clinics every single day! Doing the right thing for the patients might cost them something- It sux!
Listening to it daily for the past 4 years has taken it’s toll on me mentally- It makes me really dislike
some docs!
OMG. It is disgusting. Is there any legislation that may prevent such things from happening? If we cannot fully rely on the morale, we need to do something about this.
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Not to condone the behavior here, but I’m sure it was the EMTALA legislation that has already been passed that generally makes physicians avoid the emergency room. Patients have the expectation of never paying, and doctors now have that expectation too (that most of their ER patients won’t pay them). Agreed, these physicians should simply not take call, but many, many physicians are forced to take call by their hospital so that they can operate in their hospital or admit patients.
BTW, try calling your local furnace repairman and telling them there is only a 30% chance he will get paid for the work he does after arriving! No matter how ‘good hearted’ you think he should be, will you blame him for not showing up?
The bottom line is, if the ER was a more reasonable place, economically, for the physicians, then many physicians would WANT to be on call. In this case, the ER docs could pick and choose who they wanted to do the consults and the best performers would ultimately win out over the bad performers. In other words, it would work with the remarkable efficiency that many other businesses do!
Yes,we all suffer with our flawed health care system. However, this is the way it is and as an MD, you have to DEAL WITH IT! It comes with the territory. Don’t like it, work in an office only and take no insurance. If you want to be on staff at a hospital, suck it up and deal with it. We all have to. I don’t get paid either for these cases yet I deal. Also, life threatening emergencies are not akin to a furnace not working. Ethically it is different. Heath care is not like any other service industry - the doc’s knew that when they first filled in that application for med school. It sucks, but that is the truth.
I don’t get it… are they on call? I mean, can a physician who is off call or just at home not answer his phone and get in the same trouble? Can a physician ever say no to something.?
I’m not familiar with medicine, so these are honest questions.
jimmy,
it’s hard to force someone to come in when they say “no.” you can encourage, cajole, beg, plead and threaten them, but if they just say no you are out of luck. The only good alternative is to have a good hospital staff who will demand accountability, or to actually file an EMTALA complaint, which is a nuclear weapon, and after the fact.
Yes, they were on call. And these were very reasonable cases for them to consult on. They were either too lazy, greedy, or both. And by the way, the case involving the neurosurgeon was with an insured patient so he was just being a lazy, arrogant, slug.
[…] AND at night and on weekends, either no one is around or available or….well, see this post and you will see what I am talking about. Anyway, transferring a patient is not as easy as calling […]
[…] did a post a little while ago about three instances where on call specialists refused to either come in and see or to treat patients in the ER. The […]
Oh dear,
I am so, so sorry to hear about those poor, rich doctors not getting a little money. My sinus tach heart with frequent PVC’s is breaking. Try having having responsibility over life and death for more than 12 hours straight making less money than the young lady who flosses my teeth.
I just saw an internist today about several issues I’ve been having for some time, my main concern being sudden onset lymphedema for 4 weeks. My foot has deep pitting edema and is so swollen that I cannot wear any shoes. I have been wearing my husband’s sandals, which are about 5 sizes too big. The doctor claimed he could not tell the difference between my normal foot and the swollen one. After trying to talk to him for 5 minutes and watching him try to squirm away, I mentioned that I have been on a strict diet for a month and have not lost a pound. He told me to “stop eating”. Not to eat less, but to completely stop eating. He said, “Just drink water all day and don’t eat at all. Don’t eat anything.” What?? What kind of doctor says that? I still have no answer for my edema, and he said to “just get used to it, because it will only get worse”. Doctors suck.
Maybe you just need a different doctor. Not all of them suck, although I’ve met a few who do — mostly older males, for some reason.
ok I think every profession has more than its share of lazy ‘tards. But as a profession that has a standard of “do no harm” that is so central to the profession its part of the oath you take to be a part of it some of these stories go past the line of lazy and into negligence.
Case 2 and poor guy who ended up tubed, trached and a much more extensive surgy and recovery should be suing the shit out of the refusing to be bothered doc.
It wont happen because and I am not saying folks dont sue when they shouldnt either looking for cash or just wanting to blame someone when a loved one died. The system we have sucks ass to be blunt. Last weeks Parade has a small article with Justice Scalia. He said something is fundamentally wrong with our legal system because of the sheer numbers of attorneys we need in America. It also doesnt help that the medical profession has its own blue wall of silence like in law enforcement.
You should be able to report the doc in case 2 to the state medical board which would be a public record and some malpractice shark would find it and get the injured patient to sue. IN a case like this it should be the doc paying not the hospital. But I realize the employer would find a reason to let you go if you were narcing out the incompetents to the unsuspecting public. You also wouldnt want to end up with a system where personal fueds/dislikes were pursued via anon whistleblowing.
I live in Texas and basically you are screwed if you want to screen your doc or hospital. They just started trying to tract prob indicating stats at the state level and the initial laws are far from robust. We also have newer malpractice laws where god help you if you need long term care after an incident because the max awards are tiny. I got run over snow skiing at age 8 my lumbars over 3 verts canted over opposite of the impact point on my right knee as far as they could go without snapping my spine. Took 6 months to get folks to take me to a orthopedist after the injury -told I had no medical prob yet it hurt to carry a 50 lb bag of animal feed. I lived on a farm and had 100 head of sheep for a 4-H project so I carried a LOT of 50 lb feed bags. Over 30 years later I still have issues with lower back pain.
Now doc in case one refused to do his job as an on call doc -so basically he refused o do his job so easy solution he DOESNT GET $2K to sit on his ass at home and/or sleep.
Doc in case 3 I do not know what the appropriate punishment should be. Even a layman can see why the consult in that case was warranted. But I am sure he had some consequences if an admin doc got a 4 am wakeup call over it. Even if it was just no raise when annual reviews came up.
AND finally I agree with 17 -lots of good docs out there-my family DO was a stellar doc-I use him as a eval tool when dealing with other ones. He always gave you the facts on your situation and then would when you had options to ponder told you what he would do if it was him or his kid ( I was his son’s age) and he was very willing to send you to specialist even when he was sure what your problem was. He also made the appointment for your while you were in the exam room-amazing how fast you could get into that other doc’s office that way.
And lets here it for the true little people too-lots of great staffers, therapists, and nurses out there.
What have we learned from this?
Don’t run from the police.
Especially if they are men - whatever the fuck that means.