"go to the emergency department every time your child has a fever" -- Kamala Harris

[AlmostAnMD]

Thank you for that lovely gem last night Kamala

Can't wait till a perfectly fine kid with a temp of 100.1 checks in because Kamala told them to do it

I'm sure, somewhere, its already happened

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[Birdstrike]

On the bright side, at least she didn't say, "Go to the ER for a pelvic and rectal exam."

 

[Groove]

EMTALA and Obamacare have bred and continue to nurture an entitlement generation of ED abusers. They watch their parents abuse the ED which conditions them to view the ED as nothing more than a 24/7 "free medicine" clinic where they can dictate their care and abuse staff. I had another one last night that I picked up over in our fast track because the main ED was slow... 22 yo G3P2 15 weeker making up abdominal sx so she could get an US to check on her baby progress...really there for nothing more than a toothache. Demanding, rude and condescending to the nurses. Kept making threats because "things were taking too long", etc.. Absolutely no respect for me or anybody else taking care of her. I get so sick of taking care of these people. Zero gratitude and they all throw temper tantrums if they get down triaged d/t a real emergency that rolls in around the same time causing them to wait.

The next pt I picked up back there? Mom bringing her kid in for ringworm. Already had a Rx from an urgent care. Wanted a second opinion and the appt at the pediatrician's office in 2 days was just "too long to wait".

How many of these people do you think actually pay their bill?

 

[GonnaBeADoc2222]

Thank you for that lovely gem last night Kamala

Can't wait till a perfectly fine kid with a temp of 100.1 checks in because Kamala told them to do it

I'm sure, somewhere, its already happened

Yeah I heard this and cringed

 

[TooMuchResearch]

Thank you for that lovely gem last night Kamala

Can't wait till a perfectly fine kid with a temp of 100.1 checks in because Kamala told them to do it

I'm sure, somewhere, its already happened

Wut?

Why even watch this crap?

 

[Brigade4Radiant]

This just in HCA wants a door to Tylenol time in less than 15 min this is a new metric.

 

[TooMuchResearch]

This just in HCA wants a door to Tylenol time in less than 15 min this is a new metric.

Not sure if serious. But I don't doubt it.

 

[carbonizedeyesockets]

She actually didn't say that. I mean, there are things she said to pick apart, but at least actually quote her.

 

[thegenius]

Yeah I heard this and cringed

Where is the video clip?

 

[Dr.Bruh]

EMTALA and Obamacare have bred and continue to nurture an entitlement generation of ED abusers. They watch their parents abuse the ED which conditions them to view the ED as nothing more than a 24/7 "free medicine" clinic where they can dictate their care and abuse staff. I had another one last night that I picked up over in our fast track because the main ED was slow... 22 yo G3P2 15 weeker making up abdominal sx so she could get an US to check on her baby progress...really there for nothing more than a toothache. Demanding, rude and condescending to the nurses. Kept making threats because "things were taking too long", etc.. Absolutely no respect for me or anybody else taking care of her. I get so sick of taking care of these people. Zero gratitude and they all throw temper tantrums if they get down triaged d/t a real emergency that rolls in around the same time causing them to wait.

The next pt I picked up back there? Mom bringing her kid in for ringworm. Already had a Rx from an urgent care. Wanted a second opinion and the appt at the pediatrician's office in 2 days was just "too long to wait".

How many of these people do you think actually pay their bill?

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

 

[GeneralVeers]

She actually didn't say that. I mean, there are things she said to pick apart, but at least actually quote her.

She talked about parents in a car with their "Hand on their child's forehead" wondering if they should spend $4000 to go to the ER. The answer is most likely "no". I suspect some staffer wrote that little piece for her as a way to tug at the emotional strings of parents. Remember, to the muggles they don't know the difference between a fever and an actual dangerous illness. To them every fever is a cause for extreme anxiety and they have no ability to recognize sick from not sick.

 

[alpinism]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

First of all most earaches and fevers go away on their own without any treatment and don't require a trip to a pediatrician let alone a trip to the emergency room. Second of all most cities have multiple subsidized and free clinics available instead of the emergency room. Unless you got admitted to the ICU or OR I'm going to assume you would have been just fine without misusing the ER as a child.

Also just so you know every minute we spend taking care of non emergencies is less time for those patients with real life or death emergencies. There's only so many of us with limited time and resources and misusing the emergency room absolutely hurts and even kills people.

 

[carbonizedeyesockets]

Remember, to the muggles they don't know the difference between a fever and an actual dangerous illness. To them every fever is a cause for extreme anxiety and they have no ability to recognize sick from not sick.

Yep. Which is why people go to the doctor. Unfortunately, there are plenty of sensational news stories about sepsis and people dying of something that was seemingly benign. Sure, it annoys me and I frequently think about how parents seem to be big babies, but when I step back and consider all the factors, I kinda get why so many parents take their kid to the ER. Primary care isn't exactly known for their great ability to see patients urgently when they're open, never mind when they're not.

 

[TooMuchResearch]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

Bringing a kid without primary care to the ED with a fever is different than what he mentioned above. One patient who just wanted ultrasound pictures and was willing to getad at staff to get them. One who already had a diagnosis and follow up and wasn't getting worse.

 

[GeneralVeers]

Yep. Which is why people go to the doctor. Unfortunately, there are plenty of sensational news stories about sepsis and people dying of something that was seemingly benign. Sure, it annoys me and I frequently think about how parents seem to be big babies, but when I step back and consider all the factors, I kinda get why so many parents take their kid to the ER. Primary care isn't exactly known for their great ability to see patients urgently when they're open, never mind when they're not.

