Saturday, 5 July 2014

Love-Hate Relationship

Anyone who knows anything about me knows that I have a love-hate relationship with emergency physicians.  I hate them, and I love to hate them.  I'm sure many people out there think that I'm just some asshole with a vendetta against these fine folks, and that may be true.  But there's a very good reason for my feelings - those people torture me.   They don't just torture me, they do it often.  And I'm firmly convinced that they enjoy torturing me, they collude to figure out exactly how to torture me best, and they do it at every opportunity.

What, you want proof?  Yes?  Then read on and be amazed and satisfied.  Or hopefully at least just satisfied.

A few weeks ago I got a call at 1 AM (Hey Call Gods, why the hell is it always 1 AM?  Call me at noon, damn you!) from an emergency physician at Outside Hospital.  Doctor Stupid (not her real name) had a young man who was shot in the femur (not shot in the leg, "shot in the femur" - the distinction will become crucially important in a moment), and because they do not care for trauma patients at that hospital, she wanted to transfer him to me.  It sounded like a perfectly reasonable request, and I had no dispute.  "Fine, send him over," I yawned, knowing that I might at least get about 2 more hours of sleep, since that's how long it would take for the ambulance to drive him the 10 km from there to here.  Why it takes that long, I have no idea.  Perhaps they walk the patient over.

Regardless, when he finally arrived (3 hours later, in fact), I went down to see him, and there were two innocent-looking bullet holes on the side of his leg, nowhere near where his femur should be.  It looked suspiciously like mere flesh wounds, and when I looked at his X-ray, what I saw was a completely, totally, 100% intact femur.  I bandaged his wounds and sent him home, grumbling the whole time about how ridiculous it is to trump up a story just to get the patients out of their emergency department and into my trauma bay.  I not-so-silently cursed Doctor Stupid and prayed to the Call Gods to send her 273 "I Just *cough* Don't Feel Right" patients that night.

How's that for proof.  Enough for you?  No?  Really??

You're awfully demanding, aren't you.  Fine.  You obviously aren't one to believe that history tends to repeat itself. 

FORESHADOWING ALERT

This past week I got a call at midnight (at least it wasn't 1 AM, I suppose) from Outside Hospital #2.  Dr. Fuckwit (not his real name) had a patient with - are you sitting down? - a gunshot wound to the leg.  He must have heard me chuckle as he told me the patient's story.

"Wait, what's so funny?" he asked testily.

Nothing, I told him.  Remembering what had happened just a few weeks prior, I made sure to ask him if the femur was broken.  "Yes, there's a femur fracture," he assured me.  

"I just want to be sure," I said in a flat, emotionless voice as red flags went up all over the place.  "Because I had a purported GSW to the femur transferred to me a few weeks ago, and the femur turned out to be fine."

"Yes, it's broken" is what he actually said next, but the tone in his voice made it sound much closer to "Yes, it's fucking broken, you raging asshole."

Four hours later, the young lady arrived.  I was entirely unsurprised (though appropriately irritated) when I looked at her X-ray and saw another perfectly normal, intact femur.  (You can't possibly be surprised either - come on, you DO know what foreshadowing is, right?)  When I informed her of her normal X-ray and that she would be going home, she, on the other hand, was very surprised.

"Why did they bother sending me here then?" she asked as we patched her up.

Why indeed.

I know I give ER docs a bad rap.  I know it.  But how can anyone blame me?  It's very easy to do when stuff like this happens routinely.  I don't want to feel like beating the shit out of ER docs just for calling me, because I do enjoy taking care of legitimate surgical problems.  I would be much happier if we could co-exist in peace rather than fighting like cats and dogs.  But as long as they keep treating me like their own personal garbage dump, I will continue to love to hate them.

17 comments:

  1. Do these things ever get reported, or are the ER doctors just able to throw you their patients by misdiagnosing them as they please?

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    1. There is supposed to be a system at hospitals where things like this come back to them. The idea is that folks can learn from making mistakes like this again. The problem is when the offenders are at another hospital. It's nigh impossible to get these mistakes back to them.

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  2. I'm not a doctor, but I am willing to guess.

    The ED doc saw bullet holes and did an xray. He doesn't see a broken bone, but the radiologist is off duty. A memo has warned him that he isn't an expert; that is what a radiologist is for. He imagines vividly the patient's lawyer asking him why he overlooked "whatever", he not being a radiologist. He works with the radiologist, so he doesn't want to wake him up just to confirm (ironically) what is obvious. He convinces himself that it is best for everyone in his little circle to see a broken bone and send the patient to you. Better to be wrong and a lying assh**e 99 times than be in court once. Hospital rules.

    This will have to be the the system until ObamaCare replaces all the doctors with physician assistants. Juries will be more sympathetic toward their mistakes, ironically because they have less training and are expected to make mistakes. Public policy will be to forgive them, because any sort of universal healthcare will depend on them.

    Doctors can't be forgiven because they are rich. (Not my point of view).

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    1. That's great and all, but given spelling and his propensity for the metric system, Doc probably doesn't live in the the US.

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    2. Unless that's what he wants you to think.

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    3. I don't know how familiar you are with hospitals, but from what you've written here I'll make the guess of "Not very".

      Radiologists go "off duty" radiology departments don't.

      Doctors don't perform X-rays... Radiologists Do.

      Radiologists aren't allowed, qualified nor authorized, to make a diagnosis... Doctors ARE.

      If you get sent for X-rays, then you get sent to the Radiology Dept. Referral in hand/on the system. Then make your merry way back later. ER docs, Trauma Surgeons, every heck-hoolally-one-else doesn't just go around zapping people with Medical equipment because "they didn't wake to wake the technician".

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    4. UMMM... in my local hospital, if you're in the ER, the radiology department comes to you. - and they kick all the civilians out of the space and "zap" the patient right there.

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    5. to further clarify - the X-ray tech is not the radiologist.

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    6. The radiology tech (who is not a doctor) does the X-rays, and the radiologist (who is a doctor) reads them. Not every hospital has a radiologist on duty 24 hours a day, so in those hospitals the doctor who orders the study has to interpret it. This is something that emergency physicians should be able to do, especially for something as simple as a femur fracture.

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    7. I'm thinking Doc isn't from the U.S., either. More likely, the U.K. When he talks about having to operate on someone, he refers to what we in the U.S. call the 'operating room' as the 'operating theater'. I had never heard it called 'operating theater' before until I recently saw a T.V. documentary about a British guy trying to lose a bunch of weight. His surgeon was speaking about the man's upcoming visit to the 'operating theater'. Just a guess - but I could be wrong!! Wherever you're from, Doc, your blog is my most favorite reading material ever! Keep up the great work!! Please!!

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  3. You had me up until Obamacare, Doc doesn't live in the US. So that can't factor into his issue with ER docs.

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    1. right, and if doc does not live in the US, that means it is already a single payer system. so the correct knee-jerk anti-Obama response would have been "because the doctor will get paid whether he does anything or not, so it is in his best interests to dish the patient off - because soshulized medicine."

      so I agree with penguinhalo's question: is there any recourse?

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  4. OT a little. How's Mrs Doc Bastard doing? Is she carrying on with the little cough that couldn't or shed it altogether? Ms Amulbunny is still dealing with pop up fevers and an evening cough that only settles down with 5/325 Norco and Cheracol with codeine. This is going on 3 1`/2 weeks. I have things to do and food to cook. Not a happy bunny. Hope things at your house are better.

    da coughing bunny

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    1. You must have missed this: http://docbastard.blogspot.com/2014/06/mrs-bastard-update.html ;)

      She's doing better. Back to work, trying to do everything she wants/needs to. I'm still helping out around the house as much as she'll allow me (she seems to think I sort the laundry wrong).

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  5. You sure it's a love-hate relationship? Looks more like hate-hate to me.

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  6. Great read, thanks ! I love it, I love it so much that the greedy gnome in me wants more.

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  7. This comment has been removed by a blog administrator.

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