UNIVERSAL HEALTHCARE

As an ER physician, the concept of universal health care is appealing, but is it feasible? One of the several reasons why health care costs so much is due to scores of people, especially at the university/teaching hospital level, lacking coverage. Obviously there will continue to be a dilemma regarding the treatment of illegal immigrants, but will universal coverage bring down health care costs? I don't know.


Please give me your comments on this topic. Remember, it does not matter if a person has insurance or not, or is a legal citizen or not, I have to supply the same level of care to that individual regardless since I'm an emergency physician and required to do so by law.

THE CHIROPRACTIC DEBATE

After reading the comments left by several proponents of chiropractic medicine and looking further into the curriculum and extent of the chiropractic scope, I have concluded several things for myself as a one practitioner of medicine.

I am, in the large medical realm, one practitioner. It would be purely arrogant and ignorant for me to believe that all answers to human suffering are found in the form of medical care I practice. Medical doctors have proven time and time again that we are not perfect and err as often as any other human. Unfortunately, we are in a profession where such errors may lead to bad outcomes or death. For a medical doctor to "look down" upon other medical practitioners would be egotistical and narrow-minded.

The field of medicine has a united goal to treat the patient and not do harm or be neglectful. Western medicine cannot fix everything, it may not fix many things. Patients deserve options to medical care. If one form of medical care does not work, they are fully entitled to seek other forms of treatment. With this said, if a patient has a surgical issue, they need surgery. If a patient who has cancer requiring resection (or other surgical ailment) opts to forgo surgery and seeks alternative treatments instead, that patient has a right to decide that for themselves despite what any medical professional believes. As long as patients are educated about the ailment, told of the options, and are of sound mind, they can decide their own fate...even if it will likely lead to death as long as that is known to them.

Osteopathy, physical therapy, alternative medicine and yes even chiropractic all have a place/role in treating patients. For one health care worker to speak unfavorably about one or the other is doing that profession a disservice. We need to be a united heath care team. From my own experience and ignorance, I can see how easy it is to fall into the trap of feeling threatened or distrust about another medical field.

After all this has been addressed, I will make a two closing comments. The general public has no clue what the realm of medicine entails. From fields of practice to tests to imaging to diagnoses to treatment options, the lay public is completely ignorant. Unfortunately, people think that if you call yourself "doctor" you went to medical school. The title of doctor has lost its uniqueness and magnitude amongst the public. Most people do not know the difference between PhD, PharmD, PA, DO, DC, DPT, DDT, MD, or even doctor of podiatry. Here's what I'm getting at, those that seek help in these different fields of practice should be informed about who they are seeing and their true scope of practice. Personally, I have no problem if my mother goes to see a chiropractor; however, if she believes that the chiropractor can treat/cure certain medical issues that require medications or even surgery because the chiropractor is a "doctor" that is entirely false and potentially damaging. People should know the scope of practice and capabilities of the medical professional they are seeing. Furthermore, we as medical professionals should be forthcoming with our limitations as practitioners.

Lastly, any medical professional using chest or abdominal xrays should not only be trained in their reading of the images but also have radiological oversight. Yes, dentists get xrays of the teeth, but they are very limited and usually just show the teeth. From what I know at this point, chiropractic medicine gets images of the thoracic and lumbar spine. These images likely also show both the chest (with thoracic) and the abdomen (with lumbar). My concern is this, is there professional radiological oversight regarding the chest and abdomen with these images? I have learned from recent discussions on this blog and elsewhere that there are chiropractors trained in radiology reading, but I have not been told if they also have been trained in reading body xrays.

My final comment...finally.
I make errors in my practice almost on a daily basis. Most are very small errors that are corrected immediately and will never cause any harm. Unfortunately, all medical doctors in my field (emergency medicine) could say the same thing. If they deny making errors, it simply means they don't know about their mistakes or they're kidding themselves. Also, every medical doctor went through residency, this virtually guarantees they've made errors. For one of us in any field of medicine to attempt to justify why our field is more superior is purely egocentric and false. Thinking about my prior comments regarding the debate between chiropractics and traditional medical practice, it is easy to see the somewhat separatist viewpoint many medical professionals take. The goal of medicine is to treat the patient, and treatment can come in many forms.

ON WAR

"I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones."

- Albert Einstein

PLEASURE READING

I will not recommend any medical books here because I strongly believe that we should try to learn about other realms of life instead of what we are already accustomed to. The following is in no particular order.

1. 1984 - George Orwell
2. The Iron Heel - Jack London
3. Oh Pure and Radiant Heart - Lydia Millet
4. The Call of the Wild - Jack London
5. Walden - Henry Thoreau
6. Solitude: A return to the self - Anthony Storr
7. The Curve of Binding Energy - John McPhee
8. Essays on Nature - Edward Hoagland
9. Anything by Arthur C. Clarke - wonderful science fiction
10. The Stand - Stephen King
11. Huckelberry Finn - Mark Twain
12. SAS survival handbook - John Wiseman

BETTER

For you physicians or practitioners reading this, which is probably numbering about three total, there is a good book out there written by a general surgeon and focuses on ways we can improve our performance in many aspects of care.

It is called "Better" and was written by Atul Gawande, an general surgeon in Boston. Besides being an excellent writer, he adresses some great topics concerning health care. From hand washing to why a long time orthopedic surgeon turned to malpractice law and now sues doctors. Truly inspiring.

For those of you who are not into an easy 2 day read, he summarizes some advice at the end about how one goes about becoming a "positive deviant" (speaking of a bell curve). His points are as follows:

1) Learn something about your patients and co-workers. Ask them one simple question about themselves and you'll be surprised at what you may learn.

2) Don't complain. It is a waste of your time and the time of those listening to you.

3) Count something. By being a scientist it will likely lead to a postitive change.

4) Write something. I can attest to this one myself...it helps make sense in a world of confusion. By writing this blog, I'd like to think I've learned something and become less ignorant.

5) Change. Be willing to adapt and try new things. We have only come this far b/c someone what willing to go out on a limb.

UPDATE ON LIFE

Since my complete lack of posts to this site over many months, there have been changes both in my life and medical practice. Some have changed the ways in which I view some issues. Yes, the experiences one deals with on a daily basis do in fact mold the impressions we form of society and affect the way look at and treat others.

