Your doctor probably hates you

6:00 – Arrive to work.

6: 15 – Gather list of patients. 20+. Six new ones. Only three that need to be here.

6: 25

RN: “Patient in room 4 is requesting more pain medications”

MD: “For what?”

RN: “Their back pain.”

MD: “What are they getting now?”

RN: “Percocets. They want something IV. They say it works better”.

MD: “…. No.”

RN: “Ook…”

6:30

RN: “Patient in room 4 wants to talk to you about their pain.”

MD: “I will see them in a little while.”

6:45

RN: “Patient in room 10 wants tylenol and none is ordered. Can you order some?”

MD: “Yeah, sure”.

6:50 – *Admission pager* Admit from ED. Room 3. Intractable abdominal pain. MD: (God damn it…)

7:00

MD: “So what brings you to the hospital?”

Room 3: (half asleep) “I’m having horrible abdominal pain, doc! It’s like 12 out of 10! It’s all over! I can’t eat! I’m vomiting a lot!”

(Empty food wrappers noticed on bedside table)

MD: “Were you able to eat any of that?”

Room 3: “No, I tried. But couldn’t keep it down. My pain is so bad right now!”

(Review chart: Patient admitted multiple times a month for same complaint. Extensive work up shows nothing. Patient frequently demands IV pain medications)

MD: “Ok, well, we will bring you in and watch you for a day or two.”

Room 3: “Can you tell the nurse to bring me more IV pain meds?” (eyes still closed)

MD: “We will give you pills while you are here…”

Room 3: “But I’m so nauseous! I need IV!”

MD: “We will give you anti-nausea medications”

Room 3: “But pills don’t work for me! I’m in so much pain!” (eyes still closed, covers over them, stretched out comfortably)

MD: “I’m not giving you IV at this time. We can re-evaluate later”

7:23

Room 4: “Doc, why can’t I have IV pain medicatons?! My pain is so severe! My back hurts so badly! These beds are so uncomfortable!”

MD: “Do you have back pain normally?”

Room 4: “Yeah”

MD: “And what do you take at home?”

Room 4: “Well, nothing. Or tylenol.”

MD: “Then why do you need IV pain meds here?”

Room 4: “Well, because these beds are uncomfortable and my pain is worse here. I just need a pain shot, doc! Just give me one pain shot and I will keep with the pills.”

MD: “IV narcotics are not indicated for chronic low back pain”

Room 4: “But you don’t understand! My pain is 12 out of 10! I can’t get comfortable! Just one shot! Please! (breakfast tray in front of patient, half gone already)

MD: “No. You need to get up and walk around.”

Room 4: “But it’s hard for me to get up” (BMI 42 with 8 self-inflicted co-morbidities)

MD: “We will have physical therapy help you. Otherwise, your blood pressure seems to be improving, your blood sugars have gone down, your oxygen requirement is going down with treatment of your pneumonia, we have arranged for home health care to come to your house and assist you with medication management and daily activities (which you have no excuse to not be able to do at the age of 43), we have set up a primary care physician for you, and we have started the approval process for medicaid (as you seem to be unable or unwilling to do this for yourself and have no insurance). Is there anything else we can help you with?

Room 4: “But I really just need a pain shot!” (MD leaves room)

7:28

Room 7: “My sickle cell pain is horrible!! I need more IV dilaudid!” (playing on cell phone with multiple food trays on table and TV blasting)

MD: “You have been here for 4 days, your labs are improving, you are eating and drinking fine. I am not increasing your IV narcotics. In fact, starting tomorrow, we will begin weaning your medications down.”

Room 7: “But I’m still having my sickle cell pain! It’s horrible! I can’t sleep or eat or ‘nothin! You don’t understand! You don’t know! No one treats me fairly here! If I don’t get more pain medications, I’m going to leave!”

MD: (Please God, Please leave! Please leave! Please leave! Go verbally assault someone else! Dear God, please let them leave!) “Well, I’m sorry you feel that way. But we are going to be sticking with your pain plan and will start weaning you down tomorrow. If you feel that you would be better served somewhere else, you are more than welcome to leave whenever you would like.”

