Viewpoint: A Letter to the Country from an Emergency Physician

Viewpoint: A Letter to the Country from an Emergency Physician

Jacobson, Michael E. DO



Author Information



Dr. Jacobson is a graduate of Kansas City University of Medicine and Biosciences and the emergency medicine residency at Henry Ford Macomb Hospital in Warren, MI. He lives with his wife and four children in Omaha, NE.


Dear America,



I am an emergency physician with an apolitical message in this rather politically charged, polarized time in our country. I have worked for some time in this profession, and have noticed a disturbing trend about which I must speak out — the growing number of emergency department scenarios in which the selfishness and entitlement of those without real emergencies drown out the quiet suffering of those in real need.

This morning a middle-aged woman came into the emergency room in cardiac arrest. ACLS was performed to keep her alive. Other patients were in the ED before she even arrived, certainly with what they felt were emergencies, but treatments for these individuals were placed on hold as this event took precedence. After 75 minutes of continual heroic measures and life-saving interventions, with her grief-stricken husband crying, holding her hand for the last time, and stroking her face, she died.

This was no movie, no reality TV show. This was as real as it gets. Real life and real death. Family huddled around the bed to say their goodbyes and wished they or we could have done more.

I walked to my office, emotionally drained and exhausted, and from across the emergency department another patient, upset that she had to wait, spoke out brashly in tones that carried to every room in the department. “I know someone's dying and all, but I am in real pain here.”

What most of America don't know is the emergency department staff are graded with a nationally based report card by hospital administration. A survey is sent only to those who are discharged from the ED, not to those who actually needed admission to the hospital for an emergency or to those, like this new widower, whose loved one passed. This survey is a customer service tool used to see if people like coming to our ED and asks whether we did a good job. The ED staff know this survey is skewed because of the population to which it is sent, and certainly it is not the only tool hospital administrators use to evaluate us. That is another topic for another time.

But you must understand, the real emergencies are rarely graded or surveyed; they only go to those vast hoards of folks who were sent home, many of whom did not get their narcotic medication refilled, like Ms. “I'm-in-real-pain-here” who screamed her needs for all to hear, just within earshot of a new widower.

Mitt Romney recently was secretly taped speaking to his party base about the 47 percent of the nation that feels entitled to health care, to homes, to handouts, and to ever-present help from the government. If this lady represents that 47 percent, I have a few things to say.

The widower and his wife were also in need of care and financial aid. They came to the hospital for emergency care and received it. He was gracious about it, even when the scenario ended in a way he did not want. He and his family were thankful for the care. They will not be asked how they felt the care was, but screamer lady will be. It is doubtful that screamer lady would have been happy short a lifetime supply of narcotics, free ambulance rides, meals, and immediate gratification of all perceived needs. In fact, she and her friend raided the refrigerator for food and beverages without asking permission of staff or being cleared for eating or drinking prior to her labs and tests returning.

This widower and his family behaved in a way that acknowledged that there were others in the ED. They realized a limited but adequate number of doctors and staff were available. They were calm in the face of a real emergency, but never acted as though the world should stop for them, even though it ended tragically. They knew how to play fair even though their real emergency was not fair.

We live in a society that David McCullough Jr. describes as rewarding mediocrity because everything fairness and equality. Everyone is special, so nobody is. Everyone should get a prize for participating. And even though Johnny didn't win, we're going to give him a trophy for trying because he is special, too. Competition is bad because there is a winner and loser, and that's not fair. This fundamentally wrong notion breeds false equality and ultimately false fairness and entitlement. We do no one a favor by preaching this. We are lazy parents if we can't find a constructive way to celebrate the winner and help our children be happy for him. Instead, we have chosen an easier road: to make all things fair and equal. If nothing can rise above, be more important, or be first, then all must be mediocre. If all must be fair and equal, all will assume the position of being just as important and just as entitled as everyone else despite the real emergency or the real need.

The government mandates I evaluate and treat everyone who steps foot in our emergency department, regardless of the ability to pay or the acuity of the complaint. The government has passed health care legislation that makes it so everyone must have insurance. Now everyone is equal, everyone is the same — the broken physically, the broken emotionally, the broken spiritually, the broken psychologically, and even the broken culturally. Many have primary care doctors, but they storm the ED at 2 a.m. with the Burger King entitlement of having it their way rather than waiting for their own doctor to see them the following day. They will demand to be treated equally regardless of the acuity of their emergency. And you know what? They will probably get it because we don't want a bad report card from the feel-goods upstairs intent on establishing great PR or the lawyers who will use government mandates to take away your pain and make the other guy pay.
Were I to say something to screamer lady about her behavior, she likely would fall back on the clichéd finger-pointing canard, and say, “You're a doctor. You are well off. You don't understand. You can't relate. And you are the one responsible for the high cost of health care. It's your fault.”

