Tuesday, March 19, 2013

I Am Not Your Primary Care Provider, But I Play One in the ER!

I did not go into Primary Care or Social Work because that is not what I chose to do with my career. I completed an "Emergency Medicine" residency because I like Emergency Medicine and I think I am reasonably good at it. This article explains about half of my recent dissatisfaction at work. This is a post you surely see many ER MD's complaining about and I am just adding my two cents.

Last night I had two patient's (out of 23) with actual "emergencies" and the rest were simply those without access to regular meds, drug seekers, homeless without a place to stay and psychiatric patients. I agree that anxiety, urinary tract infections, sore ankles (for 2 weeks), abdominal pain & bloating (for 2 years), the common cold and headaches are all reasonable medical issues that need to be evaluated and treated - but they are not emergencies. Of the two "emergencies" I did see, one was because a 27 year old ran out of his insulin and one was a bad asthma attack. Again, I did not go into Primary Care or Social Work but that is what I am doing the large majority of the time. In addition, the majority of these patients cannot pay their large ER bill (which means I do not get paid for taking care of them) and those with "county" insurance or this so called "safety net" insurance think their visit is "free" and they came because they couldn't pay the $50 copay at the Urgent Care.  This means that basically everyone in the ER is working harder & longer hours than ever, getting pay cuts the whole time, feeling frustrated with the system and the patients which degrades all aspects of the care and the true emergencies are afloat in the waiting room amid a sea of discontent while the ambulances are lined up outside waiting for a bed to open up. This system is not working.

Thursday, January 10, 2013

The Gravity of Guns

This is a frightening story but a good lesson about an ongoing issue on our country. Please watch this video below from ABC and this link to a short essay on the mind-set and ethics of a concealed carry permit permit holder (referred to as CHL or CCW often)

Many people seem very frightened of guns and their potential for harm which is understandable. I have offered this post because I feel that unless more of the responsible, reasonable, mature & intelligent gun owners don't start standing up and voicing their beliefs most the country will still think that the term "gun owners" remains synonymous with Billy Bob Yahoo in his truck shooting up road signs while drinking a 12-pack.

I agree that guns have caused a lot of pain and misery in our country but the point is that they often have done it either in the hands of a violent criminal or someone immature, irresponsible & untrained. This video is the best case I have seen about a responsible adult who was aware of the dangers, was prepared, trained and willing to protect her family.

Protecting yourself and your family is not just about stopping the bad guys, it is about the avoidance of negligent injury to yourself or family because of improper handling, training & access to the firearm as well. I was taught that the gun is the LAST option - not the first, second or third and not an everyday play toy. Even as a last option it is only safe and useful if you approach it with a responsible attitude and take it's lethality *very* seriously. You must train with it and be aware of how dangerous it can be to you and your family if you fail to understand these things. Take classes, buy proper gun safes & consider these simple rules with regards to deadly force (again, read this short article):

1: Be AWARE. There are usually warning signs of possible problems - keep an eye out for them
2: If you sense something potentially dangerous try to AVOID it. Walk down a different street, etc....
3: If you can't avoid it try to FLEE safely or hide. (this woman did her best)
4: Finally, if all fails and someone intends to harm you or your family, *FIGHT back*

The fight part is always your last option - LAST. When there are no other choices. Most trained responsible gun owners truly hope this NEVER happens and never want to reach #4, but they still prepare and train for it just in case. Many people who are frightened of guns & private gun owners seem to think we are hoping to shoot up the bad guys and run around like cowboys leaving loaded firearms all over the house. It is not true. I would support gun laws that promote more intelligent, responsible & trained gun ownership and limit certain unnecessary threats.