Female physicians are to blame...

[mags]

My point is that what appears to be apathy may be exhaustion, lack of control, a self preserving behavior to allow the health care giver to be able to have energy for the next person. It could be frustration at something else entirely. Perhaps the EMR system is not working correctly, making it difficult to obtain and share information. Maybe one of the insurance companies is on the floor doing a chart audit that is making some information difficult to obtain. Maybe the adminstrators are getting tough about using too many paper supplies for each patient. Maybe there is an inspector timing the handwashing of caregivers on the floor. Maybe the doctor's own mother is also sick, or their child was just deployed to the Middle East.

Maybe the doctor has had unrelenting all day "morning" sickness for weeks. Maybe the last patient just asked for his/her copay back because the doctor didn't give antibiotics for a cold (which makes me, personally, feel like a well-educated drug dealer.) Maybe the doctor's daycare provider had a pipe burst overnight and is unexpectedly closed for the day. Maybe the doctor just found out that her 90 year old patient w/ dementia is still driving and just had a wreck last week DESPITE the doctor talking with the family on several occasions about taking away the keys but family can't do it because "Mama will get mad." Now the doctor has to report the patient to DPS and is terrified to drive home today. Maybe the patient has just demanded that the doctor use a medication that their insurance will pay for but the patient hasn't bothered to bring in a list of meds that the insurance will pay for (aka, a formulary.) Maybe the patient expects the doctor to spend 30 minutes w/ him/her then spend the next 3 hours tracking down an op report from 20 years ago that may or may not even exist anymore. But this goes back to a patient taking responsibility for some some of his/her health care...

[fundifugee]

I am a female physician. Been at it for 26 years. It has not been easy to break into the "old boys club". I have put up with more crap from self-entitled primadonna male physicians and administrators than you can possible imagine. Female physicians are still not paid for the same work as well as men. When I was younger, I was admonished for the way I look, the way I dressed, for being to compassionate and for having a sense of humor.

Now that there are more female physicians, many things have improved. However, the pay differential still exists.

The physician lifestyle is hard. The social expectations of women are also hard. Blending the two is nearly impossible. The expectations of even the average husband simply cannot be met. Doctor's wives have tolerated the neglect for generations because in return they get status and security. Women in our culture were raised at least in many respects to tolerate second status and were better able to accept the role of Physician's spouse.

Women have stayed in the profession for the opposite of apathy. I can tell you that despite ALL of the frustrations, I still get joy from caring for patients.

. . .

We need to make a decision. Either Health care is an entitlement or it is not. If it is not, than we need to do what many Hard Right folks think we should. If it is, then we need to streamline the process and let us just do our job. And yes, because the renumeration will be less and our authority will be less, then give us time to ourselves in return. It is not apathy, but personal time will help us be better able to approach our work with softer hands.

FlorenceHamilton, thanks for paving the way for me and your other junior XX colleagues.

You can say that again!! regarding the lifestyle plus social expectations of women. I am at that stage in my life and career and dammit, I need a wife. Even modern, new-age, sensitive almost-female hippie husbands just don't even come close to cutting it.

And great last paragraph. I exiled myself from the USA to work in a single-payer health care system to your north. Massive improvement, although the pressure to work like a maniac with super powers still exists. (And turns out the pay is just as good).

[Hane]

Ah, introducing another contributing factor -- the idea in the US and elsewhere that doctors can fix EVERYTHING. And that patients have a RIGHT to perfect health, which doctors have the ability to give them, but are all just holding back. That is a fantasy.

So true--and a major reason why fewer and fewer doctors choose to specialize in obstetrics: parents think doctors should be able to guarantee them the perfect "product"--a 100% perfectly healthy child, 100% of the time.

Same problem with orthopedists, who, IIRC, get sued for malpractice about as often as obstetricians do, because people expect to magically be made whole and painless, whatever traumas their bodies have undergone.

[watchdog]

Maybe the patient expects the doctor to spend 30 minutes w/ him/her then spend the next 3 hours tracking down an op report from 20 years ago that may or may not even exist anymore. But this goes back to a patient taking responsibility for some some of his/her health care...

