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Viewpoint: A Letter to the Country from an Emergency Physician

Jacobson, Michael E. DO
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Dr. Jacobson is a graduate of Kansas City University of Medicine and Biosciences and the emergency medicine residency at Henry Ford Macomb Hospital in Warren, MI. He lives with his wife and four children in Omaha, NE.

Dear America,

I am an emergency physician with an apolitical message in this rather politically charged, polarized time in our country. I have worked for some time in this profession, and have noticed a disturbing trend about which I must speak out — the growing number of emergency department scenarios in which the selfishness and entitlement of those without real emergencies drown out the quiet suffering of those in real need.

This morning a middle-aged woman came into the emergency room in cardiac arrest. ACLS was performed to keep her alive. Other patients were in the ED before she even arrived, certainly with what they felt were emergencies, but treatments for these individuals were placed on hold as this event took precedence. After 75 minutes of continual heroic measures and life-saving interventions, with her grief-stricken husband crying, holding her hand for the last time, and stroking her face, she died.

This was no movie, no reality TV show. This was as real as it gets. Real life and real death. Family huddled around the bed to say their goodbyes and wished they or we could have done more.

I walked to my office, emotionally drained and exhausted, and from across the emergency department another patient, upset that she had to wait, spoke out brashly in tones that carried to every room in the department. “I know someone's dying and all, but I am in real pain here.”

What most of America don't know is the emergency department staff are graded with a nationally based report card by hospital administration. A survey is sent only to those who are discharged from the ED, not to those who actually needed admission to the hospital for an emergency or to those, like this new widower, whose loved one passed. This survey is a customer service tool used to see if people like coming to our ED and asks whether we did a good job. The ED staff know this survey is skewed because of the population to which it is sent, and certainly it is not the only tool hospital administrators use to evaluate us. That is another topic for another time.

But you must understand, the real emergencies are rarely graded or surveyed; they only go to those vast hoards of folks who were sent home, many of whom did not get their narcotic medication refilled, like Ms. “I'm-in-real-pain-here” who screamed her needs for all to hear, just within earshot of a new widower.

Mitt Romney recently was secretly taped speaking to his party base about the 47 percent of the nation that feels entitled to health care, to homes, to handouts, and to ever-present help from the government. If this lady represents that 47 percent, I have a few things to say.

The widower and his wife were also in need of care and financial aid. They came to the hospital for emergency care and received it. He was gracious about it, even when the scenario ended in a way he did not want. He and his family were thankful for the care. They will not be asked how they felt the care was, but screamer lady will be. It is doubtful that screamer lady would have been happy short a lifetime supply of narcotics, free ambulance rides, meals, and immediate gratification of all perceived needs. In fact, she and her friend raided the refrigerator for food and beverages without asking permission of staff or being cleared for eating or drinking prior to her labs and tests returning.

This widower and his family behaved in a way that acknowledged that there were others in the ED. They realized a limited but adequate number of doctors and staff were available. They were calm in the face of a real emergency, but never acted as though the world should stop for them, even though it ended tragically. They knew how to play fair even though their real emergency was not fair.

We live in a society that David McCullough Jr. describes as rewarding mediocrity because everything fairness and equality. Everyone is special, so nobody is. Everyone should get a prize for participating. And even though Johnny didn't win, we're going to give him a trophy for trying because he is special, too. Competition is bad because there is a winner and loser, and that's not fair. This fundamentally wrong notion breeds false equality and ultimately false fairness and entitlement. We do no one a favor by preaching this. We are lazy parents if we can't find a constructive way to celebrate the winner and help our children be happy for him. Instead, we have chosen an easier road: to make all things fair and equal. If nothing can rise above, be more important, or be first, then all must be mediocre. If all must be fair and equal, all will assume the position of being just as important and just as entitled as everyone else despite the real emergency or the real need.

The government mandates I evaluate and treat everyone who steps foot in our emergency department, regardless of the ability to pay or the acuity of the complaint. The government has passed health care legislation that makes it so everyone must have insurance. Now everyone is equal, everyone is the same — the broken physically, the broken emotionally, the broken spiritually, the broken psychologically, and even the broken culturally. Many have primary care doctors, but they storm the ED at 2 a.m. with the Burger King entitlement of having it their way rather than waiting for their own doctor to see them the following day. They will demand to be treated equally regardless of the acuity of their emergency. And you know what? They will probably get it because we don't want a bad report card from the feel-goods upstairs intent on establishing great PR or the lawyers who will use government mandates to take away your pain and make the other guy pay.

Were I to say something to screamer lady about her behavior, she likely would fall back on the clichéd finger-pointing canard, and say, “You're a doctor. You are well off. You don't understand. You can't relate. And you are the one responsible for the high cost of health care. It's your fault.”