During my sabbatical away from this blog I had a son. Not to sound cliché, but he is the light of my life. Funny how he is the one to need everything literally spoon fed to him and helped at every step of the way, yet I am the one who feels empty when away from him. Having a child, changes a person. I will always be a cynic at heart, but now I have to have hope for the future. No longer can I watch the evening news simply b/c of the violence painted over nearly every story.

Another affect a child can have on a parent, which as sad as it may be does not happen sometimes, is that the parent suddenly wants to be a better person. You tend to let go of the mundane and minor squabbles of your past and focus more on the positive, or better yet, what could be.

With that said, I will state a few things that, after reading most of the entries in this blog, may surprise you...

First, I have received and posted several replies about the chiropractic issue, which I have addressed in the past. After reading them and considering the topic further, I wanted to address some thoughts again. Patients deserve the best care possible. Whether they are helped by medical, chiropractic, or other means is irrelevant. What matters is that patients get better or are helped in some way THEY deem appropriate. Obviously, if someone's having a heart attack, they need a hospital, not an adjustment. Along those same lines, aggressive medical care is not always appropriate and other means should be sought. My chiropractic colleagues have just as much a right to try and help patients as I do. Whether the patient chooses an MD, DO, DC, PT, or any other two-letter degree is their prerogative. It is not my place to criticize any profession when I make mistakes on a daily basis. Medicine is more an art than a science, and from college I can tell you I'm no artist.

Second, we as a society are in distress. I have no idea as the state of the rest of the world but it appears that in this country we're in trouble. Children are becoming parents by the age of 16, and worse yet, given their total lack of knowledge or fear of birth defects, they smoke, drink, and do drugs during pregnancy. The elderly, who are revered and looked upon as the highest tier in some cultures, are left for dead in nursing homes - rotting away for years at the expense of the American tax payer. (I only bring this one up b/c I really worry about what will happen to my parents with age.) The middle class, those that make up the majority in the country, are carrying the brunt of the financial problem. They work and make a wage, yet do not qualify for certain health care aid programs and still have to save for retirement and their children’s' college years. Our politicians are so two-sided and divided that this country will likely never feel as a united front, despite whatever terrorist act takes place next.

We are a nation of aggressive, back-stabbing, cheating, selfish, undermining, materialistic gluttons who are spiraling down. I can only say these things because I too am part of society.

I am afraid for our children.

BEEN A WHILE

It truly has been some time since my last post. Deeply sorry for those who care. If your into excuses, I've been working quite a bit and trying to deal with the balancing act of family and work.

Funny how I typically post ideas or experiences within my medical experience. I say this b/c I witnessed an interesting situation yesterday.

I took my dog into the vet for some vaccinations and checkup. While checking out and paying my bill, I overheard a conversation at the other end of the counter. A woman with her elderly dog was checking in and she was obviously in a bad mood. The desk attendant asked her if it was time for the dog to pick up more heartworm medicaiton. The lady replied in a very unpleasant tone, "I don't know, don't you guys have records for this sort of thing?" This really caught my attention. The desk attendant, trying to stay professional, said that she would try to find out and then asked if the unpleasant woman knew what medication the dog had been taking recently. This was great. The woman was obviously pissed off now and acting like a total bitch. Her reply, "I don't know. She gets it every day. Don't you have records of any of this?" OK, I couldn't believe it. This bitch was chewing out the desk attendant, a woman who had never seen this dog in her life, because she her self didn't know what medication she had been giving the dog every single day for a long time. What a complete idiot and total witch this woman was being.

I think most people experience both of these feeling at different times in their lives. Some days, we are the desk attendant - feeling beat down for no reason and abused by people that obviously have no logical thought. Other times, we are frustrated and pissed off b/c something isn't going right in our lives. Even though the people we are dealing with at that time have no idea what may be wrong, we treat them like shit anyway b/c it makes us feel better to take our frustrations out on someone or something else.

Needless to say, I felt bad for her dog.

ORION

THE ANSWER...MANDATORY STERILIZATION

It's always been a ridiculous notion in the back of my mind, but after writing the last entry of this blog I think it is not such a bad idea. We should have mandatory sterilization in this country.

It's so clear now. The answer is simple! If only we could sterilize some individuals in society, specifically but not limited to the drug abusing, sex-offending, prostituting, 19 years old on medicaid with 4 kids already, domestic abusing, have fathered multiple children with multiple women, or those gang-bangin' pieces of shit we all know and love - we could actually improve American society.

This way, these individuals would have more time to find a job, contribute to the human race, improve the efficiency of society, decrease the amount of poverty in this country, produce a better life for the children they already have, and allow more free time for the people who actually should be producing children to do just that.

A FATHER, A ROLE MODEL

Some gang-bangin' thug was brought to the ER for a head injury he sustained in a fight with two other guys. Apparently, this poor guy was minding his own business and had no reason to be assaulted. I guess he was simply in the wrong place at the wrong time. Pretty common story.

Well, his head CT was normal and I stapled his head laceration. After a while, he stopped being so aggressive with the nurses and myself and informed me that he just wanted to get home to see his girlfriend and kid. I asked him about his young son and told him we had stuffed animals in the ER, and that he should take one home to give to his little boy. He said fine so I gave him one. Prior to discharge from the ER, he simply threw the stuffed animal in the garbage and then spit on it. For all fathers out there, here is our role model.

Maybe this guy would be an excellent candidate for the first ever American sterilization experiment.

WHAT IS THIS ALL FOR?

Why do people believe that being happy in life revolves around success and what comes with success? I have spent most of my life thus far, albeit some of the most energetic and capable years of my life, ensnared with the thought that if I go to school, study hard, have a good career, and make a good living, life will be prosperous and satisfying...in the end. Well, life is prosperous and usually quite satisfying, but why do I feel a large void in my life?

Maybe because as child, I actually wanted to have a career focused on the ocean. Medicine as a life choice didn't enter my mind until well into college. I spent my childhood and high school days dreaming of the ocean and the life it posed for my future. Unfortunately the ocean was hundreds of miles away. I didn't care about money or trying to pay the bills, but I suppose that is one of the great privileges of being a child.

Maybe that is the destiny of our human race; to throw away everything sacred in our lives to instead focus on the innate and unimportant. To put life on hold in order to be "successful", to simply discard dreams and replace them with postcards of how things should be, to take the easy route because it is just that...easy.

I like that I am a doctor; that I help people and even feel like I actually save a life once in a while, but I often think of the effects this path has had on my life. I still dream of the ocean and what could have been. Although it is still hundreds of miles away, I can still feel that grasp it has always had on my life.

In regards to success, I think their are three true groups of people in current society. First, there are the lazy-no hope-drains on society that themselves will never account to much. They will not only waste their time on Earth, but also produce children that will likely continue in their steps. Secondly, there are the wealthy success stories. These people have it all, or at least appear that way. They are productive members of society, chair many important groups, take part in social activities, and have spouses that are only good for characters in daytime TV shows. Lastly, there are those who are simply happy and content with life and what it has dealt them while they avoid playing the "drain on society" role. These are the people enjoying what they do no matter what their income is. They had dreams as children and followed those dreams to their completion.

Our society is in trouble. Think of the three groups above. I would place a large wager that most of America, falls into one of the first two groups. How unfortunate. We are too busy worrying about the next step and not focusing on what is in front of us now. Many of us are going to find ourselves at the end of our lives, which for some turns out to be sooner than expected, regretting the chances we did not take or the life we lost.

Life should not be about "what if".

HEY, NICE TRACK MARKS

Why is it that patients who are obvious drug users actually deny drug use when you ask them? I have patients all the time who present complaining of chest pain or heart palpitations (racing heart) and deny drug use when they have very obvious track marks on the inside of their elbows. What absolute idiots.

Here's the funny thing, if I were to miss the track marks or the patient smokes crack or think that this patient really didn't do cocaine recently, one of my first line treatments for chest pain that appears to be due to their heart would be a beta blocker. OOPS! Giving a beta blocker to a crack user can kill them. But they wouldn't know that would they.

Here's an idea. If you are a patient and come to a doctor for treatment, answer every question they ask honestly. Stop being so stupid and hide the pride. We see you naked, at your worst times, and violate every physical aspect about you in an uncomfortable setting...trust me, I've seen just about everything. You shouldn't feel ashamed to give an answer or have something examined, it is our job and we are simply trying to help you. Please don't make the lawyers' jobs easier by lying to us.

TO ALL LAWYERS or LEGALLY GIFTED

Yes, I am glad you are productive members of society (depending on how you look at it), have an education, a job, and are not a free-loading on our economy. However, if you would like to post a comment or question on this site, please stop talking out of your asses and use basic English instead of your very unimpressive legal jargon. I, along with others who read this site and its comments, would really like to be able to understand what you are saying so that I may answer appropriately. Go ahead and feel good that you know the legal lingo, but truthfully, I'm not impressed. I know some other languages as well, but don't flaunt them here to try and impress people.

I will say this though, if you are willing to put your full name, address, and cell phone or pager number with your comment (so that everyone who reads it can write or call you and let you know just how stupid you sound), I would be more than happy to allow such legal lingo on this blog. If not, just speak like a human being. If that is still too difficult for you, just don't write anything at all.

ANSWERING THE FAN MAIL

Anonymous said...
I hope you have time to answer two questions, mostly because I don't understand your problem with this kind of healthcare and I would like to know more.If everything you are saying is true, Caduceus, why is it that chiropracticors are liscened and allowed to practice? Also, would you be more comfortable with chiropractics if they didn't have the title of doctor in front of their names?

Caduceus reply...
1. Medical doctors are licensed by a board of medical doctors/examiners. Chiropractors, I believe are also licensed by a board, but of other chiropractors. Both have to meet certain criteria and/or pass exams to become licensed. As long as you have an acknowledged medical specialty, you can become "board certified" in that specialty after some period of training and passing a highly regulated exam. Chiropractics has a nationally recognized board and must meet certification to become licensed. Medical doctors have nothing to do with it, and shouldn't. I really have no idea what the certification or exam, if any, is like.

2. Honestly, I don't think that chiropractors should be called doctors. I also don't think that doctors of physical therapy or other non-MDs should be called "doctors" either. I know this sounds arrogant and self-righteous, but there is a simple reason. It confuses people. Most patients, especially the elderly, have no idea that one doctor is different than the next. They are used to the old time town doctor that was the local practicing physician (MD). These days, it seems like anyone who obtains some form of secondary education is called a "doctor". Everybody wants the title and feels like they've earned it after so much schooling, but the problem is that we are using a very powerful term to describe very different things. These doctors are completely different. You may not realize this but lots of small town "doctors" are actually Physician Assistants (PA) or Nurse Practitioners. Here is an extremely dangerous situation. Residents of these towns many times call these practitioners "doctor so-and-so" and think they are seeing a Medical Doctor. What really annoys me is that many times, these PAs and NPs don't correct the public and state they are indeed NOT doctors - further allowing the public to become more confused as to the services they are obtaining.

Chiropractors, physician assistants, nurse practitioners are not "doctors" as the public percieves the term doctor. Don't be mistaken, these are not the same as medical doctors.

IN REGARDS TO PLAN B

Anonymous said...
Are you encouraging promiscuity? Thats just insanity, you democrat you.



Caduceus said...
I don't encourage promiscuity, I embrace the hope that our society will turn a corner and actually start producing children with a bright future instead of families that are an economic drain on our society.

Also, I acknowledge no political affiliation.

DID YOU HEAR ABOUT CONGRESSMAN FOLEY?

I am getting sick of all the media-hype surrounding the man. Ok, he was a congressman, maybe flirted with young men, maybe even was abused by some priest, but it is all getting way too old.

I am sick of turning on the television and seeing junk like this. Why can't the news be about something good that happened. Instead, most nightly news programs focus on the people shot and killed that day, the new rape cases in the local park, or the [insert new political scandal here]. The American media systems sucks. We are so focussed on all the shit and human stupidity in this country that we have completely lost focus on the wonderful things humans do.

People use negative reinforcement to deal with unruly children, whereby they ignore the child. Eventually, that child may learn that nothing good comes from being a pest. Now, in our media we exploit and popularize every negative event that occurs, what is that doing for us? No wonder we have kids shooting up schools, the media, along with video games and poor parenting, encourages it.

Maybe the American public is just so mindless that shows like "Cops" and the nightly news have to be about guns, violence, incest, rape, and death, or people wouldn't watch them. If that's the case, we are more pathetic than I thought.

FAT AMERICA

Why don't people get it? If you eat like a fat person, you will eventually become a fat person. We live in one of the most developed nations in the world with indoor plumbing, electricity in virtually every home, and fitness gyms in almost every town, yet a good portion of the American population look like cows ready for the slaughter. Foreigners must look at our country and laugh (for so many reasons).

We look stupid. We've learned how to abuse most advancements in our developed country. We use cars instead of bikes. We eat fast food because it is just that...fast. Some even watch those rediculous infomertials about a new weight loss diet or piece of equipement and buy it thinking now is the time I'll turn my life around. You want to know the truth. I bet you'll buy that equipement, use it pretty well for a week or two, and slowly begin to taper the amount of time you spend on it until it becomes a decorative piece for your living room.

Do you want to lose weight? Really? Then here are the facts nobody wants to throw in your face. Your fat. Forget all those people saying be happy with your body - their are only saying that because they are hoping to feel better about their own. Just look at them sometime, they are all fat too. Go to a gym and get a membership and if you have the money a trainer too. This is the only way, unless you really are able to turn your entire life around and do this all yourself (however, since you probably know nothing of fitness or healthy eating, because your fat in the first place, this will likely not work for you). The trainer is there not just to show you what to do, but to keep you coming back. A bit harder to skip out when you have a coach to answer to. And of course, stop eating like that cow in the pasture and try to eat somewhat better, maybe even smaller portions. It is ok to be hungry once in a while. I think most Americans don't even kn0w what that feels like.

And if you think that this is just another skinny person speaking their mind, you're wrong. I used to be fat and took action because I got sick of looking like just another fat American.

THE END RESULT OF A LAWSUIT

Short, but true story...

An ER doctor who had been happily practicing medicine for many years had his first lawsuit brought against him. From what I was told by his friend, this ER doctor absolutely loved his profession and helping people. Concerning this lawsuit, he did not make any medical error, showed no negligence, and performed his job to the best of his abilities. His insurance company would have easily settled out of court, which to all doctors is like a big slap in the face. His medical record would have been tarnished and he felt like it would be admitting fault, which he was morally against, so he fought the case in court to prove himself right. The court case lasted a couple years, he was humiliated in court b/c that is what a good lawyer will do, spent thousands of his own money, and eventually won the case. You would think that this win would boost his confidence, but instead, he felt betrayed by the patient and the patient's family, abused by the court system, and worried about a another possible future lawsuit. This doctor then quit the practice of medicine and refused to keep his job, despite the begging of his employer.

My congrats to those patients and lawyers out there destroying American medicine. You're doing a fine job of wasing our time and talent.

THE TRUTH ABOUT RESIDENCY

People may think of medical residents and residency as what they see on the television. Pop culture has advanced interest in medicine and health care with shows like "ER", "Scrubs", "House", and "Grey's Anatomy". The increased interest in the medical field is wonderful, but while a couple of these shows provide some comic relief from the horrors of real life medicine, others worsen the publics perception of modern medicine.

Here's the truth about residency...
Residents get paid a salary - usually around $39,000 per year. This is a nice compensation, but most residents work far more hours than the everyday Joe. Up until recently there wasn't a cap on hours a resident could work; however, after a few large medical mistakes and deadly car accidents, a cap has been set at 80 hours per week averaged over 4 weeks. This means a resident, or house officer in some locations, could work more than 80 hours a week for a week or two as long as the other two weeks are less than 80 a piece. Using $39,000 as an average yearly salary, this means medical residents get paid about $9.38 / hour - IF they adhere to the 80 hour work week. Not a very good salary for 8 years of post-high school training.

Here's the really good part, many of these residents actually like to enjoy life outside of work and a lot even have a spouse and kids. Now, if you were getting paid by salary and it didn't matter how many hours you were at work, would you want to stay at work longer to learn more...of course not. So, here's the skinny about residents...

1. More work does NOT equal more money, so why would you want to work more. From the emergency department persepctive, medical residents who are called to come consult or admit a patient in the ER can be some of the most lazy and work-adverse people in the hospital. They will think of any reason possible to sweep that patient to another service, which leads us to the next point...

2. It is always better to consult than admit, which is why many services will try to avoid the admission. This means less calls in the middle of the night (b/c you are not that patient's primary admitting doctor) and no discharge summary. Less work, less effort.

3. They hate their pagers. Pagers mean more work.

4. They absolutely hate ER consults or admits. These take lots of time out of a day and usually happen when you least want them (like 3 AM). Another reason to try and sweep the patient to a different admitting service.

5. They hate having lots of patients in the hospital (more patients = more time = more work).

6. They really hate difficult and/or needy patients and patient's families . Who wouldn't? These patients take up more time than they need and make work much harder to tolerate.

7. Unlike shows such as "Grey's Anatomy" in which all the residents are getting laid most of the time, medical residents are more often lacking in the sexual realm and sex-deprived; hence, why many medical marriages don't work and why many residents and doctors end up marrying attractive nurses. Now, what do you think it would be like with a two doctor marriage?

8. Medical residents are supposed to be studying a lot and reading every medical tidbit they can get their hands on. Truth, why would you want to read if you worked 80 hours that week and never really got to see your spouse or kids...and your sex-deprived?

9. It is true, residents can usually fall asleep anywhere. This includes floors, elevators, meetings, lectures, and while driving in cars.

10. For you patients out there who demand the "A team" and ride into the hospital on your high horse, shut up and take what you get. Do NOT by any means ask if the doctor speaking to you is a resident or staff. They all know what you mean by this quesion, it infers that you are more worried about their care and that you think the resident does not know what he or she is doing. The truth, aside from the operating room setting, that resident has probably performed the same amount or more of the basic hospital procedures than the staff doctor in the last year. I don't know how many times I've watched a staff physician who is a bit out of practice, b/c they spend more time educating than performing, absolutely screw up a small and relatively easy procedure. My advice, unless the resident is obviously nervous, shaky and sweating, have them perform the procedure, you'll never know the difference. Plus, you will have contributed to that physician's future.

Last note, upon leaving residency, all of these traits will change. They will make much more money, will get paid extra for consults and admissions from the ER, and will have more time to spend with family and doing things they love, like sex.

"RETAINED FOREIGN BODY"

Ladies, for those of you that use tampons, please tell me; how easy is it to forget you left a tampon in? I think most young women have learned not to do this, but when I have to go fishing for a tampon lost in the vast expanse of some poor woman's vagina, I start to wonder.

Please, ladies, remember to take you tampons out. It is extremely dangerous to you health to leave them in (toxic shock syndrome), and to be honest, the smell of a tampon stuck for days in that warm dark place is enough to kill a horse.

HOMICIDE...REALLY?

This story made recent headlines. A woman apparently presented with classic signs of heart attack and was placed in the ER waiting room for 2-3 hours where she died. The case is being handled as a potential homicide...yes homicide! None of the articles I've read about this event give any details as to what was happening in the ER at that particular time (how busy it was, who was being triaged into the ER ahead of her, etc.). I agree that some large errors were probably made; however, is this homicide? The American College of Emergency Physicians (ACEP) president Rick Blum, MD, gave an address on Sept 18, 2006, concerning the event and gave this quote:

"... emergency physicians and nurses go into emergency medicine to save lives. To criminalize their efforts would be a terrible mistake and have a severe chilling effect on people going into the medical field."

Read the information about this event and let me know your opinion. Should the triage nurse or ER staff be charged with homicide?

VACCINATIONS

There are many outside the medical profession who do not vaccinate their children, because for some reason they feel the vaccines are potentially dangerous or may cause unwanted reactions.

I've got two things to say to these people: SMALL POX and POLIO

Now, this wasn't a big argument, but I don't think it should be. I know you love your children and it is fun to feel trendy. But, for those of you out there not vaccinating your children...you're idiots.

Disclaimer: some patients should not get certain vaccines due to prior medical problems. If you are one of these people, this blog entry doesn't apply to you.

CONCERNING QUALITY CONTROL

Quality control is a good thing, especially in healthcare.

For those out there concerned about "medical misadventures" (aka medical mistakes), I have two comments. First, medical errors, although rare, will always happen. Healthcare is not perfect, so don't expect it to be. Second, there are many quality control measures in place within a hospital or clinic setting to ensure medical mistakes don't occur.

Some examples:
- All prescriptions and medications ordered for patients in a hospital are filled through a pharmacist. The pharmacists are trained to pick up on doctors Rx mistakes and are quick to correct the problem. Unfortunately, if a pharmacist makes a mistake in the med they then give or the dosage of that med...good luck.

- All labs are viewed by lab personnel, and if a lab is abnormal, it is usually flagged in the system. Critically abnormal labs (those that need to be dealt with immediately) are called directly to the MD or nurse taking care of the patient.

- All radiology images performed in a hospital or clinic setting (at least for MDs) are looked over by a professional radiologist to ensure nothing small or large was missed by the primary doctor.

Now, read then next entry...

THE CHIROPRACTIC DEBATE

Apparently, I pissed off some chiropractor with my previous entry on chiropractic medicine. I wanted to post his message and my response here so that people could send in their thoughts on the issue.

Chiropractic Comment:
To each in their own opinion, however i thought it might be helpful in your condemnation of chiropractic schools to get the facts correct. A chiropractic student must complete a 5 year program at an accredited college. They must take the board exams which consist of 4 parts taken over a period of 3 years, the last part of which is an oral/practical exam. Students take 270 hours of Radiology (as opposed to the medical counterpart who recieves 30 hours of training). To round it off, chiropractic students take 585 hours of Anatomy, 75 hours of Biochemistry, 345 hours of Physiopathology, 120 hours of microbiology, 525 hours of Diagnosis, 75 hours of Clinical Lab Diagnosis, 1,320 hours of Internship.... and many more not worth mentioning. No, Chiropractors cannot treat pathological problems, but they are taught to recognize them so when the patient comes in complaining of back pain the DC can differentially diagnose if it is or is not an emergency which should be referred out. I would advise not stereotyping a profession in which you obviously have the facts incorrect. Im sure you would agree that there are many MD's out there riding that subtitle for unethical reasons. Dont forget that healthcare is for the patient, and the best thing for the patient is for all health professions to work together.

My response:
Points well taken. I fully agree with thoughts on unethical MDs, and the team work approach to healthcare. However, your facts, just as mine, are a bit off. I will address only one here simply for the sake of time and because right now, I don't care.

Concerning your quote on radiology hours in training. It seems to me that an extremely large part of your practice as a chiropractor involves the use of xrays. So, in your 5 years of training, you undergo 270 hours of radiology. Then, you are practicing in the community reading thousands of xrays yearly as a fully functioning chiropractor - with no professional radiologist over reading these xrays looking for things you've missed. Basically, chiropractic care, at least in the realm of radiology, has no quality control.

Here's the big difference. You were wrong on the idea that MDs only get 30 hours of radiology. To make it simple (like finding a pulmonary nodule on a portable chest xray), I'll break it down for you. Med students go through 4 years of med school, in which they see xrays throughout, but much more their 3rd and 4th years. All typically take a rotation in radiology during their 4th year where they sit with practicing "radiologists" (those who are professionals in radiology) and learn the basics of how to read the different modalities of imaging, xrays or other. Now the good part, after med school, MDs have to do a residency! That's another 3 to 5 to 10 years depending on how crazy they are. No matter what field or subspecialty they go into, they will be reading xrays, CT, and maybe an MRI or two the entire time on all their patients. Plus these are over read by professional radiologists so that things aren't missed. Medical doctors have a quality control system in place.

So the breakdown stands as such,

Chiropractors:
Practice nearly revolves around the use of xrays and they get 270 hours of radiology. Then they're reading them on their own - without radiologist over read.

MDs:
Little formal radiology training, but spend nearly 4-8 years reading xrays every day and having them over read by professionals before they are out in the community. Plus, once out in the community, the xrays are still read by a radiologist.

You do the math.

PLAN B GOES OTC

Plan B, the emergency contraception, medication has gone over the counter for women 18 years of age and older. Those under 18 can still get it, but need to get a prescription from a doctor. You can find my comments on the matter in one of my prior posts entitled "Emergency Contreption". Any thoughts?

COLLEGE SAVINGS PLANS

I am looking at different educational savings plans and would like advice from any of you finance-savvy people out there.

Mutual fund vs. 529e vs. Custodial account? Hmm…

I’m a bit torn. I like the tax advantage of a 529e; however, don’t like the idea that the money can only be used for one purpose (education). What if the college-bound student doesn’t need the money due to scholarships or attends a school with lesser tuition? I just like being in control of my own money and not having rules placed on it. With an income above the average American, I am in need of tax advantages, so I suppose I could learn to deal with the loss of control.

Any comments?

READ THIS

Here is a story that I just love. It involves so many wonderful learning issues, including human stupidity, natural selection, repeated unplanned pregnancy / irresponsibility, distrust with Western medicine, alternative medicine, and my personal favorite - the immediate lawsuit filing after a loved one's death. This story is so good, I just wanted to share it with everyone.

(In doing some research in toxicology, I found this article about a herbal substance known as pennyroyal. It is found in most herbal stores and used in pennyroyal tea. Funny, since it causes abortions and severe liver and renal failure with death.)

AND THE SHIT KEEPS ROLLING IN

This malpractice site ran by a New Orleans law firm actually listed an article in a blog entitled "Doctors Have the Upper Hand At Trial". Yes, we do have an upper hand at trial mainly because if we actually take the time and effort to go to trial, most cases that go that far are bullshit in the first place and pressured there by you social vultures.

What they so delicately forgot to mention was that most malpractice lawsuits don't even go to trial in the first place. Insurance companies would much rather settle out of court for a lesser amount than it would take to go to trial and support the doctor - hence potentially lose more. So, if a doctor wants to actually prove he/she did nothing wrong, that doctor has to pay for it all themselves.

Trial attourneys love to encourage paitients to file suit simply becasue the suit will likely be settled out of court by the insurance companies and lawyers. So, the patients are happy, the lawyers really happy, and the doctor is pissed off because most of the time he/she never did anything wrong in the first place. Really makes you wonder - if most suits that actually go to trial are ruled in favor of the physician, who do you think is right in all those settlements that don't go to trial?

Doctors are so sick of lawsuits, and why wouldn't we be? We do our jobs, usually extremely well, and when some patient has a bad outcome, they immediately think it was the doctor's fault. (Ignorance is bliss.) Wake up! Medicine is not perfect (and never will be), doctors are not perfect, and patients have a good tendency of making a hard job even harder. Now the patient is upset and what happens, they see some advertisement on the TV for some random personal injury lawyer (aka social vulture). The patient calls and the lawyer proceeds to have a great day because usually, if there is any sort of sad outcome, they know that the case will never go to trial and instead be settled out of court for some "undisclosed amount". Well, a good percentage of that amount goes to the lawyers - those nice folks out to serve in the best interest of their clients.

Give me a break. Any personal injury lawyer who says they went into practice to truly help people is so full of it, they reek of it. I'm trying to help people when the need it most, while the vultures fly in and try to feed off the dead. Feed away boys, at least my children can be proud of what I do.

READING THIS IS LIKE DOING ANOTHER RECTAL EXAM

http://medmalblog.thecochranfirmno.com/archives/cat-medical-malpractice-lawsuits-do-not-increase-health-care-costs.html

IS IT A HEART ATTACK ?

A middle-aged female patient comes into the ED with chest pain, a very common chief complaint. She was extremely concerned that it may be her heart and was sure it was a heart attack. I obtained a good history, which sounded like a possible heart attack (acute coronary syndrome vs. infarction). I always ask about alcohol, smoking, and drug use - especially cocaine, meth, etc. She strongly denies all the above. I tell her we will work her up for cardiac chest pain and get the labs cooking. As I'm walking out of the room, she asks, "Doctor, could this be caused by injecting Ritalin, because I do that." Boy, did I feel stupid for not remembering to ask that very important Ritalin injection question they teach you in med school.

RIGHT or PRIVILEGE ?

There is a debate out there as to whether medical care is a right or a privilege. Immediately, most people would say it is a right, but the argument is much deeper than that. Currently, there is a health care crisis mainly because of this argument. Patients and the general public believe health care is a right, while many of those in the medical profession, from nurses to doctors to pharmacists, think the contrary. Here's the dilemma...

Right or Privilege:
If health care was a right of every person, every patient, US citizen or not, would have access to medical care - whether they could pay or not. Actually, this system is already in place at every state-funded university or teaching hospital in the nation. Due to EMTALA (Emergency Medical Treatment and Active Labor Act), emergency physicians and hospitals are FORCED to see and treat people who can't pay. EMTALA defined- any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives. So, we as ED physicians and the hospitals that house us, are forced by law to see and treat patients who can't pay for services, and then are still liable for litigation by those patients when there is a bad outcome. I'm sorry, but if I am to be forced by the government to see and treat you, than the government should be liable, not me. Better yet, don't sue, be thankful your even getting care, and stop being a drain on society.

What is supposed to happen in this system is that people get their medical care and the government picks up the bill; however, in our current system, this doesn't happen. So, people get their free care and who pays? Nobody. The physicians and hospitals supply all their services (nursing time, equipment, supplies) free of charge. Basically, the hospital and physicians are giving charity care, which should not happen. The end result, hospitals have to overcharge patients who CAN pay for medications and supplies in order to partially offset the enormous costs of giving away care to the millions that can't afford it.

In the last decade, over 400 emergency departments have closed while the number of patients seeking emergency care has jumped over 10 million - leading to problems with waits for beds and boarding of patients in EDs. Now, in a monitary economy such as ours, you would think that with such a demand for emergency care, emergency departments would be springing up like weeds. Simply put, medical care, in selected areas throughout the country is socialized and free. It is the non-paying American public (citizen or not) who is driving American health care into the ground.

Health care is a privilege, not a right. Every person deserves care for actual medical problems, but with so many people actively abusing the system (getting free care for non-life-threatening problems and wasting our time) my sympathy on the matter is gone.

SMOKING

Patients who need to walk outside in a hospital gown trailing IV poles to smoke cigarettes are extremely frustrating. They waste everybody's time. The nurses sometimes have to wheel them outside, plus, I stop by in the 2-3 minutes I have to see them during the day, and they aren't even there.

I understand that smoking is quite possibly the hardest addiction to kick, but it is just bizarre to see a patient outside with IV pole in hand, gown on, no shoes, sick as hell, and smoking. Kind of defeats the purpose of a what we're trying to do at the hospital, don't you think?

On a different note, smoking should be absolutely banned from any public building, including the outdoors part of a restaurant. Sorry, just because you made the extremely bad decision to start smoking doesn't mean that I shouldn't be able to enjoy a meal outside. First of all, you smokers stink (how can you not tell?), and secondly, your smoke always seems to blow right in my face. But, when you come into the emergency room for your chest pain, shortness of breath, and massive heart attack, you won't be smoking then...there's no smoking in the hospital.

NATURAL SELECTION

I think the whole concept of natural selection is completely wrong. People who become highly educated, acquire good careers, and actually have something to contribute to society usually have to wait to have children. By the time they do have children they have an increased risk of birth defects or problems with pregnancy. On the other hand, it seems like any teen with half a brain, but able to screw, is able to get pregnant on the first try and have a completely normal baby. Unfortunately, these teens will have their babies, never go far in school, will take the scut jobs in the world and be total drains on society, while all the highly educated people who can't have kids end up paying high taxes to cover the medical care, food, etc. of these young societal black-holes. Natural selection is failing miserably.

