Rolling Dice

Photo by Josh Appel on Unsplash

When you see your doctor, hopefully you have a nice relationship already. Hopefully you can freely ask questions and choose paths together. Hopefully you have time to think.

On the other hand, when you sidle up to an ER or roll in by ambulance, you get what you get. While there are “standards of care,” your range of experiences can be remarkably wide depending on many variables. Personalities and strengths of ER docs vary quite a bit, and this applies to nurses and admitting docs as well. Variability exists within each caregiver too depending on ER crowding, time of day, whether or not your caregivers have eaten, etc. I’ve had letters of praise and letters of complaint. Shift change is particularly treacherous.

I type this thinking of a particular doctor and experience at work a few months ago. I called this doc for advice and instead got an earful, followed by another earful the next morning in person, simply for placing the call. It wasn’t late and I wasn’t even requesting admission; just guidance. It felt like medical school. Definitely no help. Fairly shocked by the second round of verbal abuse especially, my parting words were “what’s missing in all this is the humanity,” to which the consultant angrily replied “I don’t do humanity.”

Maybe this person was simply hungry, or had had a bad moment or a sad case. Maybe I had interrupted Game of Thrones. Unfortunately, however, most of my colleagues have received the same surprising treatment.

After a few weeks running this through my mind, it occurs to me that for every future call to this person, I’ll be bumping up against both the hippocratic oath and the golden rule. Would I let this person care for my family? Unlikely. Nurses tell me the same. I guess it will be case by case and shift by shift for me now. I’ll most certainly be transferring anything challenging.

The Pre-R teaching points are these:

  1. Solve what you can using people you know and trust first.
  2. Institutions make good care possible, but it’s the individuals who will make or break your experience. You may get Mother Teresa. You may get Twisted Sister.
  3. Next time you are in an ER needing hospitalization or surgery, look your doc straight in the eye, and ask whether he or she would permit the admitting doctor to care for or operate on a loved one. Sometimes you (and the ER doc) are just stuck. But sometimes other options may exist.

Shifts following that rough interaction have been surreal; as if nothing ever happened. Unfortunately, these days I’m like a senile elephant. I lose my glasses on my head, but never forget a slight.
As such, today I no longer address that consultant with the title “Doctor…” I just go straight in: “Got a guy in room 3 with coccigiitis who needs your expertise.”

But that leads to my parting question: Like the lonely tree falling in the woods, is a zinger still a zing when the zingee doesn’t know they’ve been zinged?

For Pre-R though, it’s a non issue, because no call lists. I refer only to docs I like.

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