As a young, married medical student, my family and I participated in Medicaid because having insurance was a requirement for my rather expensive medical school. I felt grateful, not entitled, to be able to sign up for the program. I know poverty in America because I lived it for a decade despite help from family. Government programs can help for a time. But know this, I spent my high school years working on grades and homework and at a job. I went to four years of college, working on grades and a job. I went to four years of medical school working on grades and leaning on the government for help, which I am now paying back. Then, I worked four years as a resident on call, on 12- or 36-hour shifts with just enough sleep to go back and start again. Now I work. And I work. Work and making good life decisions result in prosperity. No one — I repeat, no one — becomes prosperous on government programs. Student loans, food stamps, Medicaid, and unemployment benefits are there to help temporarily, but for heaven's sake, government aid is not a right and living your life like you are entitled to eternal government care is not right.

Anyone who wants to can go to school for 12 more years after high school and work, incur student loan debt, drive a 14-year-old car for 12 years, and study (while passing on TV, movies, parties, conversation, family life, sleep, and eating to study some more). They can then make a living that buys a nice home, clothes, insurance for family, and, hey, a new car. Anyone who can work can do this. And I'm all for government help for those who, through no fault of their own (and not their poor choices), can't work.

This woman, however, would reach into my pocket and take my hard-earned money while tapping impatiently on my watch to give her more of my immediate time and attention when others need it more, still claiming I am a cold-blooded heartless rich guy intent on robbing her of all the government assistance that is her due while simultaneously stiffing the hospital for what she considers an unconscionable medical bill. I am not cold-blooded or heartless, just tired and beat from the work I do and proud and gratified that I can do it. The same is possible for anyone here in the land of opportunity.

Are we so far gone as a society, in the name of popular progressivism, that we now don't view work as something to be valued, specifically when the work requirement is removed from the welfare bill? Are we so far gone as a nation that we vilify someone for their hard-earned wealth and elect a national leader who believes in taking that away to pay for those who would act as drains and not aquifers to the national pool of prosperity? Have we developed a national mindset that makes it normal to expect others to take care of us?

I think we develop a self-absorption that is callous in the face of anyone else's need when we rely on the government to handle our every need. No respect. No decency, no restraint, no responsibility, and no apology for it.

Frankly, our government cannot fix this, they cannot mandate a solution to this, and they cannot legislate against this. Nor should they. The solution to selfishness and entitlement can only be fixed with a mother and father (who know how to model character) teaching a child that work is hard and rewarding, that life is not fair and never will be, and that the freedoms you enjoy in this life are because someone else paid the price. Get up and get fixing.

Sincerely,

Michael E. Jacobson, DO

http://journals.lww.com/em-news/pages/ar...p;type=Fulltext

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My wife has told me stories like this happen everyday, if not 5 to 10 times. 60% of her patients are drug addicts looking to score, and they return weekly, since all they do is hospital hop from one to another till they get what they want. (all for free mind you)

She would tell me almost every week during end of her Internal Medicine Residency that had she known what life would be like as a Physician, she might not have picked it as a profession.

Dr. Jacobson is not exaggerating about the sacrifices people like him give up in order to become a Doctor. Student loans over $220,000, giving up 11 year's of your life or more in education, no life outside, all this just to be spit on because you will not falsify disability forms.

I have said before in another post, that physicians have the highest IQ of any profession and as such will not work in conditions like this. ( to be the slave of the entitled) Why you might ask, because they can change to almost any other profession and likely be very successful. So as "we" embrace socialized medicine here in the US, we all will soon see that with free healthcare, "you get what you pay for."

The guy says it perfectly. By no means did I go to college which was my fault. But I workedómy way to a job where I won't get rich but i can make 40-50k a year/, which lets me and my wife make our mortgage payment and live comfortably while she has went back to school full time. We work hard for what we have. Now we dont get to go on vacations all the time or buy stuff left and right. But then I jump on facebook and see people I went to school with that dont work have 3 or 4 kids. Drive newer cars than me and go to disney world for vacation. Then in the next breath get mad and write on facebook that their food stamps are late or complain because they had a $5 copay.

Not sure if any of that made sense, this subject has just got me riled up lately.

We were at the hospital yesterday with my brother, and they had a "Code Brown". Well, my sister in law is a nurse, and she said that it means that there is a missing adult patient.

She works in an emergency room, and she said that they frequently get people in who claim incredible pain trying to score pain medication, and when they realize that they aren't going to get it, they just leave.

My ex is a nurse....she was a nurse for the entirety of our time together. I've seen this time and time again. I've heard the stories of the same patients being there and "drug-seeking". And it is very hard for the nurses and doctors to take any patient seriously. There is always a certain amount of skepticism.

It's a sad state of affairs. And a few bad apples really do spoil the whole bushel.

