RE: Re: AAFP president's response to an Emergency Medicine News editorial

[Guest guest]

I think

you can understand a lot about this ER doc by seeing where he hails from. He is

on staff at Case Western. That would be in Cleveland, OH. What

we know about Ohio is that it is really a dead zone, so primary care docs have to run

patients though just to make a living (and from what I have read, a lot of docs

are packing up and leaving). We also know Cleveland is a specialty haven (ala Cleveland Clinic). Remembering the

Dartmouth Atlas data showing that the more heavily laden an area is with

specialties, the higher the cost and the higher the utilization, it stands to

reason that he is seeing a lot of stuff he should not. No doc is “in

charge” of these patients. They go to the ER when their bp is high because the FP tells the patient to call the

cardiologist who tells the patient to call the FP.

Ironically, his argument is a call for a

medical home (even though he does not know it). He states that he longs for the

day where doctors practice the full scope of what they should do, where docs

follow their patients to the hospital, etc. Ummm, isn’t

that a call for more (but better) primary care??

He is right in his concerns (certain patients

should not be in his ER), but wrong in both the cause and the conclusion. I do

have to give him credit, however, for being able to rant like he knows what he

is talking about. Too bad he doesn’t.

Re: AAFP president's response to an Emergency Medicine News editorial

i'm shocked, just shocked, that an ED doc would rail so forcefully and

with such vitriol against us stupid, lazy, no-nothing family doctors,

and against doctors in general, trained nowadays. after all, we

didn't grow up the hard way, wading through the blood and guts of the

knife and gun club, saving lives by shoving sharp metal objects into

dying patients' orifices while slurping down caffeine by the gallon to

stay awake for another 36 hours at a time.

but i digress.

i would merely ask dr ED three questions: does he believe that a

medical home or however he would name it, is a valid and valuable

concept? what would the well-functioning and efficient dr ED health

care system look like? are there any elements of our current health

care system that would be incorporated into dr ED's system?

dr ED is concerned about the failings of our health care system, and

rightly so; i see many failings in it, too.

what solutions does dr ED have? it's legitimate to criticize; one's

criticism is validated by offering solutions. i'd like to hear dr ED's.

LL

[Guest guest]

My firewall always flags tinyurl as a spyware site. Can someone print the article to a pdf file and post it or something?

To: Sent: Thursday, December 25, 2008 1:19:07 PMSubject: Re: AAFP president's response to an Emergency Medicine News editoriali'm shocked, just shocked, that an ED doc would rail so forcefully andwith such vitriol against us stupid, lazy, no-nothing family doctors,and against doctors in general, trained nowadays. after all, wedidn't grow up the hard way, wading through the blood and guts of theknife and gun club, saving lives by shoving sharp metal objects intodying patients' orifices while slurping down caffeine by the gallon tostay awake for another 36 hours at a time.but i digress.i would merely ask dr ED three

questions: does he believe that amedical home or however he would name it, is a valid and valuableconcept? what would the well-functioning and efficient dr ED healthcare system look like? are there any elements of our current healthcare system that would be incorporated into dr ED's system?dr ED is concerned about the failings of our health care system, andrightly so; i see many failings in it, too.what solutions does dr ED have? it's legitimate to criticize; one'scriticism is validated by offering solutions. i'd like to hear dr ED's.LL------------------------------------

[Guest guest]

You know, we've actually been seeing a decrease in the quality of ED care in our area. Alice did a fellowship in critical care and worked ED for 10years so she'd know. We had one patient that came in for fatigue and I dont really know what else, but they ED didnt draw blood on her. Good thing we did. Very Anemic--to the point we got a call from Quest and had to call her and send her back to ER. Another patient had an infection on his leg that wasnt healing or something. They called. I hear Alice asking if they checked for mrsa (?) They hadn't. Guess what type of infection he had? But I'm sure the author of this rant & rave (which I haven't actually read, but i can read your comments) would prob. deny these incidents

happened.

