“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Tuesday, March 27, 2007

Why do I have to be an @ss&*!# ....

"God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. "

~The Serenity Prayer

Sometimes this is all I can say to prevent me from being one of those yelling, cursing surgeons. Why are they testing me? Why does it have to be so hard? I fill out the booking sheet. I speak with the family at length about what is going to be done. I speak with the scrub people the week prior. I speak with the equipment rep to make sure all of the equipment is going to be present. So why is everyday like ground hogs day?

I would like to say that this is an uncommon problem, but it is not. At every hospital, in medical school, residency, fellowship, and now in practice, I have encountered the same things. You would think if you do similar cases and the same people are there, they would stop asking you what suture you want. This is why people say, "we do it the same way everytime." I don't, but I wish I could say it.

Everytime I am in the OR, it is like we have never done the case before. Nurse says, "Doctor would you like the thingamodo, or the hickamagig?" I say, "well nurse, I have never used that before, so why would you ask?" "Well that is the way doctor soandso does it." (REDFACE)

I just want to come to work and things to run smoothly. No b!#ching, no complaining, JUST GIVE ME WHAT I ASK FOR D@M!T.

Now I feel better. Thanks for listening.

“Each one has to find his peace from within. And peace to be real must be unaffected by outside circumstances.”

~Mahatma Gandhi

1 comment:

Anonymous said...

I've previously responded re: 80hr work complaints by the "old guard". I did read you reply carefully and notice you mention it in this post.

The problem I have with the old guard is the mess they are leaving behind. Social Security is going to collapse. This is not an exageration or dramatization. The excessive medical spending of the 70-80's and the resulting sequelae will be the most important influence on how our practices are shaped financially. I can take complaints about only working 80 hours a week. I just wish I could get some answers.

1. Who is responsible for the offences that necessitated Stark I&II and Antikickback legislation - the majority of which resembles and was modelled after attempts to combat organized crime?

2. Who can explain to me pg2687 of the December JBJS-A? Plastic surgeons at a traditional "old school" program, U of M, "the U" have essentially been given distal radius fractures by orthopaedics (they put volar locked plates on 161 IN 2 YEARS and Ann Arbor isn't exactly a dangerous place). I've looked into it minimally - it came down to ortho attending level surgeons not wanting the call responsibility.

3. Why has industry in recent years so readily embraced overseas providers and non-physician providers? The most common response is physicians pricing themselves out of the market. A recent AMA newsletter detailed non-physician providers gaining authority to offer services through THEIR OWN BOARDS. Of course the podiatry board will be willing to certify their members for knee arthroscopy and pilon reconstruction. In many states it is becoming a legislative issue. Who let this get away? Why is there another report every month about elective hip and knee arthroplasties in India and China? The common response by American surgeons: well we'll band together not to take care of their complications when they are back in the US. It won't be a problem, it will probably be cheaper to keep flying the patients back and forth. None of these employers or benefit plan administrators will even have a list of local providers around the office - nor will they miss it.

Non-physicians and their boards

Why doesn't the public care?

"Some Hospitals Call 911 to Save Their Patients" is the title of a 4/2/07 NY Times article detailing a mortality in a surgeon owned specialty hospital. This topic is on its way to legislation (AMA News 3/26/07).

NY Times

AMA about specialty hospitals

They are given plenty of reason not to trust us.

Whenever I hear about the "old guard" commenting on something such as the 80hr wk I wish they would just ask themselves how their generation is leaving the world of medicine? I wish everyone who came out of medical school with less than $100k of debt would take one step back. The time of a national plan is coming it will be generations before "pay for performance" critereon are reasonable and actually based on meaningful medical performance measures - no one reading this in 2007 will see that day.

The old guard lived fat off the system. They'll never admit it but SSA isn't going to collapse because they worked a few extra hours a week during residency and that extra work cost Medicare. We're going to be at the mercy of the system that results while they are retired in some house on some beach I'll never see. I just wish instead of the grief, they'd just say "sorry for the mess," and leave us to see what we can sort out.