The Beautiful People

People talk about burn out all the time in this field. I know I’m only two years into this, but I’m pretty sure it’s not the job that burns people out, its the asshole patients. Those people that are just unkind, cruel, self centered.  I fully admit, that I have positively loathed some of my patients.

“Hey there, I’m Dr. X, how can I help you?”  “Fuck you, fix my arm”  Ohhhhh kayyyy then.

But these people aren’t anything new. They exist in every ED. They suck your good will out and just pour it down the drain. But fine, whatever, I’ll deal. But everyone once in a  while…. you get that one guy….

There is this guy that comes into our hospitals about every two months. Always an overdose of his calcium channel blocker, usually a half assed suicide attempt, always goes to the ICU, gets tuned up, set up for out patient support, psychiatric follow up, never goes, comes back two months later, rinse and repeat. The thing is though, he is the most racist, sexist human being I have ever met, or even heard of for that matter. Once he comes to, wakes up, he runs his mouth constantly, spewing forth the most vile things you’ve ever heard. When I was in the unit with him one time, he had this kind, sweet nurse, one of the good ones, whom he quickly sent out of the room by calling her a “cunt nigger”.

Everybody hates this man, loathes him, wishes one of these times he would just get it right and come in as a code blue.  How horrible is that, to think that, and then having to perform life saving medicine on him. That’s what burns the docs and nurses out, that’s what eats at the fiber of your soul.  It takes 50 happy, kind, thankful patients to replace one of the scars left by these horrible people.

I wish more than anything, we didn’t have to put up with it. I’ll treat you, quite happily, but only when you act like a human being.  Fine, I’ll come back in 20 minutes and you can try telling me about your arm again. But nope, not allowed to do that, cause door to dispo times matter more.  We have to take it, to the let the patient smear all their vile feces all over our faces, while we stand there and take it. THAT’s where the burnout comes from, not from the long hours, not from the over crowding, lack of resources, or what ever other factor experts say makes us burn out.

It IS a problem though, even in residency. A poster that was presented at ACEP showed  that 50% of EM residents experience mild burnout, 25% of them have SEVERE burnout (Ironically, 50% of participants failed to respond to the follow up survey)

And deep breath. I’m not saying I am in any way burned out. Far from it. I am a little angry about it, but beyond that….well, just keep doctoring on,  and doing my best to not stab these patients in the eye with a angio cath, at least for the time being. There are days when that is a distinct possibility. And I think I’m better than most at keeping my cool. One of my other residents almost came to blows, patient telling the resident “GIRL I WILL FUCK YOU UP IF YOU DON”T GIVE ME A SCRIPT FOR PAIN MEDS” and her in response… getting right in the patients face and going all calm and quiet Clint Eastwood like…. “Go ahead, hit me, I dare you”…..    Yup, let’s just keep packin’ powder into that keg.

I’m not sure what I’m going to do about, other then just vent about it anonymously for the time being. And a good vent always helps. Ahhhh, much better.

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on November 6, 2012, in Deep Thoughts, Emergency Medicine. Bookmark the permalink. 5 Comments.

  1. Good rant! You do develope a detachment with these patients after a while but we all can still be rattled occasionally. Keep on truckin.

  2. Wow. I stumbled into this blog, actually coming from a discussion about professionalism, and right off the bat I get to read about your asshole patients and how you suffer in taking care of them. Would you say these things in a crowded elevator in your hospital? Would your program director be proud to know that your are posting this?

    It is not too late to change specialties. Perhaps you should do your patients and yourself a favor and switch to something like pathology.

    • You’re point of view is an easy one to have from a class room. I had it once too. But If you make it through your training without thinking these thoughts about a single patient, I’ll let the church know you returned. And let’s be clear about professionalism, I’m not mocking these patients, belittling them, making a joke about them. I’m talking about the way they make me feel, my response to the way they act, I’m coping with this impossible situation in a way that lets me go back to work the next day with a smile on my face. So I have no quams about posting this, would gladly let my program director read this, and I know for fact that he would think it’s pretty great, cause he’s there too, slogging through the shitty days with the rest of us.

  3. Not sure why you think I am commenting from a classroom. I dealt with my first hateful patient in 1979, worked as an Denver paramedic when giants like Rosen and Marx were inventing a new specialty and serving as role models, graduated from medical school in 1988, and have been practicing ever since. I’ve had my share of unpleasant patients, been assaulted, etc etc. I’ve served as Chief of Staff at two institutions. Now I work in a rural ED and have a faculty appointment as well. I’ve been going to work with a smile on my face for more than thirty years.

    Whether you don’t think you are mocking, belittling, etc., is not the point. Neither is how your patients make you feel, your condescending attitude towards the uneducated but well intentioned staff at a referring nursing home, the personal suffering you have to endure as you slog through your shitty days, and so on. The point is that you refer to your patients as assholes and talk about your desire to stab them in the eye on a public forum.

    The fact that your director would think this is great is quite telling, and sheds some light on why new doctors are the way they are. No doubt my concept of professionalism is an anachronism, and I may well be written off as hopelessly clueless. On the other hand, there are a lot like me still out here in leadership positions, and we can and do discipline and even fire doctors for unprofessional conduct such as this. Perhaps expectations in “podunk” (we work 24 hour shifts here) hospitals are different than in urban residency programs.

  4. I entirely respect you viewpoint on this, and I’m sure many would agree. But I don’t. I think this should be talked about in a public forum. I think it should be known to the public that this is the kind of thing we deal with. That we have to sit there and take it with a smile on our faces. More people should know about it. We come to work every day wanting to help others, to do good, and we get shit on by these types people, and there are zero consequences for it. And it’s not right, and I’m not sorry for talking about it. And nothing is going to change if we just bury it, whisper about it in the doctors lounge, soothe it with a glass at the end of the day.

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