150 people in an auditorium, I asked the prof a question, and then pointed out when he responded that his explanation didn't match the book or some such 2nd-year med student snarkiness. I got, in response, a long, loud, diatribe about how we were the most entitled bunch of whining babies he had ever seen come through the school. I achieved enough notoriety that some smart fellow yelled out to tell the doctor, quick, as I went up to read my match day assignment.

I was hurt at the time; I had worked hard to get there--working full-time and completing pre-reqs as well while trying to see my newborn daughter every once and a while--and he was telling me I was entitled?

But now that I've seen more patients, and seen more of the system, I see that I was--admittedly a bit spoiled--but also just the last straw for an ID doc who was sick of people whining about wanting antibiotics, vaccines causing autism, people not doing their jobs and patients wanting more, better, faster, and cheaper.

Over at M.D.O.D., the posters have little, if any, patience left for the people we treat as a community, who think health care is a right, and that anything less than perfect, enjoyable care is not good enough. This goes in line with the 'quality' movement sweeping through health care based loosely on the six-sigma line of thinking.

I don't know yet how much this affects the field. I will note, however, that the ED I'm about to begin training at has all private rooms, with flat screens and cable TV in each one. I'll also note that they hand out consumer satisfaction surveys to patients. In theory, this may sound great. In practice, it worries me.

Patients are not customers. Putting cable TV in the rooms certainly improves the wait, I'm sure, but aren't we sending the wrong message? When we spent trillions on health care with only so-so outcomes, are flat screen TVs really where we should put our money?

I happen to favor national health care a la the system seen in the UK, the NHS. However, I also acknowledge that this is often advocated in a very indignant way, as if it is an injustice that we don't yet have it. I used to feel the same way. How can the US, which is so advanced and spends so much money, not yet have universal care? Being a schizoid combination of realism and idealism, I like the idea of universal health care, but having watched our government screw up a lot of other things--public education, welfare, land management, and so on--I'm pretty sure we'd screw up health care, too. Instead of decreasing idiotic subjective meaningless griping surveys, it would probably increase them, and JCAHO would metastasize, becoming totally inoperable.

We are becoming a nation entitled. They say it's bad parenting now to tell your children that there are starving kids in Africa that would gladly eat those carrot sticks, but isn't it totally true?

We should tell patients that, too. You just waltzed into this ED at 2 am because you need a refill on your Percocet and got seen within an hour while you sat in your private room and watched the Top Chef marathon on the Food Channel. You personally will not be charged for this visit because we won't be able to find you, and because I am totally exhausted you might even get some narcs out of me. Then, you'll complain how I wasn't compassionate enough on the survey the nurse is required to hand you, knowing full well that the parent of the pediatric resuscitation that went perfectly down the hall won't have the time or energy to fill out a survey because they have more important things to worry about. There are patients in Africa who would gladly take this level of health care.

It's nice going into residency being pre-jaded. At least I won't feel the pain of my ideals burning away.


dr_dredd said...

How true it is.

Oh, by the way, I love your tag line, "I Matched! I Matched..." I didn't blog as an intern, but mine would have been, "Help! Someone call a doctor... oh, wait... that's me. We're all doomed!" :-)

Good luck with your residency.

tyro said...

Thanks! I'll need it. A friend who is a 3rd year the other day was like, 'aren't you excited, you're almost done!' and my response was, 'sure, but a bit terrified, too...actually having 'MD' after my name...'

Anonymous said...

You write about how the drug seekers irritated you....and you still want an England style NHS???!?!?!? WTF
Oh thats right you are a gen xyz baby. You still haven't grown up. Shoot, and all those hours spent in the ER rotation didn't teach you anything? Or you didn't have your eyes open? I would suggest that you follow some sage advice I received from an old firefighter...."boy, the first year you keep your fucking mouth shut, and we'll let you get to your second year"
Have a great life doctoring them thar folks up.


tyro said...

Anon, good quote from the fireman. Of course, if I kept my mouth shut, it'd be a boring blog!

Reminds me of Point Break: "You know nothing. In fact, you know less than nothing. If you knew that you knew nothing, then that would be something, but you don't."

My point was we're a nation entitled and that includes our somewhat naive yearning, often at the student level, for universal health care, but we also want access at all times to everything. This is the standard reason people argue against universal care--wait times and rationing. We can't have it both ways, but I'm not totally convinced that nationalized health care is so evil.

On that point, my annoyance at drug-seekers has little, if anything, to do with the structure of care. You think there would be fewer drug-seekers or more based on what coverage they had? I don't think so, but, as you point out, I'm still a rookie, for sure. Talk to me in two or three years--or read about my slow transformation into a wizened curmudgeon. :)