Since I'll take that as a swipe at myself, I'll answer. No, I would never expect a doctor to track down an op report from 20 years ago, especially one from out of state, but how many people would even know to do that? I didn't mind doing that legwork myself. What I don't like is for a doctor to rely so heavily on a test like an MRI that is being interpreted by someone who doesn't have all the facts. What I don't expect is to tell a surgeon who's about to do surgery on me that not only does "this part" hurt, "that part" hurts, too, so that while he's in there he can look at everything. Instead, in this case he was in and out in less than 30 minutes according to my family waiting outside and admittedly never addressed "that part." Nor would he address it later, even after his "team" (physical therapy) brought it to his attention and also expressed concern. I got tired of his 10-second visits during which he would hardly make eye contact with me where he'd tell me on his way out the door to come back in two weeks (for what?) while I'd see him chatting it up with the young male jocks in the hallway, often being forced to wait while listening to them talk about who was going to win the Final Four and other equally irrelevant subjects.

OTOH, there have been times when I've tried to take responsibility for my own care when a doctor has thrown a short, 2-page paper back at me and angrily shouted, "I'm not interested in looking at that!" Well, I didn't expect you to take the time to read the whole thing right now, if ever, but I would appreciate your at least being open-minded enough to consider an alternative.

The cardiologist who did my mother's angioplasty wanted her to take a particular blood pressure drug. Her PCP had already prescribed the timed-release version of the same drug - which I'd found on the internet and researched (he didn't know there was a TR version as it was new at the time). When my mother mentioned that she was already taking the TR version the cardiologist insisted that there is no TR version. I was with her that day and said, "Yes, there is. It's called Nexiclon XR, and she's got a prescription for it." From his reaction, he was not happy to hear that a patient actually knew something he didn't.

If you really want to empty a room full of physicians in a hurry (especially endocrinologists), don't shout "Fire!", just mention "Armour Thyroid." It will be unusual for anyone under 45 to have even heard of it, and most who have will run screaming from the room. Thankfully my PCP is the exception and prescribes it almost exclusively.

Sometimes I think they try to suck every last shred of common sense out of medical students before they allow them to graduate and that, at least in American hospitals, most of the staff checks their common sense at the door. Add to that the fact that hospitals are perpetually understaffed, and you have a recipe for disaster. I really do hope I'm run over by a bus or drop dead before I ever have to go into a hospital for anything major again. Even when they fix whatever you go in for, you often come out with problems you didn't have before.

[FlorenceHamilton]

Watchdog,

I am sorry that you have had difficulties with health care people. Kudos to you for tracking down old and vital information on your own condition. You have underscored the importance of the patient being a full member of their own health care team.

You also mentioned new and unexplained pain after your surgical procedure. You felt blown off by the doctors to whom you mentioned it. I can explain a part of this phenomenon. The vast majority of patiients develop unexpected new pain after a surgical procedure, especially in Orthopedics. The vast majority of these paind as functional due the new stresses on the joint as it is no longer being favored by the body because it is deseased. In the cased where the new pain is the beginning of a new problem, it takes a bit of time for it to "announce" itself for what it truly is. Docs usually try to be reassuring unless there is dsome feature of the new pain that it outside of the norm.

Most importantly, I would like to remind everyone that 10 years ago, the PCP was a dying profession. It was felt that specially trained nurses and technicians could fill that role and that al the doctors would be specialists. For the very reason that the PCP knows the patient, knows the medical physiology and has a collegial relationship with the specialists, we are now appreciated as an importnat part of health care. The fact that rather tham dying, my profession is thriving is because folks like you understad the need for a medically train advocate who knows YOU.

I hear you. I am certain that the other female docs who have posted hear you. Females are listenening. We often cannot change the outcome of a situation (sometimes we can), but by listening to how the experience affects all sides, we are learning how to approach people and their medical problems in new ways.

[browngrl]

This has been an interesting discussion to read through.

I think about these ideas quite a bit. I think most doctors do. The people who went into medicine to make money or because of a paternalistic mind set are fewer and fewer. I think the influx of women into the profession has been the instigator of this change. I would hope that one message has come through on this thread: doctors are as concerned about the medical system as patients.

[aelar]

I have Kaiser health insurance, which seems to work sort of like the NHS, even though it's private insurance, what with having their own hospitals and all doctors/labs/specialists working in the same place. It's gotten a bad rap, I'm not totally sure why, but I love it. Maybe they're not the best for extremely complicated or rare problems, but for day-to-day medical issues, it's been the best health care experience I've ever had.

The absolute best thing about it is the lack of hassle. I have a really good Kaiser plan, so I only pay a minimal copay for some doctor's visits and medications (for some reason all my prenatal care and delivery was completely free, but usually I pay $10 a visit, $35 for emergency, $5-$10 for pills). If during that visit I need a test or to see a specialist, it's all taken care of. No paperwork, no extra fees, just go get the test at the lab downstairs, or see the secretary to schedule the appointment. My medical records are all in the system, Kaiser is all computerized, so any time I see someone new, they can quickly look up everything about me, and almost always, it's clear that my doctors do scan through my complete case before they see me, even though I assume that Kaiser doctors are under the same time crunch as most US doctors.

I really can't say strongly enough how good this lack of hassles is for my mental, physical, and financial health. Knowing that it won't be a big deal or a big expense to have my medical needs taken care of means that I go in when I first notice problems, rather than waiting for them to get bad. I don't have to worry about whether I need a test or a particular treatment, if my doctor thinks I need it, it will be covered. Mental health care is part of the deal, so I take advantage of counseling to help me manage my stress and keep an eye on my mental health problems, rather than only going in when I'm in a crisis. Kaiser also loves to send people to classes and do preventative stuff and complementary medicine, yoga, mindfulness, free flu shots, etc. It just feels like a system that makes sense, because they're trying to manage their costs by keeping me healthy, rather than the fee-for-service plan that is common for the rest of US medicine.

If I have a choice, I will -never- go back to a normal 80/20 insurance, with paperwork each time, with tests, doctors, specialists all in different places with different fees, and with never knowing when a bill will come and how much it will be. UGH! I just wish I could give the whole country the same Kaiser system, though I suppose there are a lot of Americans who wouldn't want it (at least until they tried it).

[Mama Mia]

You know mags, I have some horrendous stories to tell about some truly horrible, apathetic, racist doctors who nearly killed my kid... but I'll spare you the details, since any dr. who is having a bad day apparently gets to blame it on the patient.

While I am not in the medical field I do work in an area where my decisions can have a huge life altering impact on peoples lives and it is really easy to be over stressed, over burdened and blame the clients when things go wrong.

I have crap go wrong in my life too.. but you know what I have three options - 1) I can take time off if I truly can't function well enough to do what I'm supposed to do 2) I can suck it up and do my damn job or 3) I can act like I'm better than everyone and everything that goes wrong must be someone else's fault.

[Austin]

I think Mags was just trying to make the point that doctors are people, too. They are not miracle workers, and like every other person on the planet, has his/her faults. If those faults are too distressing for the patient, the patient should seek another medical provider.

My husband had his left knee replaced in 2008. He is a big man (6'3" & 225 #), he was in pretty good shape overall (he was 55 then), and despite having no infection or anything of that sort, had a very difficult recovery. I had left my job just prior to his surgery, so I took care of him full-time throughout.

He worked very, very hard at physical therapy, until sweat poured off his brow and tears flowed down his cheeks. Still, he could not attain the degree of flexion his orthopedic surgeon wanted in the prescribed amount of time. The first time we went back post-op, the surgeon decided to anesthetize him again and force the leg to flex to >90 degrees to break up scar tissue (apparently, my husband is a person who forms scar tissue very quickly). The surgeon acted peeved about this, but was not out of the realm of unacceptable in his attitude, but it was kind of a strike one in my mind. The second time my husband had an office visit, the surgeon told him he was behaving like a "big baby". I said, "You know what? Thanks, but we're done here - please move out of the way", and got my husband's gimpy ass out of there. I was there all day, every day and I know how hard he worked and this asshole was not going to be allowed to talk to him that way.

Luckily, we have an excellent family physican and she managed the rest of his rehab. (I can't stress enough the importance of putting the effort into finding a family physican you can trust and build a long-term relationship with - this has literally saved our lives at times - thank you, god, for Dr. Sarah. This doctor will be your safety net for anything else that occurs with your health, no matter what other specialist may be involved). My husband recovered fully over time and with a lot of hard work.

My point is that some doctors are jerks, just like some attorneys and some mail carriers are jerks. This guy was a good surgeon, but not a nice person, in my view, as this was the second time he was rude to my husband (so not just having a bad day). But it would be terribly unfair for me to judge all surgeons based on this one guy, or even a couple of doctors I'd met over the years who were just not nice people. Most do care tremendously, but they are ALL human. We probably all feel we have important jobs and that our "bad day" doesn't ever leak out when we're at work, but we'd be kidding ourselves. Come on.

[YPestis]

Wow, kind of an old thread to be digging up but I just finished another ward month so I'll bite.

I've met some absolutely reckless patients so my view is a bit biased. In med school, we rotate through a couple of urban hospitals including the county hospital so the patient base we see is quite diverse and interesting. The biggest issue I find is the lack of understanding of the patients for their complicated medical conditions. We try our best to explain to them what it means to have congestive heart failure, to have stents placed, to get an MRI. However, patients sometimes don't understand/misunderstand and come away believing that their doctors aren't treating them correctly.

I can't count the number of times I've had patients tell me one thing only to read in their charts something completely different. I've had patients who don't even remember they had surgeries done or what type of procedures were performed. Most of my patients can't tell me the names of their medications.

At the bottom are the drug seekers and their enablers. I've seen entire families angry at us for perceived indifference to the patient's pain even though the patient has a documented history of narcotic abuse. The real kickers are the patients who tell me to my face that they don't do drugs as I'm holding onto their positive urine test!!!

However, I know not all patients are like that. I have a biased sampling because of the type of hospital I work in. I know there are plenty of stupid doctors too so I don't describe patients as walking tubs of lard who are eating themselves to death (even though some are....). Plenty of my patients are smart, proactive and try their best. I keep that in mind even as I experience angry drug seeker demanding his dilaudid.

To that end, I also disagree with one poster who thinks med school drove common sense out of me. Looking back, I feel I have a better understanding of how medicine works now (duh) and I think the misunderstanding between patients and physicians is that lack of understanding. The byzantine maze that is medicine is difficult to understand. If takes years of training to understand why we treat and how we diagnose. I can't expect patients to grasp that in a few short months. It's our job as practitioners to explain in layman's terms what is going on. However, misunderstanding can still occur and that can be misconstrued as indifference.

It sucks that some people have some lousy experiences with their doctors but let's not put the blame on one side here. Just as many doctors have poor patient experiences. We (patients and docs) are all human. Each side probably see misunderstanding and mistakes. Instead of painting everyone with a broadbrush (doctors lack common sense, patients are dumb), I acknowledge that people are people and mistakes will happen. I think having that attitude really helps to put things in perspective.

[treemom]

You're absolutely right. My family and I have experienced the apathy epidemic many times. Our wonderful PCP (who doesn't accept insurance and avoids the hassles that come with most of the red tape) actually says something I say all the time... "I hate doctors." And he is one! Unfortunately, we can't live without them, and there are still good ones although it's becoming more and more difficult to find one. Contrary to what all the magazine articles tell you, most physicians I've seen do NOT like educated patients. They want you to keep quiet and do whatever they tell you without question.

All that and the fact that there is simply more apathy in society in general today, and so often money (as much of it as you can get) is the bottom line. Let's face it. Too many physicians go into medicine not because they care that much about helping people but because of the money they know they'll eventually make along with the lifestyle and prestige. Pursuit of excellence has been replaced in many cases by pursuit of the almighty dollar.

But many fundies (and chauvinists) still look at everything through the "it's all women's fault" filter. Too much red tape? Blame women. Too many patients and not enough time? Blame women. After all, they birthed all those babies who grew up and got sick and are clogging the system. Competition with male doctors? Blame women. They should all stay at home and take care of the children full-time.

