[kyro]

The sad truth is that this is due to a variety of problems at a variety of levels. Of course, all that follows is highly dependent on the team, hospital, and location.

A the lowest-level, you have doctors who're just assholes. Unfortunately, they don't do a good job at filtering out abrasive personalities upon entry to medical school. In fact, I'd say in some ways they self-select for that type of person. I've worked with heads of departments at huge hospitals who've openly discussed their salaries with me in patient rooms or brushed off a patient's concerns in a condescendingly paternalistic manner only to laugh with colleagues about it the second they step out of the patient's room. I've argued many times with specialists running their own clinic about their exorbitant fees and clever ICD-coding skills -- that some brag about developing -- to squeeze every penny out of insurers, all justified by "we've got to make a living." Assholes in medicine run rampant.

Up one level and you have the sheer morbid nature of medicine that physicians deal with on a day-to-day basis. I've given chest compressions to trauma patients with self-inflicted gunshot wounds to the head, and cleaned maggots out of a patient's festering diabetic foot. To the outsider, it is all incredibly shocking and gruesome, but as a physician you grow callous to it. Unfortunately, many times that means growing callous to all emotions and stunting your ability to empathize. Mix that with a superiority complex and you get things like Hispanic Hysteria Syndrome.

Go up a level and you've got a huge logistical and resource problem. Hospital physicians, particularly residents at teaching hospitals, are often overloaded with responsibilities and patients. They often feel they cannot give every patient and every obligation full and thorough attention because they are being bombarded by pages for new admissions, calls from other staff, etc. I have seen residents breeze through a list of patients, only giving minimal attention to each, just to avoid being chastised by a superior for not fulfilling all responsibilities in the short time allotted. And when you are severely limited to the number of open beds you have, and you've got a crowded ED, it becomes a game of who can we push out the fastest without killing.

At a higher level, you have a hospital who needs to keep the lights on, needs to pay salaries, needs to maximize profits and yet treat patients as best as they can. Unfortunately, many hospitals are being swindled by suppliers who're working through group buying organizations [1], inflating costs and making it difficult for hospitals to hit their margins.

There's a lot more I could go on about.

[abecedarius]

On the callous and condescending: I've wondered how much of that's inculcated by the ridiculous working hours required by residencies. http://en.wikipedia.org/wiki/Residency_(medicine)#History_of... That's been criticized for causing lots of errors, but less immediately, after long enough, a gauntlet like that's bound to change you, right? I don't know, so I'm asking.

[hga]

It's important to note that our current residency system has two important goals for a doctor's subsequent career:

Teaching you to make acceptable/the best possible/whatever decisions when you're tired/not at your best for whatever reasons, which will likely happen in the future.

Teaching you how to deal with extreme emergencies, e.g. http://stormdoctor.blogspot.com/2011/06/first-response-mode-..., which may not happen to you, but will statistically happen to a subset of doctors who go through the system.

WRT to that link on what happened in my home town May 23rd, 2011, the local medical response hundreds of lives that night, keeping the death toll down to ~ 160.

[GabrielF00]

I'm curious what percentage of people who come into an ER have routine problems, but are being sent to the ER because other components of the health care system either don't want to deal with them (because of lack of insurance, or other reasons) or are being overly cautious and advising them to go to the ER when it isn't necessary.

I've had two experiences when I was told to go to the ER even though it was completely unnecessary. Once I had a very painful hemorrhoid. I called the nurse's line for my insurance company and they told me to go to the ER immediately. This freaked me out, since I figured it was a minor (albeit painful) issue, so I called a doctor who was a friend of the family. He told me to just go to a walk-in clinic the next day (I didn't have a regular PCP) and that they might give me a referral to a surgeon, but most likely they would let it heal on its own.

A second time, I was out of state for the summer and needed a refill for a prescription. My doctor's office told me to go to a local ER.

I would imagine that having to handle both emergencies and also routine nonsense that should be handled elsewhere has got to be really grinding on an emergency department.

[robbiep]

I am a current ED/A&E/ER Doc (in Australia). It's one of my 5 3 month first year terms. About 50% of presentations are for things that don't need to come through ed. Phone lines always say come I to ed because it is a get-out-of-jail. If they say carry on and you get hurt, they get sued. And it is near-impossible to do a proper consult with someone over the phone.

Having said that the Australian health system is so radically different to that of the US (for the better) that very little in the above article applies to my working conditions

[sillysaurus3]

If you find time, please do go on about it. It's very interesting.

[afarrell]

I too am interested in a detailed treatment of the systemic multi-abstraction-layer analysis of the problems with healthcare. Especially if it is on audiobook.

[lisper]

+1 (Yes, I know it's bad form, but in since point counts on comments are invisible this is the only way to let the OP know that others are interested)

[kyro]

Whoops forgot...

[1] http://www.washingtonmonthly.com/features/2010/1007.blake.ht...

[NAFV_P]

> A the lowest-level, you have doctors who're just assholes.

I was physically assaulted by a doctor around six years ago, I would use a much harsher term than asshole.