It is hard for me to believe that I have only had a month of shift’s this year. Corporate emergency medicine has taken over Florida and they won’t hire me, but have no legitimate reason. On paper it is impossible to explain why I am not running a residency at this point and that was my goal. It is a real hurt for me because it was my dream. I have medical licenses in 5 states I maintain (IL, IN, AZ, AL and FL) but the locums environments in all of these places are not so great. Several hospitals I have worked at has staff who are awful; I actually take care of the patients. The nursing staff doesn’t want that they just want to “street em not treat em”. A young man comes in with an SVT (supraventricular tachycardia) from PCP and methamphetamine…brought in by police and they were concerned he might die and they are right he could…. he is grossly paranoid and all over the place in his exam room looking for things that might poison him…nursing staff at a hospital which will be unnamed refused to place an IV because he might “sue them for battery”…I’m not sure who is more paranoid and stupid…them or this young man who took this stuff…since he was paranoid…he had NO CAPACITY AND NEEDED TREATMENT! They called the administration to determine if they could treat a confused patient. I am not laughing in these situations I just get what the patient needs and treat them. He is fully able to be classified as a person with no capacity and thus should rapidly be treated given his condition. It is such a low standard in all of these “critical care access hospitals-I view it as a national crisis. Understaffed…so much so I am even running their ICU at night”…doing all the medication/vent adjustment orders so the intensivist can sleep! Why? Because they approved me to do it after asking me…so I did…I am not complaining about that. Meaning I am able intellectually and work the ER SHIFT for 24 hours and run their ICU at night…not a problem. I find other doctors have “rebound patient events” at this ED because they don’t undress their patients…one completes a full cardiac workup for what I found the next day in the same patient who returned was back spasm referring to the left shoulder and was instantly relieved with an injection. Absurd, just like the director who says my words are “too big” for him for him to understand and I should not use such intellectual words in my dictations…LOL. He says he is insulted if he has to read: big words. Jesus Lord help me. This is the mess of our country; education values to the left and right…all your fault Judith Tintinalli…yes I think I will blame you… because Im not complaining…but you don’t go to Congress, sit and talk about the failures of emergency medicine especially the cancer of corporate emergency medicine and what it costs our nation. I am not supposed to practice ICU medicine. If I refused I would not have even those thirty days of shifts. I am never tired of work…I love work…I’m tired of the mess that is getting worse. I am going to expose it all while I keep dong what I do. All of you who have damaged emergency medicine. I just read judith Tintinali/s CV. She has an honorary FACEP…for what? Oh don’t get me wrong the woman has done great things but she is not done. Over 500 people wrote her book and I know I sold over 12,000 copies because you may not enter my classroom without it (yes I tell each client to have a copy of the latest edition). What has she done to stop the rampant negligent education and abuse of Corporations costing our nation billions. Billions that don’t need to be spent on middlemen who serve no purpose; they play a shell game with doctors…and hospitals. I am speaking of recruiting. We don’t need scheduler companies and we don’t need recruiters. We need people to wake up and stop this crap; sorry but you are all just middlemen driving up the price of medicine enormously to the tune of billions, tens of billions and so I hope POTUS reads this. It is all crap and it is just for the all mighty dollar of profit to companies who do nothing to make medicine better. THEY MAKE IT WORSE..so much so that now iatrogenic morbidity and morality is a major cause of harm to AMERICANS. It ranks in the top seven to ten causes of death-just being in a hospital! Hundreds of thousands of people harmed every year in America by undereducated but well-meaning APPs and EPs who were not properly trained and at times are also not so caring because of burnout.
I have met and worked with hundreds of them. It is lunacy. Residency program director quote who was fired: “If I could make this much money doing something else I would leave medicine because I hate teaching.” He was making almost 7 figures for less than 10 shifts a month. He sent home a 24-year-old female patient with a fever of 104°F tachycardia with pyelonephritis because he saw an ovarian cyst so small that it is a normal study…but he decides it must be the cause of her illness but no pelvic exam just big bold fever and left flank pain with dysuria and frequency with shaking chills (rigors), WBC 27,000 with left shift. The pus in her urine, her fever, her TNTC WBCs in the blood and urine…and her Left CVA tenderness and rigors and he did not put that together in his little brain because he uses it in the ED for damn, “F” and other foulness that cause his brain to misfire-his amygdala, hypocammpus are no longer connected to his tiny frontal lobe command center. And he has no remorse when she comes back nearly dead. 1/100 Americans are psychopaths; He may actually be one. I received an update that happened this year in 2017 that he and his evil associates were all fired from their positions…thank God! It took the hospital many years to do this only because they feared no doctors would go to their isolated location in Mohave County, Az. One of their board members advised me of this after I arrived for my 5 months there to train their residents. They were all good guys but suffered from what I would definitely call abuse by the faculty who took pleasure in emotionally hurting these residents. Some residents had actual timers programmed in their cell phones…the dates and timers are related to the day they get to leave what they called a “hell hole”. Sadly they were referring to their residency director and much of the faculty…all of them gone fired as I said. It is not surprising to me that finally they were replaced. So to continue with the poor young lady with pyelonephritis…here is what the residency director failed to do…or if you wish to read it this way:
No antibiotic, no antipyretic, no IV fluids…he forgot the “2-2-2” rule: 2L saline, 2G Ceftriaxone, and 2GAPAP and you can add 2 hours of observation the “2-2-2-2” rule to decide on disposition but this was clearly an admit…he totally missed the diagnosis because he goes tooo fast! Did I write enough “o’s”? He had no remorse only anger when I advised him of the case and I am obligated to tell him. All of this happened because he did not look at the U/A. No pelvic exam either yet he made a “pelvic diagnosis”. I see her near death the next day. I treat her and she is admitted. He has no desire to hear about it and curses at me when I begin to tell him about the case. SO I repeat a few year later he is finally fired. Yeah! Another one down. I will always be an advocate for patients. I will also protect doctors being injured by doctors or others who work in a hospital. If you are a provider you should expect and be prepared for violent patients. That is part of the job. You need to know how to manage that and how to use pharmacology to sedate patients. You always need to know the primary cause of the violence because it may be pathology that needs to be treated. One of the worst repeat mistakes is staff putting a violent patient in a room, closing the door after physical restraints. This can lead to rhabdomyolysis, renal failure and death. You need to exclude the serious causes of the agitation that is why the patient is in your ED. IF you let your emotions control you or those of other providers, you will surely fail the patient.