There's nothing wrong with staying home and raising the children full-time if that's your choice. However, I'd like to see what would happen to the healthcare system if all the women, from physicians to nurses to techs to cafeteria workers to housekeeping crews stayed home for even one day. The system would fall apart. Fundies want it both ways. They want female physicians to be there to take care of their wives, and they want female nurses and support staff to be there if they or a member of their family get sick, but at the same time they insist women in the workplace are not living according to God's will.

You can't have it both ways! This article was a good example of all those things.

I bet I know who your dr is!

[treemom]

And if it is who you think it is, he is a great dr! I have recc'ed lots of friends to him if they feel like dr. Nelson is over interventionist. It does suck he doesn't take insurance on one hand, but from everything I gather it makes it so much easier for him to be a great dr.

[Burris]

As for Florence's example, it sounds like grandma is her own worst enemy. With the growing epidemic of obesity in the US and elsewhere, I'm sure there will be many more like grandma in the future. My mother never smoked or drank and is slender and in very good health for her age. Obviously higher risk than a 30-year-old just by virtue of her age, but not because of unhealthy lifestyle choices.

It's been interesting hearing about the experiences of those in countries with socialized medicine. As almost everyone has said, no system is perfect. Thanks for sharing your stories.

You assumed the healthcare system here in Canada was broken. You don't like the one there, either, so you go to a doctor who's too good to accept insurance. And now the fat-shaming, Very nice.

[treemom]

You assumed the healthcare system here in Canada was broken. You don't like the one there, either, so you go to a doctor who's too good to accept insurance. And now the fat-shaming, Very nice.

Although I can see what you are saying, I will say I don't think this dr is too good to accept insurance, but rather he felt he couldn't treat his patients appropriately when he was stuck under the confines of managed care.

[mags]

Wow! This is an old thread to bring back. Nice reminder of a really tough week...

Mrs S2004 -- Yep, doctors are people too. We have bad weeks and good weeks both at work and outside of work. I think by this point I've figured out what choices I have when I'm getting frustrated at work. Your advice is not needed. And sometimes a bad day CAN be blamed on a patient just as a bad day in any other profession can sometimes be blamed on a customer/client. It doesn't mean that I'm unprofessional or inappropriate toward the patient or the plan of care.

YPestis -- Love your username :) Wards are the most difficult of rotations due to the physical and mental exhaustion and there's always a couple of not-so-wonderful patients that overshadow the rest. One particularly memorable night I dropped in to check on a patient only to find her trying to melt down an oxycontin tablet so she could inject it. She had raided the sharps box for a needle and syringe. But it does get better. You said you just finished wards so I hope you have a nice easy rotation with lots of time off to recharge :)

[HijabiLady]

i am a female and a physician so this hits pretty close to home. She is very wrong when she states the residency hours were shortened to fit a female's schedule. Those hours were shortened because the stats showed a huge spike in mortality and morbidity due to extreme sleep deprivation. There was a famous case of (Libby Zion) where she died due to a number of errors some poor resident made because he had not slept in over 24 hrs. (male doc btw) She died from a completely preventable issue and her father, who incidentally was a lawyer, sued to have the resident work hours more tightly regulated.

I don't get this mentality that doctors SHOULD go days without sleep all while making life saving decisions as well as delicate calculations. It's the stupidest thing I have ever heard. We don't expect the same thing from airline pilots. The new ACGME requirements make a lot more sense. When you are on-call you work until 9 pm. You will also work 2 months a year of night float (7pm to 7 am) so you will have the same patients. Most patients stay more than 24 hrs so that breaks down the argument about not having continuity of care since no one works 24 hr shifts anymore.

Doctors are human too and just as prone to horrible mistakes under significant sleep deprivation. But for some reason there is this sadistic belief that all doctors must suffer this bizarre hazing to "earn" their right to be call doctor.

[2xx1xy1JD]

i am a female and a physician so this hits pretty close to home. She is very wrong when she states the residency hours were shortened to fit a female's schedule. Those hours were shortened because the stats showed a huge spike in mortality and morbidity due to extreme sleep deprivation. There was a famous case of (Libby Zion) where she died due to a number of errors some poor resident made because he had not slept in over 24 hrs. (male doc btw) She died from a completely preventable issue and her father, who incidentally was a lawyer, sued to have the resident work hours more tightly regulated.

