Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What has emergency medicine wrought? Helplessness.

Edwin Leap, MD
Physician
September 26, 2019
Share
Tweet
Share

It seems that all day, every day, I care for patients who simply won’t take care of themselves.  And I sometimes think that we in emergency medicine have caused more harm than we expected.

Now let me first say, I also take care of those who can’t care for themselves.  There are those who, through age, infirmity, or poverty, simply have no means.  The patient with a chronic condition who can’t see a specialist. The patient who has no family or transportation outside the ER staff and the ambulance. The demented, the mentally challenged, the broken children.  Bring them on!  All day, all night, I’ll give it my best and advocate for the rest.

But then, there are those who simply can’t be bothered.  Who won’t pick up the antibiotic or antihypertensive after we search for the place they can get it for free.  Who won’t keep the appointment with the specialist we spent two hours trying to arrange.

Those who won’t put down their phone to listen to what we say about their febrile child, then come back in twelve hours because ‘nobody did nothing, nobody told me nothing either.’

There are those who are frantic about their chest pain and upset that they can’t get their heart medicine but still smoke one or two packs per day even after we tell them, again and again, you have to stop.  There are those who need us to treat their intractable vomiting but refuse their constant use of weed.

We have, in some ways, created this phenomenon.  Part of the problem is also that people devalue what costs them nothing.  A great deal of care in the ER is given away because it is covered by government programs or simply by EMTALA. It has no cost and no intrinsic worth to those receiving it.

We have created an enormously successful system of care that is timely and high quality. By being available and willing, tenacious and capable, compassionate, and longsuffering, we have encouraged a kind of medical, even social, helplessness among untold citizens of this nation.  Cut yourself shaving?  Won’t stop?  Meh, go to the ER.  Menstrual cramps, like always, but they really hurt?  Why NOT call 911?  Sad (not suicidal) because of a breakup?  An unkind word?  Don’t talk to family, friend, pastor, priest, or rabbi. The ER will know what to do!  And (hope springs eternal) perhaps offer some pharmaceutical comfort to the situation.

Woke with a strange hot and cold sensation?  Sweating and chilled?  And endured it for an entire hour without taking anything? (Probably a fever, but who knows?) Vomited once?  Baby coughed?  Bug bit?  Why wouldn’t you go to the emergency department?   It’s the easiest thing in the world. And it’s what everyone else says to do.  Call your doctor for a last-minute appointment?  “Yeah, you better just go to the ER.” Call your dentist?  Ditto.  Ask almost anyone what to do in almost any situation, and the answer remains the same.

And once there, medics, techs, physicians, PAs, nurses and all the rest do the kind thing, the compassionate thing, even as we bite our tongues until they need stitches.  We tolerate the general, learned (and chosen) incapacity of competent adults.  In part because we believe it is a kindness. In part because, well, customers and all that. (And rest assured, customers who don’t know any better and have beat a well-worn path to the door are coming back over, and over and over. This is a behavior administrations want to encourage.)

I think about this and find myself frustrated.  I find myself even more concerned.  It reminds me of fatherhood.  Now, I’m a pretty good doctor.  However, I’m a Jam Up dad.  And there have been times I have over-indulged my four children out of love.  I still do as they move through young adulthood.  I’m just that way.  I’d do anything for them and their lovely mother.

Still, it hasn’t always been the right thing.  Any good parent will tell you that children need some trouble and self-sufficiency. They need to learn to navigate problems.  They need to develop an emotional reserve to deal with stress and to solve problems. They have to be educated and prepared to face crisis.  To indulge, to solve every problem for them is to cause them irreparable harm in life.  This is because we parents will one day exit.  And it will be up to our sons and daughters to carry their families, their culture, their nation forward.

On the other hand, I don’t see a time when we won’t have hospitals, 24/7, providing anything, anytime to anyone in the U.S.  It’s too ingrained.  Too popular.  Too lucrative.  And too necessary for vast numbers of people; some who really need it, some who simply don’t know anything else.

One day we may face shortage, disaster, chaos.  Just as our phone-addicted generations would melt-down if the Internet ceased, our ER addicted patients would be dumbfounded, gobsmacked, discombobulated, and completely unhinged.  I mean those who have abdicated responsibility, those for whom we have kindly solved every crisis and illness with no expectation of their growth or maturity.  Those from whom we have demanded no ownership or accountability.

ADVERTISEMENT

I’ve joked before that in emergency medicine, we stand squarely in front of natural selection and try to defeat it.  But there’s a dark truth here.  Not that we should let people die to advance evolution.  But that struggle produces resourcefulness and advances growth and capacity.

And as long as we do it all for everyone, we may ultimately do more harm than good.

What has emergency medicine wrought?  Helplessness.  And that’s a terrible, terrible unintended consequence of our self-congratulatory messiah complexes.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan. 

Image credit: Shutterstock.com

Prev

What's the best way to treat doctors and nurses with drug addiction?

September 26, 2019 Kevin 1
…
Next

The answer to physician burnout isn't resilience training

September 27, 2019 Kevin 0
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
What's the best way to treat doctors and nurses with drug addiction?
Next Post >
The answer to physician burnout isn't resilience training

ADVERTISEMENT

More by Edwin Leap, MD

  • The emergency department crisis: Why patient boarding is dangerous

    Edwin Leap, MD
  • Hospitals at a breaking point: Lack of staff and resources leave ERs in chaos

    Edwin Leap, MD
  • Trapped in a cauldron of suffering, medical staff are weary

    Edwin Leap, MD

Related Posts

  • A scribe’s haunting view of emergency medicine

    Nicole Russell
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • Denying payment for emergency care: a physician defends insurers

    Michael Kirsch, MD
  • A prayer from an emergency physician

    Edwin Leap, MD
  • The climate crisis as viewed by an emergency physician

    Elizabeth M. Barreras-Rivest, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD

More in Physician

  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • International doctors blocked by visa delays as U.S. faces physician shortage

    Arthur Lazarus, MD, MBA
  • How I redesigned my life as a physician without abandoning medicine

    Ben Reinking, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What has emergency medicine wrought? Helplessness.
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...