It was a legitimately nonprofit hospital and he probably was overpaid, but at least he was a practicing physician at one point and did seem to give a damn about his staff.

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I once worked at a hospital in the ER where the department director was a union-busting bastard, but the CEO was pretty reasonable. After I left, one of the other ER techs went to the CEO about our pay being messed up and got everyone $5-6/hour raises to actual market rate. Also, there were a few weeks when we were really understaffed that the hospital encouraged admin folks to volunteer as “candystripers” in the ER to do stuff like help clean/turn over rooms, and answer patient call lights for water, blankets, etc. And the CEO was down in the ER for a couple hours every evening helping out most of that time period. It was encouraging to see the CEO of the hospital putting on some gloves and helping us with basic stuff like cleaning and stocking.

The current recommendation for colon cancer screening in those with a family history is to start routine colonoscopies at the age 10 years younger than the family member who was diagnosed. So if your Dad was 55 when he was diagnosed, you should start getting regular colonoscopies and screening at 45 (which is around the recommended age these days anyways).

NPs working under a physician with actual oversight is fine. The ones I have problems with are the ones that have a physician sign the hundreds of notes a month while maybe reviewing a handful, and worse, the ones pushing for independent practice without even that sham of oversight involved.

I saw “milsim” in the title and came here looking for other Arma 3 nerds.

Day by Day Cafe in downtown St Paul is lovely. They have a nice library room to sit in during the winter and a patio with a koi pond out back for summer. They have some of the best breakfast food I’ve ever had and their early bird special is a really good deal (especially when I’m on nights).

Yeah, I’m a grad student with limited funds and I contributed to the server when I joined last summer. I don’t really want to sacrifice this account, but if we can’t interact with anyone else, it kind of defeats the purpose of being federated.

Unless you are obfuscating something, or there were some very unusual mistakes involved, I would think that medical neglect that caused a disability in an acute timeframe would warrant a consultation with a malpractice lawyer.

I think you misunderstood. EMTALA defines disability in relation to an emergent condition, injury, or acute illness. The degradation of a chronic condition into a disability is not something that an ER can or should be trying to treat. Disability as a whole can include things like chronic pain in addition to other neuropathies, parasthesias, or paralysis, but the definition of “disability” in terms of emergency medical care is entirely related to the disability being caused by an emergency medical problem, not a chronic one.

Per the laws involved here, “permanent disability” means something like paralysis from a spinal injury, or loss of organ function due to acute critical illness like a necrotic bowel or something. Unfortunately, according to the medical and legal literature on the topic, disability from pain or chronic disease is beyond the required services of an ER. Arguments can be made for acute-on-chronic situations like splenic damage or rupture in sickle cell crisis, but those areas can get pretty fuzzy.

What I have been trying to say is that we didn’t make any assumptions about that guy. We treated him with the same standard of care and urgency that any emergent medical condition would warrant until we had proof that he was faking it and after he grabbed a nurse’s breast so violently and so hard that the entire right side of her chest was bruised for a couple of weeks. We made no assumptions and only acted on his behaviors and proven medical condition.

The experiences you have had are horrible, but they are not universal. Unfortunately, the way the emergency medical system has been stretched to its limit lately means that the best the ER can do is to keep people from dying, and diagnose and treat the more straightforward conditions. For most of the more complicated and chronic stuff, there’s very strict laws about how much medication for what duration can be prescribed by an emergency physician, and a significant amount of the time, the best we can do is make sure you’re not actively dying and put in a referral to the specialists with a note that you should be bumped up the waiting list a bit depending on severity. Hell, even trying to admit people to the hospital isn’t a sure bet these days because the inpatient departments are allowed to enforce their staffing-to-patient ratios, so the ER gets stuck trying to take care of inpatient and even ICU patients with ER resources for up to days at a time.

My somewhat glib comment about people not being aware of what counts as an “emergency” is very literal when it comes to triage. We do our best to treat everything that comes through our doors, but if there’s not an immediate threat to life, limb, or permanent disability, there’s pretty distinct limits on what we’re able to do on a short timeline and what the hospital allows us to do for free. EMTALA stands for “Emergency Medical Treatment And Labor Act” and it dictates that anyone who turns up to an ER with an emergent medical condition that poses immediate threat to life, limb, or permanent disability will be treated and stabilized to the accepted level of care regardless of ability to pay, and a mother presenting in active labor will be provided with delivery care or appropriate timely transfer to a labor and delivery department if appropriate regardless of ability to pay. There’s very strict rules about the level of treatment to be provided and when or if transfer to another facility or provider is warranted and permitted, but past the stipulations of that law, it comes under the hospital administration’s rules and regulations about what level of care can be provided by the emergency department.