Room 7: “I’ll think about it” (Never leaves)

7:34

Room 9 (62 year old patient that is neurologically devastated from massive stroke with progressive multiple sclerosis and intractable seizures. Baseline activity is breathing, random eye movements, and occasional sighs)

MD: “How are things today?”

Room 9 family member: “Doctor, I have some concerns.”

MD: (Christ…what now…) “Ok”

Room 9 family member: “I’ve been noticing that my (insert mother, father, son, daughter, niece, grandmother, or next door neighbor) has been having some occasional twitching in their arm. And then I notice that their blood pressure will go reeeaaallllyyy high for a little bit and then go back down. And then occasionally they cough. What is that?”

MD: “How high is the blood pressure?”

Room 9 family member: “Like the top number is like 150!”

MD: (……) “I do not think I have a definitive answer for you right now, but we will keep an eye on it.”

Room 9 family member: “How do you not know what is going on?! You’re a doctor!”

MD: “These are very nonspecific findings so it is very difficult to say if this is something to be concerned about or not.

Room 9 family member “Well, I think we need to do a scan of their brain.”

MD: (Their brain is dead and so are they) “We will look in to that…”

7:41

Room 11 (52 year old morbidly obese male with type two diabetes here for recurrent infection in his foot from uncontrolled blood sugars and poor follow up with podiatrist)

MD: “How are you doing today?”

Room 11: “Hey doc, when am I gonna get breakfast?”

MD: “I do not know. I do not control that.”

Room 11: “Well, they need to bring it soon. I’m starving! (BMI 41) Can you ask the nurse to get me something to eat?”

MD: (This is why I went to school???) “We’ll try to get you something when we can. But to update you, your foot is starting to look better, however you will need another 5 weeks of IV antibiotics to treat your infection. We will have a line placed in your arm, arrange home health care, and have you scheduled with infectious disease for follow up.”

Room 11: “Uh huh. Hey doc? Is there anything you can do about the food here? They totally messed up my dinner order last night and the food here tastes terrible.”

MD: (The last thing you need to do is eat…) “You should speak to dietary.”

7:52

Room 15: “Hey Doc! When can I leave?” (Has infective endocarditis, active IV heroin user, and needs to complete therapy at a nursing facility)

MD: “As soon as we have a final plan for your antibiotics and placement on discharge”

Room 15: “Hey Doc? Can I get more pain meds?”

7:57

Room 16: “FUCK YOU! YOU CAN’T KEEP ME HERE! I HAVE RIGHTS! YOU’RE NOT EVEN OLD ENOUGH TO BE A DOCTOR!” (Demented gentleman with no family requiring guardianship currently being treated for infection)

8:10

Room 17: “Doc, I really need something for my anxiety. It’s really bad right now. I think I need xanax.” (Comes in with vague abdominal pain, currently resting comfortably in bed)

MD: “I am not giving you xanax. They are addictive. I will give you hydroxyzine if you want”

Room 17: “Well, how about ativan? My anxiety is just really bad doc!”

MD: (You can’t medicate life. How have you made it this far?) “No. I will order hydroxyzine.”

8:15

Room 18: “Doc, I need more pain medications!”

8:18

Room 19: “Doc, these nurses don’t know what they are doing! I hit my call light like 8 times for IV pain medications and they just did not come fast enough! Can I talk to patient experience?”

MD: “Well, good news! We planned on discharging you today as you seem to have improved substantially. You will be able to sleep better in your own bed.”

Room 19: “I don’t know doc. I feel like if I leave today, I’m just going to come right back to the emergency room” (clearly veiled threat)

MD: (I’ve just entered into hostage negotiations with an asshole) “So what are you trying to say?

Room 19: “I think I will be better tomorrow.”

MD: (Two decades of schooling….) “Fine….”

8:21

Room 21: (refused all blood draws and medications) “I just want to sleep! No one let me sleep all night”

MD: (THEN WHY ARE YOU HERE?!?!?!?!?!) “We will check back later…”

9:35

RN: “Room 16 lost his IV. And he is refusing any other sticks. What should we do?”