As a young, married medical student, my family and I participated in Medicaid because having insurance was a requirement for my rather expensive medical school. I felt grateful, not entitled, to be able to sign up for the program. I know poverty in America because I lived it for a decade despite help from family. Government programs can help for a time. But know this, I spent my high school years working on grades and homework and at a job. I went to four years of college, working on grades and a job. I went to four years of medical school working on grades and leaning on the government for help, which I am now paying back. Then, I worked four years as a resident on call, on 12- or 36-hour shifts with just enough sleep to go back and start again. Now I work. And I work. Work and making good life decisions result in prosperity. No one — I repeat, no one — becomes prosperous on government programs. Student loans, food stamps, Medicaid, and unemployment benefits are there to help temporarily, but for heaven's sake, government aid is not a right and living your life like you are entitled to eternal government care is not right.

Anyone who wants to can go to school for 12 more years after high school and work, incur student loan debt, drive a 14-year-old car for 12 years, and study (while passing on TV, movies, parties, conversation, family life, sleep, and eating to study some more). They can then make a living that buys a nice home, clothes, insurance for family, and, hey, a new car. Anyone who can work can do this. And I'm all for government help for those who, through no fault of their own (and not their poor choices), can't work.

This woman, however, would reach into my pocket and take my hard-earned money while tapping impatiently on my watch to give her more of my immediate time and attention when others need it more, still claiming I am a cold-blooded heartless rich guy intent on robbing her of all the government assistance that is her due while simultaneously stiffing the hospital for what she considers an unconscionable medical bill. I am not cold-blooded or heartless, just tired and beat from the work I do and proud and gratified that I can do it. The same is possible for anyone here in the land of opportunity.

Are we so far gone as a society, in the name of popular progressivism, that we now don't view work as something to be valued, specifically when the work requirement is removed from the welfare bill? Are we so far gone as a nation that we vilify someone for their hard-earned wealth and elect a national leader who believes in taking that away to pay for those who would act as drains and not aquifers to the national pool of prosperity? Have we developed a national mindset that makes it normal to expect others to take care of us?
I think we develop a self-absorption that is callous in the face of anyone else's need when we rely on the government to handle our every need. No respect. No decency, no restraint, no responsibility, and no apology for it.

Frankly, our government cannot fix this, they cannot mandate a solution to this, and they cannot legislate against this. Nor should they. The solution to selfishness and entitlement can only be fixed with a mother and father (who know how to model character) teaching a child that work is hard and rewarding, that life is not fair and never will be, and that the freedoms you enjoy in this life are because someone else paid the price. Get up and get fixing.


Sincerely,
Michael E. Jacobson, DO

I work for one of the companies that sends those survey's to hospitals and ER's. I have seen survey's like screaming ladies completed. The entitlement mentality just leaches off the completed survey with arrogance and egomania.

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the freedoms you enjoy in this life are because someone else paid the price.

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Mildly reminiscent of a recent sentiment by a well known politico "you didn't build that".

I would be more impressed with medical doctors as a class if they didn't find it necessary to go through a business agent to treat their patients. The function of the business agent is to isolate the doctor from performing according to his oath based upon ability to pay.

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Originally Posted by palani

Mildly reminiscent of a recent sentiment by a well known politico "you didn't build that".

I would be more impressed with medical doctors as a class if they didn't find it necessary to go through a business agent to treat their patients. The function of the business agent is to isolate the doctor from performing according to his oath based upon ability to pay.

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The problem is that there is an undeclared trench war going on, as doctors attempt to insulate themselves from entitled patients who demand more and more free services and medical care "rights." To the idealist, medical care should be provided freely to those in need without any consideration of means. In reality, we as individuals have very disparate opinions about what constitute "needs" versus "wants." And any service that is provided freely without being priced appropriately soon deteriorates and eventually ceases to function at all. Only those of independent means are able to give of themselves freely without need for compensation. There aren't nearly enough of said people to care for the entire population.

I saw the Exact same scenario play out my hospital about 2 weeks ago.

This doc had it nailed right down to the fridge raiders.

And to think: this is before national healthcare takes over

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Originally Posted by mamboni

The problem is that there is an undeclared trench war going on, as doctors attempt to insulate themselves from entitled patients who demand more and more free services and medical care "rights."

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The medical profession as a whole (including pharmaceuticals) has a policy of treating the symptom rather than the disease. If there is a crisis it is because the crisis was created. Few people get cured. Many people get treated. This is less true of the Emergency staff than the rest of the profession.

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Originally Posted by mamboni

The problem is that there is an undeclared trench war going on, as doctors attempt to insulate themselves from entitled patients who demand more and more free services and medical care "rights." To the idealist, medical care should be provided freely to those in need without any consideration of means. In reality, we as individuals have very disparate opinions about what constitute "needs" versus "wants." And any service that is provided freely without being priced appropriately soon deteriorates and eventually ceases to function at all. Only those of independent means are able to give of themselves freely without need for compensation. There aren't nearly enough of said people to care for the entire population.

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Not to mention that those who have become doctors expended a lot of time, effort, energy, and money to get there.

This 'the world owes me, I deserve it' mentality is what's destroying this country - and Zero is leading the charge.

Where's MY Obamaphone?

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Originally Posted by palani

The medical profession as a whole (including pharmaceuticals) has a policy of treating the symptom rather than the disease. If there is a crisis it is because the crisis was created. Few people get cured. Many people get treated. This is less true of the Emergency staff than the rest of the profession.

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No argument from me on your first point. Isn't it remarkable how the people so vehemently demand our crappy "symptoms only" bandaid care though.

It's funny I work in a very liberal company (there are a few of us who don't believe in the all should be paid for by government.) When health care passed, I had a conversation with a department head who was very pleased that it passed. He said that's the way it should be. I responded so you're saying that hospitals have a right to the companies services? He said well no. I said so how is that different then giving a blanket to the populace who already has an entitlement mentality to say you have free health care? You're basically agreeing to commit doctors to indentured servitude. He got pissed and was adamant that it wasn't slavery.

I said not on it's face, but you're agreeing with the Administration that people have a right to someones skill, labor, talents and services. Name me any other service where you have a right to it? Nothing in this world is entitled. The only rights you have are the ones you are born with. I work in I.T. and you don't have a right to my labor, skill, talent or services without paying for it.

I just got a blank stare like he never thought of it that way. I love hitting people in the face with a cement truck of truth.

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Originally Posted by Ares

Name me any other service where you have a right to it? Nothing in this world is entitled.

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Doctors are in the same class as lawyers. They can maintain no action in their fees.

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Those indeed practiced gratis, for honour merely, or at most for the fake of gaining influence: and so likewise it is established with us , that a counsel can maintain no action for his fees; which are given, not as locatio vel conductio, but as quiddam honorarium; not as a salary or hire, but as a mere gratuity, which a counsellor cannot demand without doing wrong to his reputation: as is also laid down with regard to advocates in the civil lawe , whose honorarium was directed by a decree of the senate not to exceed in any cafe ten thoufand sesterces, or about 80 l. of English money.

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Honorarium is a tip. Like you would tip a waiter.

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Originally Posted by Ares

It's funny I work in a very liberal company (there are a few of us who don't believe in the all should be paid for by government.) When health care passed, I had a conversation with a department head who was very pleased that it passed. He said that's the way it should be. I responded so you're saying that hospitals have a right to the companies services? He said well no. I said so how is that different then giving a blanket to the populace who already has an entitlement mentality to say you have free health care? You're basically agreeing to commit doctors to indentured servitude. He got pissed and was adamant that it wasn't slavery.

I said not on it's face, but you're agreeing with the Administration that people have a right to someones skill, labor, talents and services. Name me any other service where you have a right to it? Nothing in this world is entitled. The only rights you have are the ones you are born with. I work in I.T. and you don't have a right to my labor, skill, talent or services without paying for it.

I just got a blank stare like he never thought of it that way. I love hitting people in the face with a cement truck of truth.

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Yep, it all depends on who's ox is getting gored, doesn't it.

It is my experience that the best, and fastest, way to get emergency care is to be bleeding when you walk in.

First post of the day............good morning to one and all.

V

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Originally Posted by Ponce

It is my experience that the best, and fastest, way to get emergency care is to be bleeding when you walk in.

First post of the day............good morning to one and all.

V

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Yes, walking into the ER with pulsatile blood shooting out of one's head or other body part of choice will usually get you prompt attention.;D

i went in to the er once becauuse i slipped on the ice in the parking lot of the hospital right outside the er door. the bus shuttle guy saw it happen, and he made me go in. i guess they were trained to make you do this in case of lawsuits. anyway, i mentioned my chest hurt (from falling down on my arm). i didn't even get to the explanation of why my chest hurt. as soon as they heard "chest hurt" the er staff flipped out and immediately took me in back. so, if you ever need fast attention, just remember those key words.

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Originally Posted by Ponce

It is my experience that the best, and fastest, way to get emergency care is to be bleeding when you walk in.

First post of the day............good morning to one and all.

V

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Actually, a faster way is to have an ambulance transport you there, which unfortunately adds another layer of expensive cost.

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Originally Posted by Sparky

Actually, a faster way is to have an ambulance transport you there, which unfortunately adds another layer of expensive cost.

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That's kind of like having the porter at the airport take your luggage to the front of the line.