September 27, 2016

Private Thoughts of an ER Doctor.

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MRW I start watching Grey’s Anatomy and think I can start performing surgeries based on my Netflix marathon

As a writer (and human) I’ve always been fascinated by the private thoughts of those I make myself vulnerable to.

(And have even confessed my own now not-so-private thoughts as a yoga teacher.) What’s really going on in my doctor’s mind when I peel down my pants? How do they really feel about people with addiction, obesity, things up their butts and other so called “self-made” health issues?

My favourite interviews always yield something surprising. After speaking with ER doctor Peter (not his real name) I was struck by how very real he was, struggling with workplace bullying (as many of us do) and trying to find the balance between professional detachment and the very human response many of us would have when confronted with certain cases. Who knew doctors—the demi-Gods of our society—were just as fallible, vulnerable, and struggling to do their best within their limitations, as the rest of us?

Here it is, in Peter’s words:

The culture.

Emergency medicine is the exact opposite of what you see on TV. You have to neutralise all the high drama and histrionics so you can be calm and methodical enough to do your job.

There’s a huge gap between what I thought being a doctor would be and what it actually entails. I thought was all about clinical science, but in reality, my worth as a doctor is not so much to do with how well I can diagnose, but how quickly I can process patients and complete the paperwork. How you well you document everything determines how much funding the ward and hospital get each year.

No one gets through medical training without being bullied. It’s systematic. You’re under pressure and under-resourced, so you condescend and humiliate someone down the chain. But the medical community won’t tackle bullying culture because it has no incentive to do so.

Embarrassing bodies.

If someone asks me to look at something weird on their genitals, I don’t get squeamish. I think “Oh God, I need to get a chaperone or else I’ll get sued.”

People do come in with things stuck up their butts, but not often. You have to keep a straight face. A woman came into the ER recently, well-dressed in a business suit, and calmly told us her husband would be home from overseas in two hours and she had a sex toy stuck in her bottom and she couldn’t get it out. They had to get a surgical team.

I had an 18-year-old pill popper who’d taken 50 Viagra and couldn’t get it down. But you have to get it down—it becomes a medical emergency. They party all night, then want to perform at 5:00 a.m. so they take a whole box. We had to cut it to let the blood out.

Gender bias.

The female doctors do get harassed by patients, particularly psych patients, and the nursing staff definitely cop it.

There’s a huge gender bias in medicine. There’s been a lot of media attention about female staff being harassed by senior doctors, but they also cop it from the patients who flat out refuse to deal with women doctors because they think they’re less credible

When I was a junior doctor, patients would flat out refuse to deal with my female colleagues, because they think they’re less credible. We had a patient admitted to the ward following a motor vehicle accident. My colleague on that shift, an attractive woman, approached the patient’s mother to talk about her son’s care and the mother just went nuts: “How come you’re involved in his care, where’s the real doctor?” I had to step in, and even though I had exactly the same level of experience as my colleague, the mother basically told her to f*ck off because her son needed a “real” doctor like me.

Drugs, alcohol and obesity.

I had a guy come in who’d been a heroin addict for 40 years. He looked like an alien. They found him OD-ing on the side of the road while driving. We gave him a reversing agent and he literally woke from a coma state, got up off the table and walked out.

With something like obesity, people in health care see these patients the way the community sees these patients—with disdain. Similar to drug addicts, as in “They’ve done it to themselves.”

It’s not seen as an addiction or a hard medical problem, even though it’s behind everything—heart disease, blood pressure, joint and mobility issues. We get them a dietitian and a psych review, but that’s worth virtually nothing. They’re binging for a reason; nutrition information and suggesting smaller meals won’t work. The psych team might diagnose depression, anxiety, or bipolar, but they just give them meds, which might make them bigger.

My personal opinion is we need to treat it like an addiction and create an allied health pathway like AA or Narcotics Anonymous. Give them group therapy, don’t just throw a diet at them or medication. Instead we offer them a lap band.

When you see a patient who’s essentially “done it to themselves,” you just treat the problem, you don’t see it in that judgmental way. Everyone’s done it to themselves in a way, it’s just whether it’s fast or slow. If you got annoyed at that you couldn’t do the job.

Dr. Google and the “worried well.”

There’s a whole subset of patients we call the “worried well.”

They come in with headache or abdominal pain, then go home and type whatever tests we’re running into Dr. Google and convince themselves it’s something more sinister.

Usually anxiety is behind it. Some trauma or domestic situation they’re not dealing with, so they get fixated on a medical issue. Then they doctor shop, going to all the GPs (general practitioners) and ERs, doctor shopping until they get the answer they want.

Alternative health.

I had a kid who didn’t get a tetanus shot he needed because his mum knew anti-vaxxers. I had to get paediatrics to talk to her but she still refused. We just had to document it and get her to sign it to show that we’d done all we could do.

I don’t mind if patients want to do their own alternative medicine. I don’t believe the medical profession knows everything, but there’s no massive conspiracy to prevent people using alternative medicine. We say “all these herbal remedies aren’t hurting, but try this as well.” The placebo effect is a real phenomenon—so if someone’s doing something that they feel helps, as long as it’s not doing harm, do it.

By all means continue juicing, just consider chemo as well.

A good day.

People think you must go home at the end of the day feeling great because you’ve saved all these lives, but that’s a common misconception. The outcome may be that a life is saved, but it’s never one person “laying their hands on the chest” and healing them. It’s because 20 to 30 people were involved.

The satisfaction is really about the people you come into contact with.

It’s a privilege to be involved in some cases. I recently had a young patient whose treatment quickly took a palliative route. For me, dealing with his carers and being sensitive to their issues is when medicine is satisfying as a job. Those family will remember how they were treated for the rest of their lives. It’s a privilege in that way.

If the only reward you get out of it is status and money, you’re not going to make it because it’s just too hard.


Author: Alice Williams

Image: via Imgur

Editor: Catherine Monkman

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