MD: (Let him rot in hell and die slowly!) “I’ll see if we can get him on oral antibiotics…”

10:15

Case Manager (CM): “Hey Doc, the insurance company for patient 12 is refusing to pay for his stay and wants you to do a peer to peer for further review.”

MD: (What am I?) “When do they want to do it”

CM: “They will call you between 12-5pm”

MD: “Great.”

11:24 – (Pager message: Reminder – Faculty meeting at noon! Free lunch.)

12:00 – Faculty meeting

CFO: “Glad everyone could make it! Now done to business. I want to talk about the hospital’s readmission rates, patient satisfaction scores, length of stays, and ways in which we can improve all of these elements.

MD: (Close down the hospital and open up a hotel with food court instead)

CFO: “There are some big changes coming down the road with reimbursements from Medicare and other major insurance companies and we really need to get our numbers up if we want to be competitive. Currently, patient’s are ranking us about an 8/10. But we need to get to that 9/10 or 10/10 or else we simply won’t make those benchmarks for receiving full compensation! I know we can all do it if we work together!

MD: (Stop providing medical care and invest all money into food and narcotic sales because who gives a shit if every patient dies just as long as they are high and well fed)

12:45 – *Admission Pager* ED admit. Room 19. Altered mental status.

12:55 –

Room 19 (88 year old demented female with no family in the room)

MD: “Hello. I’m Dr. X. What brings you to the hospital?”

Room 19 (staring blankly and not answering questions)

MD: “Are you in pain?”

Room 19 (falls asleep)

MD: “Ma’am, do you know where you are?”

Room 19: “It’s Easter!”

MD: (I should have gone into radiology….)

13:32

RN: “Hey Dr. X, Room 9’s family wants to speak to you.”

MD: “About what?”

RN: “They said the patient is having a seizure and want to speak with you right away!”

MD: “Is the patient having a seizure?”

RN: “I don’t know. I have to hand out pain meds right now. They just called out from the room.”

MD: “…On my way….”

13:35

MD: “I heard you have concerns?”

Room 9 family: (now multiplied) “Yeah, so, we saw some more twitching. We think they are having a seizure and we want neurology to come see them.:

MD: (The patient is a god damn vegetable and nothing will change that) “From what you have described, these seem like simple jerks. They do not seem to have any evidence of seizure at this time.”

Room 9 family: “Well, we FEEL that they are having seizures. We want neurology to come by”.

MD: (Can I see your medical degree?) “I will ask them to stop by…”

14:25

Neurology: “Hey, Dr. X? This is neurology. We got your consult. I reviewed the chart and don’t think there is anything we can really help with. Do you think they are actually having seizures?”

MD: (OF COURSE NOT!!) “No, but the family is concerned and would like your input.”

Neurology: “Well, you know, you are also a doctor. I think you should just go back by and try and re-educate them some.”

MD: (FUCK YOU! FUCK YOU WITH A RUBBER HOSE! JUST DO YOUR GOD DAMN JOB!) “I think they would like to hear it from you.”

16:30 – (Three more admissions from the ED: COPD exacerbation in a 60 pack-year smoker, end stage renal disease on dialysis that needs dialysis and missed the last 2 sessions for nonsensical reasons, and an acute alcohol withdrawal)

16:45 – Clinical Documentation Specialist (CDS): “Hi, Dr. X? This is Sherri from CDS. We were reviewing your charts and we were hoping that you could clarify a few things in your notes. You mentioned hypoxia in one note, does this constitute acute hypoxic respiratory failure or chronic hypoxic respiratory failure? And do they have type two diabetes with hyperglycemia or it is well controlled? These are all important measures that need to be appropriately documented to help capture the the severity of illness for all admitted patients.

MD: (I am a glorifed drug-dealing secretary) “I will try to make the appropriate changes…”

17:35 – *Admission pager* ED Admit. Room 14. 74 year old female with fall requiring placement.

1800 – Day is done. Six more to go. At least there is alcohol….

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