Quote:

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We were at the hospital yesterday with my brother, and they had a "Code Brown".

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I'm not going to tell you what happens when our nurses call a "code brown".

Thank you! funny you say that. The company I work for lets you move up if you want and dont mind moving sometimes. Our regional safety guy started where I am now. With out a real background in safety.

Fun with real Med Students.

Ohio State Med





The video that started it all

Ok, maybe it started apolitical, but equating the junkie incapable of empathy to Romney's 47%, while ignoring the fact that the unfortunate elderly couple probably fall into the same category is clearly political.

Nobody likes junkies racking up unpaid medical bills. I hate the fact that so many people show up to the ER when they have a cough. That doesn't mean all Americans shouldn't have access to health care... This garbage happens independent of the current health care legislation. And it certainly does nothing to make me feel that the wealthy are overburdened. What is this rant about, exactly?

Soon, you will understand.

o you may very well be the next person yelling at the Doctor about "why is it taking so long...".
Note, many of people like screamer lady are not junkies, they are Dealers that sell the pills on the street. They get a free ride downtown in the ambulance. They time it so they get free lunch, provided by the ED. Free IV Dilaudid and pills out the door. They sell the drugs right outside the Hospital. This is not as bad in Ohio as it is in Philly, where we lived for a few years, but it's starting to show up here as well.

But your right once healthcare is free it will never be abused for free drugs, free lunch, free bed, free TV, Free soda delivered to the room by staff, and if you can get disability, free house cleaning lady to clean your house. (yes this exists already today). This will never happen

As a medical professional myself seeing these types of behaviors every day, I commend him for putting this out there.

Amen, brother.

what do you do with these folks? Most of them are out of their mind, mentally ill. I work with a woman like this. She has some sort of mental illness, always going to the er thinking something is always wrong. She's not a bad person, just has some serious problems. With her state of mind, there is no way she will ever make a good living. It's just not possible. That's what this Doctor fails to understand. He's comparing himself to people with serious problems..

I'm sorry, i agree with a lot of the republicans on fiscal issues, but this doctor epitomes the reason why Romney lost the election. For most of his rant he talks about himself, and why he is better than most people. That type of condescending attitude will get the republicans nowhere.

How did this become a Republican thing?

I think the guy is spot on and I hate both the Republicans and the Democrats. I also dont think Romney's fiscal stance was at the forefront of the reason for his loss.

I also don't think this guy is making the point or taking the stance that he is better than anyone. I think he's pointing out the fact that there are a lot of people out there (more and more as time goes on) that are completely flying in the face of JFK and asking what the country can do for them and how fast.

I'm not saying this letter written by the doctor is a republican thing. I'm responding to the poster about his making it one.

I'm pretty sure Romney was damned because he cast a shadow of being out of touch socially where he was completely unrelatable to many Americans. Republicans are damned in general with my generation because they are so close minded socially.

Romney's problem was that he lacked personality and charisma ...... that he championed a healthcare law as a Governor that was far too close to what Obama passed into law for the nation ....... he was far too liberal until his recent conversion to conservatism, and his message was muddled for most people.

The nation wound up seeing him as Obama lite.

Look at Republican turnout for this election. There was a smaller Republican turnout for this election than in 2008 for McCain, and.or 2004 for Bush. Bush had 62 million Republicans turn out for him in 2004. McCain had 60 million. Romney only 57 million.

Obama actually had fewer people vote for him in this election than he did in 2008. About 10 million fewer people. he had every historic axiom, from GDP growth, to unemployment, on down the list against him, yet he still won.

McCain received almost 60 million votes in 2008. Romney received about 57 million in 2012.Romney was a flawed candidate who lacked the credentials to excite the Party base early, so he was still trying to do that late. He got big turnouts, fueled by Party loyalists ..... but he was never able to then pivot back to the middle at all.

He also never took advantage of Benghazi, and on economics, he never connected his message to what it would mean for ordinary people.

Romney ran on social issues far less than almost any Republican I can recall. I don't think that social issues did him in. He didn't campaign on abortion, or gay marriage, or anything like that. He was campaigned against, but he let it stand, and let the opposition define him in those areas.

Romney needed a more streamlined message on taxes; one that everyone could understand. He needed a more rounded message on what his administration would look like. He got too bogged down in minutia and sound bytes that were not complementary to his positions. (Big Bird and such)

He had a winning message on spending ..... "The question I will ask on every program is this: Is this program important enough that we borrow money from China to pay for it?" He didn't hammer it home though. The Republicans had an extremely inclusive Convention, then Hispanics disappeared from the campaign just as fast. (with the possible exception of Rubio ... but even he was underutilized)

The Republicans should have been in prime position to win this last election ...... but they flopped. They had 2 idiot Senate candidates who blabbered their idiocy for all to see about rape, of all subjects, and who turned people off to them, costing the Republicans 2 almost certain Senate pick-ups.

