I stumbled upon this man’s blog through a physician’s web site called Sermo. More about that another time. This is from a post called: “ER: Theses for an Emergency (Medicine) Reformation”
I’m certainly no Martin Luther, though I think he was a very cool guy. And in medicine, there’s now place to nail my theses, as Luther did in Wittenberg, and so spark a reformation. But if there were, here are a few of the things I’d say.
Physicians and nurses are weary of being the victims of assault and abuse at work, all the while perceiving that their hospitals and employers are more concerned with the rights and safety of the assailants. Shame on you, if you allowed your staff to be abused while you worried about the criminal who attacked them!
Thesis: Medical providers are under attack and need protection more than their attackers.
In all likelihood, physicians practicing full time emergency medicine don’t need to be recertified by board exams or anything else. And they may not even need documented CME. Actually practicing is its own education, day in, day out and year after year. They actually look things up and learn on the job.
Thesis: We practice medicine on real patients, and learn as we go. No more tests, no more hoops.
The pain scale, and the entire pain management culture, is (to quote my children) an ‘Epic Fail.’ It has led to addiction, abuse, dysfunction, disability, staggering cost in confabulated complaints and worst of all, unnecessary deaths from prescription medications. Regulatory panels and advisory groups need to stop wringing their hands and listen to the reality of people like us, who are asked, on every shift, ‘can I have more pain pills?’
Thesis: Narcotic abuse and addiction can start in the ED. The pain scale is worthless. The age of the ‘candy man’ must end.
The rest of medicine cannot abdicate its responsibilities, expecting emergency medicine to stand in the gap like Atlas, holding it up, so that they can avoid call, avoid poor patients, avoid drunks and have a comfortable life. Remember when they thought our speciality was inferior? Odd that we can now do anything.
Thesis: We cannot be all specialties to all people, and we cannot carry medicine for the convenience and economic prosperity of others.
EMTALA must be reformed. It has cost lives, jobs and entire facilities. And it has, like all entitlements, bred dependency, irresponsibility and abuse. Whatever benefits it accrued have been washed away by a tidal wave of reckless, uncaring misuse of the great gift the government gave the public…the gift of our productivity.
Thesis: EMTALA results in theft and abuse. It has to be reformed, or medicine as we know it will be finished in America.
Customer service has a place, but must be re-defined. A person who steals from you, abuses you and/or assaults you, knowingly, must cease to be a customer. Their satisfaction surveys should be stapled to them as they are escorted to the door.
To read the rest, go here: