20 December 2007

Hatin' on the patients

Commenter JimII writes:
So, here's my question, do all doctors hate their patients? Or is it just ER doctors, or is it ER doctors who blog? It is funny because it is clear that Movin' Meat is an Oasis in the blogosphere desert of hate that is ER blogging, but it has nonetheless opened my eyes to the people being glorified every night on the TeeVee and lauded by popular culture. The hatred of the poor is particularly obnoxious. The constant snark about people with publicly funded insurance really bothers me.

I think JimII has a pretty valid point. I try real real hard not to slide down the slippery slope of contempt and hate towards my patients. But the truth cannot be denied that the ER is a particularly effective bottom filter of society. And that ER patients frequently are nutty, or self-destructive, and drug-addicted or alcoholic, or just malignant, manipulative abusers of the system. Medicaid patients, in particular, utilize the ER too frequently and for inappropriate purposes.

So I get it. ER patients are maddening (at least a significant subset of them), and one's blog is a great place to vent about them, as I did today over at MedPage. After all, isn't ranting what blogs are all about? I can, however, see how some people might interpret the ranting as excessive, and there have been times where, reading other medbloggers' posts, I have felt distinctly uncomfortable at the demonization of their patients. I'm not sure where the line is that separates a mordant sense of humor and a bleak cynicism from outright contempt. I often worry that I am crossing that line. There are some blogs that I just don't visit anymore because they were far enough over the line that I couldn't enjoy reading them. There are some blogs that seem to skate back and forth across the line on a daily basis.

I do remember one time in medical school, when I was very frustrated trying to care for an ornery patient at the VA, when a senior resident took me aside and told me that, "sometimes, it's OK to hate your patients." It was something of a seminal moment for me. Prior to that I had the wide-eyed naive idea that I would enjoy and like all of them, I think. Getting permission to dislike my patients was a big step in learning that clinical detachment that is essential to this job.

Having been given that permission, though, it can be a challenge to keep it in check.


  1. I'm still really perplexed by JimII's desire as a Christian to rag on ER staff vs. pretty much anyone or anything in the world that's, you know, not contributing to the good of society. I don't think he makes any good points at all.


    He's comparing ER physicians and nurses to like, I dunno, gangsters and drugged-up celebrities who are oftentimes inappropriately glorified in popular culture.

    I think Jim needs to see a proctologist and get that stick looked at.

  2. I think venting of frustration at ER patients is a symptom of having faith in humanity, and of constantly hoping for a modicum of coping skill. Once I got over that, I no longer felt the need to vent. Instead, it's "how can I make your ED stay better?"

  3. One of the best parts about blogging is you get to be honest.

  4. As someone who does not work in the medical field, but has family members who do, I get that doctors and nurses need to vent about their jobs (which means the patients). These blogs are places to unburden themselves of the worst of what they encounter. Reader beware.

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  6. Nurse K:
    Since you are a good example of a whining ER staff blogger I don't expect you are "perplexed". Why don't you take a good long look at your writings.

    PS: Proctology is an outdated and rarely used term that you appear not to even know what it means. Why do you want to have a colorectal surgeon look at Jimi's penis? You do know what a urologist is correct?

  7. Sheesh, anonymi are stupid.

    You do know what a urologist is correct?

    Yep. But I would think they would laugh at a physician who referred them a patient with a stick up his a*s.

    Since Anonymous is not abreast of current idiomatic (not to be confused with "idiotic", he seems clearly aware of that) American English, I shall clarify that someone with a "stick up their a*s" has no sense of humor, lacks any ability to recognize humor, and is so anal retentive there is no way that stick is coming out without surgical intervention.

    It is worrisome that he is thinking so much about JimII's penis. I'm talking about attitude, and Anon is hyper-focused on another man's sex organ.

    Not that there's anything wrong with that.

  8. Is a comment from a random non-healthcare-professional who often reads medical blogs ok? (I'll be nice!)

    Nothing wrong with being aggravated with patients who are difficult and demanding. Or with complaining about them on your blog. That's what blogs are for. And certainly human idiocy can be funny.

    I think it's unfortunate when those patients condition you to resent (even hate) ALL patients regardless of how they act. Same thing can happen with retail clerks or anyone who deals with the public as part of their job.

    Nonetheless, that's a common occurrence, so savvy patients should EXPECT that their doctors feel resentment and annoyance toward them, and accept that as the way things are. JimII has unrealistic expectations. It's not the doctor's job to be nice to you or like you.

    I'm not speaking specifically of the ER 'cause I have no idea what goes on there. Well, I've been a couple of times but was so out of it I didn't know or care how my doctors may have treated me.

  9. Nurse K,

    I don't think ER nurses and doctors are loathsome or useless members of society. I am grateful we live in a society that has people who do the job you do.

    On the other hand, I don't think medical professionals do thankless, unappreciated work either. To the contrary, medical professionals are very well regarded in our society and very well compensated for their work. (Bitter much? Probably) So, feel free to continue to be disgusted with my opinions; I just wanted to clarify what I think that you should find disgusting.

    You also noted I was a Christian. On that front, you should know that if you help people, but with an evil heart, you might as well not help people. At least, that's the idea found in the Sermon on the Mount.

    Furthermore, nurses and doctors are powerful people. Welfare recipients are not. So, as a Christian, I'm inclined to stick up for the welfare recipient who has the nerve to use your service, even to the point of overlooking the negative impact of their overuse.

    Conclusion: I don't think ER bloggers are gangsters or druggies; hearing their contempt for the people they help lowers my opinion of them nontheless; I will have the stick and/or bug up my ass looked at, but probably after the holidays.


  10. By the way, "evil heart" is intended as a sort of term of art. Uncharitable would have been a more precise word.

  11. So, you're shocked that ER staff people are human? That we get called a "cunt" and get mad (not that mad, sometimes we laugh)? That we get assaulted and have few kind words for the patient who assaulted us? That we are the constant recipients of manipulation to get drugs?

    You try walking a day in our shoes, then try doing it 50 hours a week every week before you judge. Isn't that in the Bible somewhere? Maybe get assaulted by a client or two without warning and get called names every day by those who don't pay for your services and not have the luxury of throwing them out of your office.

    Stick up for welfare recipients by being disgusted by those who tie up the ERs with non-emergent conditions, creating an access block to those on welfare (and people in general) who actually HAVE emergencies. Jesus wanted to help the lepurs, not those pretending to be lepurs, keeping the true lepurs from being "healed" in a timely manner. He'd get irritated at them too.

  12. There are lepers and then there are lemurs...

  13. I don't hate all my patients, just MOST of them. And why write about the ones we like? It's boring!

  14. Shadowfax, some of these bloggers routinely come and commit comment violence in your blog. And yet, there they are on your blogroll. Why? Is it a tacit endorsement of them? Or intimidation by their bullying?

    They don't come here to debate or to be funny or clever. They come to insult and to humiliate. Interesting that they don't claim to practice in trauma centers - just little backwoods low acuity ERs. I think the real problem is that they ARE the B team, and they have nothing better to do with their time. Obviously they can't hold argue well - they can't use logic, reason and they certainly don't hold others in anything other than contempt. So instead, they are the Moe's of the playground - every Calvin and Hobbes reader knows them by their tactics.

    People not in healthcare may not comment much, but we read, we learn about the hostility and contempt that you ER doctors and nurses have for us, and you can't blame us if from time to time, some person calls you on what you write.

    The responses are eye-opening. God forbid that anyone ever have to rely on any of you for care. You might be able to do technical things well, but I sure wouldn't want you near any of my family and friends.

  15. Annonymoose:

    Good point. My blogroll is not an endorsement, and is poorly maintained at best. My initial plan was to be kind of all-inclusive with regard to the med-blogosphere, or at least ER docs who blog. Obviously, that's an unrealistic goal, given the scale and growth of medblogs. But initially I didn't edit the list for content, and the original list just kind of stuck. I may just delete the whole damn thing...

    There are also some folks with whom I have serious disagreements whose writing I enjoy, and who can be provocative without being contemptuous. So I don't mind linking to them, even if they can get a bit "colorful" at times.

  16. A little while ago I watched a documentary about the morbidly obese. Some 700lb guy came in for his gastric bypass. He was told on postop day 3 that he would now be expected to get himself in and out of his own bed with minimal assistance because the staff was getting injured. He pouted and then threw a tantrum complaining that it hurt his feelings...nurses are being destroyed but god forbid we hurt anyones feelings while telling the TRUTH. I mean how insulting telling a fat guy who is in hospital for a fat reducing surgery they are fat.
    This is exactly the problem with 99% of the general public. They get told the truth and then they pout and throw a tantrum.
    Somehow we have convinced all of them that anything goes the moment they cross the threshold of a hospital. Like idiots we reconfirmed their narcissism and encouraged helplessness.
    Well, it time to fix that misconception and if you think that's harsh or mean then that means you to suffer from narcissistic delusions.
    Wake up. Nurses and doctors aren't put on the earth to be abused by any of you.
    The moment you realize that and get over your awful sense of entitlement..(the ME ME ME generation comes home to roost)..then maybe we will all get along just fine.
    You stop being a selfish, self absorbed narcissistic ass and I will stop being pissy.
    It takes two you know.

    In Tanzania there is one doctor per six thousand patients. On some wards there is one trained nurse..one.
    Your family provides your care. If you don't have family you either do it yourself or wait for the nurse.
    And here in the West we terrorize the ER because we have to wait an hour for an earache.
    Every time I return from Africa I want to start smacking all of you.

  17. I truly enjoyed adventures in disaster's comments. I just finished a stretch of 4 12 hour night shifts in the ER and I am sick and tired of watching my co-workers run and run all 12 hours, wolfing down their nourishment in like 5 minutes then running again. There is an old saying "really sick patients don't bit**. The sense of entitlement the American public have of emergency medicine is enough to make you leave healthcare. But then that patient comes in who is a true emergency and a difference in a life is made. Someday I just want to tell that complaining patient or family member to SUCK IT. I'm not sorry it's only been 1 1/2 hours and you're still here. The minute you start complaining word about you spreads and every avoids you like the plague.You know who the worse complainers are? Staff that work in your own hospital and can't believe they didn't have a red carpet waiting on their sorry a**.


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