I do think that the Republican message is a good one on economic matters .... taxes and spending. The House is full of Republicans who ran on those things. There are 30 or so Republican Governors, and many Democrat Governors actually ran as more fiscally conservative to win their races.

The Republican Party needs to do a much better job on message, and on not allowing the Democrats to define who they are. They also need to reach out to Hispanic voters as Bush did, and campaign in Hispanic areas, while featuring more prominently Hispanic Republicans.

I know a lot of pharmacists from college...and all of them have similar stories like this doctor's.

It's amazing how many people try to take advantage of the system and succeed.

Nice summary on why Romney lost. I was reading some oped piece on Facebook today where some guy insists there's no way fewer people voted for Romney than McCain and that it was simple voter fraud.

His premise, he "knows" a lot of his friends voted Romney, so there's no way Romney lost. I think it's more like what you said. I really did want to like Romney, because I wasn't wild about Obama. But he was just so damned unlikeable and out of touch with the middle class. Ultimately,in the end, I didn't vote for either guy because I was not about to vote for the lesser of two evils.

I cna believe that the election turnout was down, because of simple "eyeball" evidence around town. In 2008 there were tons of Obama signs everywhere. People were excited. This time ...... almost nothing by comparison. I think that many people who voted did so without anything approaching the same excitement as last time around.

Well, Here is my question: Why do Democrat still continue to lie about what they really stand for and what direction they want to take America.
-Clearly they are against Oil and Coal, but "Say" they support it.
-Clearly they are for an authoritative, collectivist big Government, but Obama said during a debate he was not a big Government guy (Laughable - or maybe Obama was doing a comparison of himself and Joseph Stalin)
There are many more including not really big fans of free speech, or guns, or god for that matter, but always say they are. ( The line with Nancy Pelosi's my favorite word, is the word - oh come on )

So why do they do it? Why don't Democrats fully embrace big Government Progressivism, since that is what the people want, right? BUT they don't...why?

Maybe because most Americas don't have there hand out looking for Government to fill it. I feel they do it because they know they only have 47% of the nation that vote for Progressive Ideology, and still need to trick some voters into believing they are sheep, and not wolves.

Oops, sorry I misunderstood

j/c

slightly off topic...but somewhat along the same lines of the point the doctor was making about entitlements.....a light hearted joke...



A young man walked into the local welfare office to pick up his
check.He marched up to the counter and said, "Hi. You know, I just HATE
drawing welfare. I'd really rather have a job. I don't like taking
advantage of the system, getting something for nothing.”

The social worker behind the counter said, "Your timing is
excellent. We just got a job opening from a very wealthy old man who
wants a Chauffeur and bodyguard for his beautiful daughter. You'll
have to drive around in his 2013 Mercedes-Benz CL, and he will supply
all of your clothes. Because of the long hours, meals will be
provided. You'll also be expected to escort the daughter on her
overseas holiday trips. This is rather awkward to say but you will
also have, as part of your job, the assignment to satisfy her sexual
urges as the daughter is in her mid-20's and has a rather strong sex
drive."

The guy, just plain wide-eyed, said, "You're messin with me!"

The social worker said, "Yeah, well... You started it."


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Now on the serious side...I too am in the healthcare industry and can tell you first hand that one of the metrics that is a hot topic at the moment now is re-admissions. And trying to track them across 11 hospitals, 16 Family Health Centers, 64 Specialty Centers, and 13 Emergency Rooms is difficult. But being able to see those that are jumping from hospital to hospital has been a priority.

People often blame the hospitals or the doctors etc. for the high price of healthcare....But most people have zero clue as to what really drives the price. Where I work we have been a model for the country for keeping costs down. We sent teams of people to the government to talk to them about how to control healthcare costs....in the end they decided instead to bail out the insurance companies and cut the payments to the hospitals that were already unsatisfactory....

In the US...we absolutely have the best healthcare providers in the world. we have the best Hospitals Bar None. We could even pay for most or even all of it if we focused on ways to control costs instead of throwing money into the wrong places. There is NO ONE that can convince me that Canada or the UK or France has a better system than we do. Because we have a clinic in Toronto that is absolutely Booming. So much so we are looking to add another because people can't wait a month or so to get their MRI or CT etc. So they come to us and get it done right away....We are also looking to add another in the UK...So we must be doing SOMETHING right and their current system must have a flaw if there is such a demand for these clinics in these places.

The problem is not with the healthcare system...it is in how we are paying for it...and we have to be VERY careful here....because how we pay for it can have SERIOUS repercussions on the level and quality of service we can provide. And if we continue on the path we are currently on....say goodbye to some of the best hospitals in the world and Hello to the stereotypical VA hospital scenes.