CHIROPRACTIC MEDICINE

FYI, "doctors" of chiropractic medicine are not doctors, at least not the kind of doctor that works in a hospital or medical clinic. Chiropractors are not like your family physician, orthopaedic surgeon, neurosurgeon, or emergency doctor. These are all MDs (medical doctors). Chiropractors are simply "doctors of chiropractic medicine", just like some physical therapists are "doctors of physical therapy". Basically, these days anyone can label themselves a "doctor" if they go to some sort of school after college. So in actuality, the term doctor now references many professionals, from doctor of philosophy (PhD) to doctor of junk (JD).

To become a chiropractor one must attend 4 years of school from 1 of 16 chiropractic colleges accredited by the Council of Chiropractic Education (CCE). When finished, they must pass a board exam and aquire state licensure in order to practice legally. Chiropractic's original focus seemed to be on back pain, neck pain, and a thing called malallignment. These days, there are actually chiropractors out there who believe that chiropractic care is the only care and that people should obtain all their medical care from chiropractors. I won't waste time in saying that these people are complete idiots.

To become a medical doctor one must attend 4 years of medical school and pass a series of 3 national board exams. After medical school, they are technically MDs; however, are unable to go practice medicine right away. Instead, MDs who just graduated medical shool must now attend residency. Residency is where a physician learns thier selected specialty. Residencies, such as Family Medicine, Pediatrics, and Emergency Medicine are 3 years long, while surgical specialties last from 5-7 years after medical shool. Plus, after residency, they now have to pass another board exam, sometimes a written and oral exam. So, by the time a medical doctor enters the community and starts practicing medicine, that person has gone through at least 7 years of medical training.

Here's the real difference between the two. In 4 long years of medical school, students learn a lot, but not nearly enough to practice medicine on their own. It is their time in residency that truly makes them a doctor. It is the daily act of seeing patients, learning how to elicit a good history from those patients, think about a differential diagnosis for what may be the problem, and formulate a plan to diagnose the problem. All this is done under the direct supervision of an attending physician, or mentor MD.

A few thoughts:
- In no way can a chiropractor come out of 4 years of school, start working in the community, and be prepared for what may walk through their doors. So many things can cause back pain (some deadly), which I highly doubt they know anything about, i.e. kidney stones, urinary infections, ectopic pregnancy (deadly), ovarian cysts, pancreatitis, numerous forms of cancer (deadly), aortic aneurysms (deadly), ischemic bowel (deadly), aortic dissections (deadly), autoimmune disorders, fractures, trauma, spinal stenosis, ruptured spinal disc, and the list goes on and on. And I didn't even go into things causing neck pain! All of these potentially dangerous conditions can present with simple back pain. A bit scary huh? In no way should anyone with any of these problems go to a chiropractor for help. If a chiropractor says they can treat and fix any of these problems, walk away, because that chiropractor is now more deadly than any disorder I just mentioned.

- I support chiropractic medicine...for those patients with chronic back or neck pain that have not found any relief by medical means. Truthfully, if you have pain and no specific medical diagnosis was found to be causing such pain, chiropractics is for you. Many patients, from fibromyalgia to cancer, have chronic pain. I support any means to help these people, whether it's a chiropractor, masseuse, or accupunturist. But, the big bad medical causes of such pain should be sought FIRST. Once the bad is ruled out, you can then relax and try finding better means to deal with it.

- I think that any MD who says there is no place for chiropractic care in our society is wrong. The reverse of this is also true and potentially deadly.

- Many people seek medical care and are diagnosed, treated, and do not have to deal with that particular problem again secondary to medication, therapy, or surgery. Yes, the medical bills are expensive (a whole other topic of frustration), but the problem is solved. Now, who knows anyone that has visited a chiropractor and never had to go back for continuing care? It doesn't happen. That's the trick, the visit doesn't cost that much, so you keep coming back for more because they really never fix the problem in the first place. What a nice system for them. Patients just keep returning for more and never realize that the problem isn't solved. Hey, whatever works right?

- Concerning X-rays? MDs barely get enough training in 4 years of medical shool to diagnose problems on imaging studies. They'd probably be lucky to put the X-ray up in the correct orientation. MDs even require overreads from trained radiologists (other MDs trained in imaging modalities). How can chiropractors be able to diagnose all problems seen on X-rays, which may show extra problems that they aren't even looking for? Their not. This is a very dangerous game they are playing.

- IMPORTANT NOTE OF INTEREST: Medical practice is scutinized closely and held to a "standard of care" for any patient problem. This means that if a medical doctor deviates from that "standard of care" and there is a bad outcome, you are liable for litigation (will get sued). Chiropractic medicine does not have this kind of scrutiny and there is no standard of care. So, they are fairly protected from litigation since there is no standard to hold them to. Plus, who then corrects their mistakes or holds them accountable when mistakes are made?

THE COMING REVOLUTION

J. Edward Hill, president of the American Medical Assn. (AMA)gave this speech in February, 2006. It is self-explanatory.

MEDICARE CUTS

In 2007, Medicare wants to cut physician payments by 5%. Here is the response by physicians everywhere...

BROKEN HEART

Informing a family that a loved one is very sick or died used to be the toughest part of the job. The absolute worst is informing of a child's death. Obviously those times are terrible and nothing can prepare one for dealing with the emotions, which is probably why doctors have a high rate of alcohol and drug abuse. Thankfully, I have neither.

My saddest moment thus far...

An elderly woman was brought into the ER from home due to dehydration. She had a long-standing history of Alzheimer's dementia and received care from her elderly husband. They lived alone and it became quickly apparent that the woman was not dehydrated, but perfectly normal (in a demented way). The husband had a look on his face of fatigue. He had spent the last 5-7 years watching his wife deteriorate into an abusive shell of a woman. Apparently, the years had finally taken their tole and his call to 911 for dehydration was actually a cry for help. He had been trying to arrange for both of them to go to some assisted care facility in Penn. or South Carolina, where their daughters lived. Basically, he was trying to do this on his own, with no money, no family close by, and with a wife that needed constant care. I was amazed at how strong his love for her was. He was keeping his vow to take care of her in sickness and in health, and was being destroyed for it. Truly tragic.