To: Sent: Thursday, December 25, 2008 1:19:07 PMSubject: Re: AAFP president's response to an Emergency Medicine News editoriali'm shocked, just shocked, that an ED doc would rail so forcefully andwith such vitriol against us stupid, lazy, no-nothing family doctors,and against doctors in general, trained nowadays. after all, wedidn't grow up the hard way, wading through the blood and guts of theknife and gun club, saving lives by shoving sharp metal objects intodying patients' orifices while slurping down caffeine by the gallon tostay awake for another 36 hours at a time.but i digress.i would merely ask dr ED three

questions: does he believe that amedical home or however he would name it, is a valid and valuableconcept? what would the well-functioning and efficient dr ED healthcare system look like? are there any elements of our current healthcare system that would be incorporated into dr ED's system?dr ED is concerned about the failings of our health care system, andrightly so; i see many failings in it, too.what solutions does dr ED have? it's legitimate to criticize; one'scriticism is validated by offering solutions. i'd like to hear dr ED's.LL------------------------------------

[Guest guest]

I agree with all the comments and particularly llyon, joanne and graham. The guy is obviously angry, but aren't we all in some way. That said, in my experience, the guy has a point. Although the 21st century accouterments (EMR, etc.) are nice, the central component and emphasis of the medical home should be the personal doctor-patient relationship. Although the members of this list serve are actively creating medical homes for their patients based on interpersonal contacts, currently this appears to be the exception to the rule in this aspect of family practice. In my geographical area of practice, a number of practices seem to be lacking this bond between the provider and patient. As a family physician who works in an open access urgent care and sees my own primary care patients, patients with acute illnesses who are traveling or have no local PCP, as well as the primary care patients of other practices when their offices are closed (and when they're open), I truly perceive a breakdown in the doctor-patient relationship in a number of the local practices. I don't want to "name names"; but everyday, I see patients at 9 or 10 am who have an acute illness or exacerbation of a chronic problem who called their PCP and were unable to get same day appts. Pediatrics is just as bad, almost none of the local pediatricians have appts available after 3pm when a lot of parents pick up their children from day care or school and learn they are sick; and as both parents are working, they have a difficult time scheduling appts during "normal office hours". I think this ER doc is seeing the same thing. I'll agree that the current state of the health care system and its effect on MDs is driving the tendency of medical offices to fill their schedules in advance leaving an inadequate number of work-in slots and providers to consider their "reasonable" availability to be only the "normal" business hours of their office referring patients at all other times to the urgent care or ER (as a UC doc, I have a bit of this attitude myself but I don't claim to be a medical home). But it isn't easy to focus your blame on the system when you are seeing 6 or more patients an hour on Dec 26 and 50% of them have the same dozen PCPs who have closed their offices from 12 noon Dec 24th (if they even opened that day) until 8am on Dec 29th and plan to do the same thing from Dec 31st until Jan 5th. This may sound like sour grapes as obviously my billings and income go up, but it's not easy to keep smiling as the hamster wheel kicks into overdrive. Finally, I believe there is a bit of unrealistic patient expectations playing a role in the demand for immediate health care for nonurgent problems as I really don't believe it's necessary for a patient with a URI for 3 days or even 2 weeks to expect to see a doctor on Christmas Day for treatment (though I admit that my employer is partially responsible for creating this expectation). I hope everyone continues to have a happy and healthy holiday and wish everyone a joyous and prosperous New Year. StrazYou know, we've actually been seeing a decrease in the quality of ED care in our area. Alice did a fellowship in critical care and worked ED for 10years so she'd know. We had one patient that came in for fatigue and I dont really know what else, but they ED didnt draw blood on her. Good thing we did. Very Anemic--to the point we got a call from Quest and had to call her and send her back to ER. Another patient had an infection on his leg that wasnt healing or something. They called. I hear Alice asking if they checked for mrsa (?) They hadn't. Guess what type of infection he had? But I'm sure the author of this rant & rave (which I haven't actually read, but i can read your comments) would prob. deny these incidents happened.From: llyonmd <llyonmd>To: Sent: Thursday, December 25, 2008 1:19:07 PMSubject: Re: AAFP president's response to an Emergency Medicine News editoriali'm shocked, just shocked, that an ED doc would rail so forcefully andwith such vitriol against us stupid, lazy, no-nothing family doctors,and against doctors in general, trained nowadays. after all, wedidn't grow up the hard way, wading through the blood and guts of theknife and gun club, saving lives by shoving sharp metal objects intodying patients' orifices while slurping down caffeine by the gallon tostay awake for another 36 hours at a time.but i digress.i would merely ask dr ED three questions: does he believe that amedical home or however he would name it, is a valid and valuableconcept? what would the well-functioning and efficient dr ED healthcare system look like? are there any elements of our current healthcare system that would be incorporated into dr ED's system?dr ED is concerned about the failings of our health care system, andrightly so; i see many failings in it, too.what solutions does dr ED have? it's legitimate to criticize; one'scriticism is validated by offering solutions. i'd like to hear dr ED's.LL------------------------------------