I don't get this mentality that doctors SHOULD go days without sleep all while making life saving decisions as well as delicate calculations. It's the stupidest thing I have ever heard. We don't expect the same thing from airline pilots. The new ACGME requirements make a lot more sense. When you are on-call you work until 9 pm. You will also work 2 months a year of night float (7pm to 7 am) so you will have the same patients. Most patients stay more than 24 hrs so that breaks down the argument about not having continuity of care since no one works 24 hr shifts anymore.

Doctors are human too and just as prone to horrible mistakes under significant sleep deprivation. But for some reason there is this sadistic belief that all doctors must suffer this bizarre hazing to "earn" their right to be call doctor.

DITTO!

Hubby and I got married just before his last year of med school, so we were living together all through his residency. The sleep deprivation was utter hell. In addition to working all day, he had to work 1 in 3 nights. After being on call, he was incapable of driving safely and sometimes couldn't do the simplest of mental tasks. The excess cortisol also has a nasty effect on mood. None of that can be good for patient care.

[lilah]

Wow evil career having wimmen are the source of all that is wrong in the world? If I were to make a Stinking lousewife bingo card I'd have to put that one in the center. (for those who don't know about hate-forums Bingo cards, here's a good one http://theangryblackwoman.com/2009/09/2 ... o-project/ or this one http://bibliophilia.typepad.com/writing ... -card.html)

I have Kaiser health insurance, which seems to work sort of like the NHS, even though it's private insurance, what with having their own hospitals and all doctors/labs/specialists working in the same place. It's gotten a bad rap, I'm not totally sure why, but I love it. Maybe they're not the best for extremely complicated or rare problems, but for day-to-day medical issues, it's been the best health care experience I've ever had.

Count me in as another fan of Kaiser, they are so efficient, you can do a number of things online (email doctors on a secure channel, reorder meds, make appointments.). Because their doctors aren't paid by procedure they are more motivated to take a "wait and see" and don't automatically chose the most expensive or invasive solutions. Sometimes if you want the more invasive solution (for example getting an stye removed surgically vs waiting for it to disappear on it own) you have to be assertive and advocate for it, which is tough for some people who feel more conditioned to not advocate for themselves when they are working with a doctor.

[2xx1xy1JD]

Re Canadian healthcare:

If you have an urgent problem, you get urgent treatment. Hubby has been dealing with a detached retina, and he received immediate treatment.

Many primary care physicians have designed times for patients who are suddenly sick. I can generally get seen the same day if I call early enough, or go to an after-hours clinic.

The areas where problems do exist are:

1. Some non-urgent orthopedic procedures. OR times are limited at hospitals so wait times are high.

2. Access to services outside of larger cities. This is actually more of a geographic and demographic issue instead of a financial one. Canada is physically bigger than the US, with 1/10th of the population. It's not that easy to get great services to outlying areas. As well, most doctors don't really want to lie outside of the big cities. There are some hefty financial incentives to do work in under-serviced areas, and I know doctors who will fly into places whenever they need to quickly make some more cash, but that's not enough to persuade people to relocate there long-term. At some point, more money doesn't make up for lack of cultural and educational opportunities, or distance from family, or the fact that you aren't around anyone from your religion and/or culture.

[fundifugee]

DITTO!

Hubby and I got married just before his last year of med school, so we were living together all through his residency. The sleep deprivation was utter hell. In addition to working all day, he had to work 1 in 3 nights. After being on call, he was incapable of driving safely and sometimes couldn't do the simplest of mental tasks. The excess cortisol also has a nasty effect on mood. None of that can be good for patient care.

ditto from me too.

One of my patients put it very well: "I wouldn't let somebody cut my HAIR after being awake for 24 hours; much less try to fix my heart or cut something out of my body."

I might also add that physician morbidity/mortality also increases when sleep deprived, due in part to road crashes.

