I’m Back

Took a little break from writing.  Maybe I got tired of hearing my own voice.  Maybe I was fed up.  I had the urge to bang out an article many times and just as many times I looked outside at the sun and decided to go mountain biking instead…or take the dog to the pond…or do anything but bay uselessly at the Internet moon.

They say that writing is therapeutic but I find it the opposite.  It may have been pleasant initially but writing eventually became a tortuous obsession to which I sacrificed sleep, family time, and maybe even a little perspective.  My blog contributed to my divorce and maybe I could have used the sleep, especially because, as you may recall, I was a sleep-deprived resident when my blog was at its peak.

And I must confess that the absurdity of American Medicine has finally overwhelmed me and I have come to accept that it is just a smaller part of the rapidly accelerating absurdity of American life.  I work pretty hard and though it is not uncommon to for me to see forty patients in a 12-hour shift (with my record being 52) and although I often walk into the department with everyone in a panic because four ambulances have jsut rolled in and the department is packed with a full-to-capacity waiting room, three of the ambulances are non-acute patients with a little bit of stomach flu, the fourth is a routine elderly chest pain resolved with one sub-lingual nitroglycerin, and the waiting room is mostly colds and back pain.

I’m not exactly saving the world.  Out of forty patients maybe ten have medical problems that really need to be addressed and four have real emergencies.  I’m kind of naive so one day, after examining a well-looking twenty-year old and finding absolutely nothing wrong I realized that he had waited three hours to be seen because it was Sunday night and he wanted a work excuse.

You can do that nowadays.  Tie up a nurse and a doctor for twenty minutes without having to pay a dime just to get a work note, or a pregnancy test, or drugs, or any and all kinds of things that do not need this kind of attention.  And nobody cares who can do anything about it, locked as we are in the suffocating coils of the bureaucracy and the lawyers.  We are a nation now fit for nothing but decline, led by the worthless and directed by the likes of those overweight blue-shirted TSA agents who through some kind of utterly bizarre logic strip-search a mother with her three toddlers, chemically test her formula to make sure that this harried suburbanite from Des Moines has not substituted Semtex for her Enfamil, and completely ignore a big, dangerous-looking, unshaven guy like me.

Trouble…in River City

We’ve got trouble.  Big trouble.  Wait times are up.  Patient satisfaction scores are down.  Way down.  How can this be?  Didn’t you get the memo?  Didn’t you read out new carefully crafted mission statement?  Did you not internalize our focus-group approved  mnemonic to help you remember the steps to a productive customer-providor encounter?   Have we not tried to help you?  Didn’t we buy you a restaurant based electronic medical record system?  Do you not appreciate the simple utility of being asked after every order if you’re sure, really sure, and to review every possible interaction of with every possible drug on the customers medication list?  It must be an improvement over simply writing the order down on the pink sheet and giving it to the clerk…sure it only took thirty seconds that way but my God! Think of the interactions!  Got to be safe and if someone’s going down, it’s not going to be us.

Move faster.  We advertised all over town that we would see the customers in thirty minutes or less and I’m sorry you only found out about it when your mother saw it on a billboard but you’ve got to move faster. Maybe get a rollerball pen so you can scribble faster on all of those new forms, particularly the one that verifies that you really did mean what you ordered.  The lawyers asked for that one…to clearly delineate that you are solely responsible for all regrettable errors.   We also like to keep you jumping between paper and computer.  Computers are cool because they eliminate error but we’re still going to make you hand copy medications onto the admission orders because this will help eliminate errors.

And how do you like the paperless ER?  We’re working on it and should have every vestige of paper abolished by the end of this century.  In the meantime we ask you to tolerate a brief surge of paperwork. An extra five minutes here or there isn’t much.  The patients can wait