SOCIALIZED MEDICINE

This is for those who dream of socialized medicine where all people have access to medical care. Wake up! It already exists in the U.S. Any poor, homeless, or uninsured person is able to walk into any university or teaching hospital and receive FREE care. They can't be turned away, it's the law. They will walk though those big expensive doors of a state-of-the-art facility, see world-class physicians, receive the same top-quality meds that any CEO would get, and are placed into hospitals where the most cutting-edge research is taking place. When these patients leave the hospital, they still have no money, and they will never pay their bill. So, what happens. The hospital and I eat the costs.

Now, if you are complaining about the system, you are probably a well-educated and working individual with enough income that you actually do pay your medical bills. Unfortunately, the real people being screwed in this whole ordeal are the working middle-class. American medical care is expensive (due to litigation, the price of malpractice insurance, expensive medications, research, etc.), and those working enough to pay their bills bear the brunt of the problem; however, you are still terribly naive to think socialized medicine is the answer. Before you cry any longer about the system do this. Travel down to Latin America or another country with socialized medicine and try it out. Acquiring health care and treatment is quite different with such a system. You may soon change you mind and come to appreciate what you already have a bit more. Stop thinking you're politically informed and start thinking more realistic.

If you really want to make a change in the system, here is my advice. Advocate for caps on malpractice claims and consequences for inappropriate lawsuits. The price of physicians' malpractice insurance will decrease, the price of physician costs will decrease, and hospitals and doctors wouldn't have to charge so much for care. As for the extremely high cost for medications, we're all screwed.

Lastly, if you still want socialized health care that bad, leave.

ACCESS TO EMERGENCY SERVICES ACT

Here's the problem:
Physicians that work at free clinics or urgent care centers, where patients can come in for emergent free care, are at no risk of being sued. They are protected under the law from litigation. Emergency physicians anywhere else are under legal force to see any patient that walks through the door, insured or not. Hence, uninsured patients who come into the ER, 1) end up receiving free care (usually the hospital eats the cost) and 2) can still sue the doctors forced to take care of them. Basically, we are forced to treat patients for free and then have no protection from litigation. If you think about it, some patients get free care and then get a large settlement because insurance companies would rather settle out of court than defend the doctor, even when that doctor didn't screw up in the first place.

And you wonder why your medical bills suck. Read this article below about new legislation in place to help fix this problem.

For you social slugs and drains out there, be glad you live in this country.

DEFENSIVE MEDICINE

Read this article to understand one of many reasons why lawyers are destroying American health care.

LAWYERS AND MEDICAL COSTS

In regards to personal injury and/or malpractice lawyers, I think that anyone who makes a living in such a way must find it difficult to look at themselves in the mirror. I'm sure at some point during thier path to "greatness", they felt a flicker of humanity; however, it seems that such a flicker is momentary. Yes, I make a living off sick people...some may say that I am exploiting the sick just like those lawyers I speak of. If this is what helps you sleep at night, so be it. But I take comfort in the concept that, while mistakes will be made, I am trying to actually help the patient. These blood-suckers swoop in after mistakes are made and exploit not only the patient, but the physicians, hospitals, and insurance companies - all the while filling their pockets with no risk of being sued themselves.

For all you patients out there complaining about the rise in health care costs, look no further. I have your answer right here. As long as there are naive patients, with imperfect doctors and heartless lawyers, the amount I have to spend on malpractice insurance will increase, the amount of your insurance will increase, the cost of health care and medical bills will increase, and you will find yourself screwed. You, the patients, will ultimately be left behind in the end because lawyers will earn more, doctors will still earn a decent living, insurance companies will do just fine, and drug companies will run rampant over us all.

ON EMERGENCY CONTRACEPTION

I freely give emergency contraception to those who it applies to. That much should be said right now. Those of you out there that don't support medical contraception in general, let alone emergency contraception, are complete idiots. I suppose you are the same people with 11 kids you can't support and use my tax money to pay for your medical care. However, you boys and girls out there screwing without caution and getting pregnanct are even bigger idiots for obvious reasons.

I recently took care of a middle-aged woman who was raising two children on her own. Probably not that uncommon these days. From what I gathered, she hadn't had sex in quite some time. Well, single moms definitely deserve some relaxation, but her relaxation ended with one too many drinks at the bar and unprotected intercourse with a one-night stand. She sees me the next day asking/crying for help. Aside from the typical concerns about STDs, she was particularly afraid that if she took emergency contraception, she may be killing her unborn fetus. After I confirmed she was indeed not currently pregnant, I informed her of her options, and she left with a Rx for Plan B.

What you need to know...
- It is not RU-486 "The Abortion Pill"
- It will not work if you are already pregnant
- Works best if taken within 3 days of sex, may still work after, but not as well
- Usually take one pill right away and wait 12 hours to take a second dose, that's it

Two last notes. Of course abstinence works best, but let's face it, abstinence sucks. I do support emergency contraception; however, I don't think it should be given an "over the counter" label.

STEPHEN KING QUOTE

"That is the curse of the human race. Sociability. What Christ should have said was "Yea, verily, whenever two or three of you are gathered together, some other guy is going to get the living shit knocked out of him." Shall I tell you what sociology teaches us about the human race? I'll give it to you in a nutshell. Show me a man or woman alone and I'll show you a saint. Give me two and they'll fall in love. Give me three and they'll invent the charming thing we call "society." Give me four and they'll build a pyramid. Give me five and they'll make one an outcast. Give me six and they'll reinvent prejudice. Give me seven and in seven years they'll reinvent warfare. Man may have been made in the image of God, but human society was made in the image of His opposite number, and is always trying to get back home."

Stephen King - The Stand

ANNOYANCE

Last night I was working another shift in the ED (emergency dept) and was once again annoyed by the absolute abuses taking place. It was the night shift lasting from 9 PM till 7 AM, and I was having a relatively good shift. I was working though patients quickly, solving problems, diagnosing, and getting them out the door or to the floor efficiently. Unfortunately, around 3-4 AM the usual folks walked through the door. This is the "It's 3 AM and I have a cold" crew of which I speak. OK, for those of you out there who can relate to these people, you're idiots. These people, who come in all ages and ethnicities, come into the ED in the middle of the night with nothing more than a cold or flu. What's even worse is that these same knobs, if I don't get to them right away because I'm off trying to help someone who actually is sick or dying, get upset and give me attitude because they have to wait for so long. Screw you. First of all, it's an ER, not a restaurant. It is not first come, first serve. If you think so, don't come in the first place because you'll just end up disappointed. And for those of you who do come to see me in the middle of the night with some benign and pathetic complaint, I will still treat you with the same care and professionalism you don't deserve.