[bionicmlle]

One of my med school classmates DID die in a car accident on the way home from a 24 hour trauma surgery shift -- shortly before the duty hour rules changed.

I am also an evil female MD -- and I am human. Sometimes patients can ruin my day. But my career is satisfying because I love my patients and love my job. I'm not always perfect but I do care. There are THOUSANDS of lab tests we COULD order, hundreds of radiology tests we COULD ask for and a zillion medications that COULD be prescribed. This is very different than medicine of my dad's era (he was a WW2 vet who practiced family medicine for about 60 years) and one physician CANNOT be expected to know how to manage anything they may encounter.

One of my primary "jobs" is educating medical students. I take offense at the idea that we try to beat the 'common sense' out of them. You cannot teach common sense and those who have common sense make the best doctors! Sadly, the screening/acceptance criteria to get into medical school still skews towards those students with "book smarts." The thing that needs to change is NOT medical student education -- it is the identification of prospective students.

[aimee]

I am a Canadian (and an FJ lurker) and I am so profoundly grateful for our health care system. When I hear people disparaging our setup here I get really quite ticked. Long wait times? If you consider waiting several hours for medical care I guess wait times can be long but if you are in urgent need of care, you get treatment asap. I am not, in general, a healthy person and I am a klutz to the nth degree. I have PCOS, acne, arthritis, migraines and I have Bipolar II disorder and that's just to name a few ailments that plague me. Dermatologists, gynaecologists, orthopaedic surgeons etc, etc - no out of pocket cost. I also have had more than my fair share of sprains and broken bones. I've had treatment for all of the above with ZERO out of pocket expense save for the frills of stuff like crutches or prescription medication. Oh, and I see a psychiatrist on a weekly basis to manage my mental health disorder and I don't pay for that either. A year ago I badly injured myself in a fall - broken bones, sprains, contusions, severe cuts and scrapes - multiple trips to the ER (I kept forgetting to complain about the stuff that was pretty bad because I was so focused on what was REALLY bad) and specialists and I paid for my crutches, air casts and dressings for my cuts. That's it. That's all.

I have never, in all my life had to weigh the need for medical intervention against the cost of being treated. If I'm unwell, I see a doctor and I don't need to have money in my bank account to do so. I cannot fathom the agony (both mental and physical) that people who cannot afford medical care must go through. It sounds like hell. Count me among those who wouldn't want to suffer that. I have never, in all my days, encountered anyone who needed urgent care (be it surgery, x-rays, an appointment with a specialist etc.) who had to wait for an unreasonable length of time for treatment. I don't know why Americans like to harp on the wait times except to paint a poor picture of a system that, IMHO, kicks ass.

Having said all that it does really fucking piss me off when I see or hear of people abusing the system. By abusing I mean seeking medical treatment for shit that could be seen to at home. Just because you feel poorly doesn't mean you should show up at the ER or your GP's office expecting miracles. I don't even bother to go for treatment if I know I'm just going to be told to elevate, rest and ice, or stay hydrated, rest and take some Tylenol. I do applaud public health departments who are taking measures to educate the public about WHERE they should go for treatment and what they can expect treatment FOR. I know here in Ontario there are public service messages all over the place trying to educate the public about the difference between visiting the ER, an urgent care clinic or a general physician - it's about time.

[jenny_islander]

I've been reading at the 99 Percenters Tumblr. One that really stuck in my mind: Man points out that his medical bills, which are enormous and can never be paid off, would not be so huge if fifteen years ago he had been able to just go to the doctor and get his problems taken care of, instead of just hoping that they wouldn't get worse over time, as they did.

Count me as another person who doesn't want to be treated by a sleep-deprived resident. I had to medevac with my toddler recently (he's okay!) and by the time we got settled in at our destination I had had about 1 hour of broken sleep in the previous 36. I could not recognize common objects or read signs. Brain all broke. I'm so glad that everybody who worked there was on the ball and alert!

If it's "manly" (read: strong and good) to willingly make yourself stupid with fatigue before taking someone's life in your hands and "womanish" (read: weak and selfish) to expect to be well rested before taking someone's life in your hands, let's feminize medicine 100 percent!