I’ve seen quite a few physicians defy the hospital rules by ordering some of the special labs and tests that the specialist would order so that the results are already available in the system for when (if) the patient gets seen by the specialist, but they can get in quite a bit of trouble for it, and if it’s not documented just right the patient’s insurance might not pay for it. That’s one of the other delightful limitations on what the ER can do…we have to toe the line on what needs to or should be done versus what the patient’s insurance will pay for, because believe it or not, we really don’t want to stick you with a bill for thousands of dollars of tests that your insurance denied coverage for.

Due to overwork, understaffing, antiquated training, and burnout, a lot of physicians’ and nurses’ bedside manner could use a fair bit of work, but in terms of the care provided, 99+ percent of the time, it really is the best we can do under the restraints created by laws, rules, resources, and insurance.

He came in for an entirely unrelated complaint and faked the overdose to get taken back immediately. The only drug in his system at the time was meth. Literally every room was full except for the resuscitation bay where we took him, and we had to keep him there for almost 2 hours until we had somewhere to move him to. It was the biggest of the resuscitation bays we had, so if we had someone coming in that needed ECMO, we’d have been kind of fucked.

I wish we hadn’t had to deal with that guy. Every nurse in the department had minimum 5 patients, mostly high acuity, and his stunt backed up the department for an extra couple hours by pulling unnecessary attention. I much rather would have been helping the nice gentleman in the lobby who had been waiting 5 hours with chest pain and a cardiac history, or the sickle cell patient in pain crisis.

I don’t have a problem with drug seeking. Pain is horrible and substance use disorders are diseases, not moral failings. I do have a problem with attention seeking, malingering, and abuse or assault of staff. As a physician, I plan to treat pain appropriately with the necessary medications or therapies, and to treat abuse of my staff with extreme prejudice.

And an edit to add: a drug overdose is treated as the same level of emergency as a cardiac arrest. We don’t serve Narcan on a silver platter, we serve it via wide bore IV while getting set up for intubation and resuscitation if it fails because we mean to move heaven and earth to keep the patient alive. An OD gets you to the front of the line, almost no questions asked besides “what substance?” so we know what antidote to give.

I’m terribly sorry that you have had that experience, and I’m disgusted with people who have treated you that way. However, you are making similar assumptions about me that other people have made about you. Working as an ER tech, I’ve literally had mental health patients try to strangle me, then given 10 minutes or so to shake it off, and then run straight into another code on a 16 hour shift that did not include any other breaks besides that 10 minutes… and then I came back 8 hours later for another 16 hour shift because the department was so understaffed that it would have been disastrous if I called out sick.

I’ve come into work, wholly unrecovered from a kidney infection and my own trip to the ER as a patient, and never let a whisper of it show on my face so that I could provide the best care possible for my patients. I’ve been the patient in the waiting room with 9 out of 10 pain for 6 hours, and I know how much it sucks. That’s part of why I do everything I can to give every patient the time, attention, and care that they need to heal them as much as I can.

I know that the general public’s idea of what ERs are for doesn’t help. EMTALA doesn’t mean that everyone who comes into an ER will get treated for anything regardless of ability to pay. It’s that they’ll be treated and stabilized for any emergent medical condition, illness, or injury… And many people seem to have interesting ideas about what constitutes an “emergency”.

I’m a medical student that is aiming for emergency medicine, and threads like these are a special kind of demoralizing. When I was working as an ER tech, there were a fair few times where aggressive or combative patients would only let me get anywhere near them for anything because I never showed any judgement or disdain. Not that I blame my coworkers. It’s hard to treat someone nicely after they fake having an overdose in the lobby and then assault one of the nurses after they “wake up” from the narcan.

They don’t have a high fertility rate. They have a high death rate. If you look at the demographic breakdown, the number of people over the age of 30 or so drops off precipitously.

For me, it just looks like he has a certain coldness in his eyes. It’s not a dead or vacant look, it’s just the way a smile, or any other facial expression for that matter, just doesn’t seem to make it to his eyes. There’s obviously life and intelligence there, but it’s not a friendly intelligence. I pulled up the most lizard-man pictures of Zuckerberg for comparison, and even at his most robotic, his eyes still look human. Like there’s some capacity for empathy in there somewhere. With Musk? His eyes just don’t quite read as human to me in an uncanny valley sort of way.

Makeship is having a sale on their new Glow in the Dark plushies. It’s not a huge discount, but the proceeds go towards supporting independent artists which is always a good thing.

https://www.makeship.com/shop/gitd-2023

What strikes me is the complete discordance of the realities of Israelis and Palestinians shown in the pictures attached to the article. There’s multiple pictures of a grand funeral with flags, pomp, and circumstance…and compare that to the white sheets and mass graves in Gaza. The Israeli soldier gets a military funeral with honors and fanfare while innumerable Palestinians are interred in barely marked mass graves with little to no ceremony because the number of dead simply does not allow for paying respects to each victim.

Let’s rewind to the part where you look at why they are mortal enemies, and realize that the same problem is still happening in the West Bank at the same time as the mass murder in Gaza.