I’m not looking to start an argument, but I’ve heard this from drs before. My question is this (and I think it’s a reasonable one): What would you do if a patient demanded opoids or an unnecessary surgery or a CT scan that they didn’t need?
I’ve had incidents where I went in with something in mind, but the dr effectively communicated with me and talked me into another route or into giving time for the problem to resolve. Hell, a dr explained why they weren’t giving my son a CT scan (and instead were running a hundred other tests) when the CT scan would’ve answered all of our questions. (Turns out there’s a lot more radiation than the general public is aware of.) I thanked him for explaining it to me and backed off.
Many parents/patients get frustrated because they’re living with the cycles of infection (and all the misery that goes with it) and, in many cases, they do need antibiotics regularly. But I promise you, in those cases, a patient would welcome an interested dr who said, “Let’s get to the bottom of this problem so we can get you healthy and keep it that way.” I don’t know anyone who loves antibiotics. They cause their own problems.
Again, I’m not tying to be confrontational, I just don’t understand why drs are such strong, confident professionals and effective communicators in every other area except this one.
Make sense?
And yes, I am genuinely listening with open ears and an open mind for your response.
Marie, there is a big difference between Class II narcotics and antibiotics. Using Class II medications as an example of something a doctor refuses, when he doesn’t refuse antibiotics is an absurd comparison.
Not only that, these would generally not be prescribed by the same physician. A pediatrician will by and large prescribe Class II narcotics very seldom to children. A chemo physician would prescribe them to their patients. Generally it’s to their geriatric patients or patients in life ending situations.
A child in this situation would generally have been passed off to another physician specialist.
You sound like a reasonable person, and amenable to education and rational argument. Many of the patients we see are not. I’ve gone the education route with parents and earaches ( 90+% are NOT bacterial and don’t need an antibiotic). And then they go to their pediatrician, or the urgent care and get the antibiotic, and then write a patient complaint about the stupid doctor, who wouldn’t write for the antibiotic and their child got the antibiotic and was better in 2-3 days. Can’t tell you how many times I’ve had parents demanding a CT for a child who bumped their head and has no indication for CT. Try to explain to them the amount of radiation involved ( like 50+ chest xrays) the cumulative effect of radiation over a lifetime etc etc etc. How big an ugly scene do you think I can take over and over in a busy ER?
Narcotics. Pain is now the “5th vital sign”. Don’t “adequately address their pain”, which to a drug seeker is narcotics and only narcotics ( “I’m allergic to tylenol,NSAIDS, Toradol, tramadol”) and they file a patient complaint, or worse. Not that you didn’t give them a fix, no you were “uncaring, rude, didn’t take their complaint seriously” etc etc. I’ve been in practice for nearly 30 years NEVER had a complaint from a state med board never been sued. One day 2 years ago I get 3 in the mail the same day. I go check the charts and it’s a woman with foot pain, her husband with back pain, and a friend with chest pain. Long story short I was able to demonstrate they had conspired together ( forgery of letters and signatures ) and I had done everything appropriately but they threatened my ability to feed my family. I was lucky, I didn’t need to hire a lawyer like many of my colleagues. And you know what? The woman had the balls to show up BACK IN MY ER. I had to go see her for her “back pain” ( I made the nurse stay in the room the ENTIRE encounter from start to finish so I had a witness.
Currently the big push by management is “customer service” Note customer NOT patients. Customers get what they want. Patients get what they need. Also the “customer” and the patient may not be synonymous. The customer is the one who pays the bill. That may be the patient, or their boss, or the insurance company or Medicaid. Management now likes to use a “Disney” customer service model. News flash the ER is NOT a trip to Disneyland. Over my career I’ve seen less and less respect for my knowledge, training and judgement. “I read on the internet”, “I have a sister who is an LPN in a nursing home who said”, the fact I’m a residency trained, board certified specialist with nearly 30 year experience who is actually evaluating the patient doesn’t matter. The attitude of administration is “make em happy, give them what they want”. Our pay, and jobs are tied into patient satisfaction surveys and ratings. That comes straight from CMS and the insurance companies. Woe to the ER doctor who doesn’t get good ratings.
Lately we’ve been told to hand out business cards, and tell the patients “ you may be getting a survey and unless we get rated excellent...”, sound familiar? Think car salesman. Not a professional, car salesman. That’s where we are now. That’s also where i drew the line. Not gonna do it. You would be shocked to know how many doctors are looking for an out and any other way to make a living. One of the biggest conferences currently is “ Non Clinical Jobs for Physicians”.
And you know what? The REALLY sick patients aren’t an issue. Helping a critical patient or someone in real distress is still rewarding and any staff member of an ER will tell you they live for those occasional patients.