There really needs to a fever education campaign. Pediatricians, schools, and communities should educate parents that fever is a normal and natural part of their child developing, that it's not inherently dangerous, and give pointers on how to treat fever at home. They should be given education on warning signs to look out for, and when to bring the child to the pediatrician, or more rarely the ED.

Why do we even treat fever as a "disease" and as if it's harmful? I instruct all parents I see that the fever is just their child's immune system reacting to environmental stimuli, and that ALL kids get a lot of fevers and that it's normal.

 

[Birdstrike]

Nobody owes you gratitude bc you treated them.

I can’t tell you how much this gives me the warm and fuzzies. Knowing this attitude is so prevalent is exactly what recharges my batteries after a hard day at work doctoring.

 

[GonnaBeADoc2222]

There really needs to a fever education campaign. Pediatricians, schools, and communities should educate parents that fever is a normal and natural part of their child developing, that it's not inherently dangerous, and give pointers on how to treat fever at home. They should be given education on warning signs to look out for, and when to bring the child to the pediatrician, or more rarely the ED.

Why do we even treat fever as a "disease" and as if it's harmful? I instruct all parents I see that the fever is just their child's immune system reacting to environmental stimuli, and that ALL kids get a lot of fevers and that it's normal.

My wife is a pediatrician and did this at every appointment in clinic in residency.

So much of general pediatrics is education and anticipatory guidance. They spend a lot of time educating families.

It's futile.

 

[GeneralVeers]

My wife is a pediatrician and did this at every appointment in clinic in residency.

So much of general pediatrics is education and anticipatory guidance. They spend a lot of time educating families.

It's futile.

I know it's futile. But so often I hear the opposite from families "We called the nurse help-line and they said go STRAIGHT to the ER!" They've set me up for failure before I even see them.

 

[GonnaBeADoc2222]

Nobody owes you gratitude bc you treated them.

Yes, they do. It's called being a normal person.

When I go to the doctor, I say thank you.

When I go to the dentist, I say thank you.

When I go to the mechanic, I say thank you

When I order a beer, I say thank you.

If the bar is crowded, I don't throw my glass against the wall and start threatening the bar staff. I don't tell and curse. This is because I would be arrested if I did. However, for some reason this behavior is tolerated in the ED.

Thanks for your insightful medical student perspective though. The adults will continue talking now.

 

[thegenius]

where is the damn video clip? I want to hear what she actually said

 

[GeneralVeers]

where is the damn video clip? I want to hear what she actually said

 

[Groove]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

I rest my case.

 

[carbonizedeyesockets]

where is the damn video clip? I want to hear what she actually said

Or you could just google the transcript. Why do you expect people to do your work for you?

 

[thegenius]

Or you could just google the transcript. Why do you expect people to do your work for you?

Because I'm superior to you.

 

[AlmostAnMD]

I can’t tell you how much this gives me the warm and fuzzies. Knowing this attitude is so prevalent is exactly what recharges my batteries after a hard day at work doctoring.

I don't expect gratitude. I do expect people to not throw their Wal-Mart bags filled with human feces (using them because they ran out of colostomy bags, she duct tapes them to her abdomen) at me when I deny requests for dilaudid for chronic pain

there is a gentle middle ground between someone kissing my ass for gratitude and getting a Wal-Mart turd bag thrown at me (fortunately this has happened exactly once, and she completely missed--10 pounds of crap hit the wall and the room had to be deconned).

 

[thegenius]

Thank you GeneralVeers! I really do appreciate it. I spent some time trying to find the clip...and you helped me.
May you have a great day.

 

[emletters]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

I didn’t realize having manners was limited to a particular socioeconomic class.

 

[GeneralVeers]

there is a gentle middle ground between someone kissing my ass for gratitude and getting a Wal-Mart turd bag thrown at me (fortunately this has happened exactly once, and she completely missed--10 pounds of crap hit the wall and the room had to be deconned).

I hope you immediately discharged her with/without security. Not tolerated at my shop.

 

[thegenius]

So she really didn't say go to the ER when your child has a fever.

I am so glad I didn't listen to these debates. They are utterly annoying.
They need a mute button like what exists on Around The Horn. You get muted if you talk out of turn.

Maybe ERs should be ER + Clinic. And they are staffed with 24 hr pediatricians ALONG with Emergency Doctors. If you are dying...the Emerg docs take care of you. But pediatricians can manage all these stupid fevers "fever in a well child" that come in. I would be happy with that.

Honestly....the number of times that a family becomes happy by just seeing a temperature get reduced by tylenol and motrin is astounding. Whoever wrote above that we need fever education in this country is right.

 

[Birdstrike]

I don't expect gratitude. I do expect people to not throw their Wal-Mart bags filled with human feces (using them because they ran out of colostomy bags, she duct tapes them to her abdomen) at me when I deny requests for dilaudid for chronic pain

there is a gentle middle ground between someone kissing my ass for gratitude and getting a Wal-Mart turd bag thrown at me (fortunately this has happened exactly once, and she completely missed--10 pounds of crap hit the wall and the room had to be deconned).

So, you don’t want a simple, free, occasional thank you. You just literally want reassurance that Walmart bags full of Satan’s candy won’t be thrown at you in the ED by your patients anymore?

I’m sorry, but that’s not a realistic expectation.

 

[AlmostAnMD]

She got up and left immediately. Because she threw her bags, she had an open colostomy that just tracked down the hallway. It was lovely.

 

[thegenius]

In general, right now clinics require co-pay and ERs have no copay. It should be reversed.

Seeing your primary care doctor should be free (and subsidized). Going to the ER should cost money. Everyone should pay a little bit of money to go the ER. Regardless of the complaint and your socioeconomic status. Why should health care be FREE, and everything else you pay for? It doesn't conceptually make sense.

 

[GeneralVeers]

In general, right now clinics require co-pay and ERs have no copay. It should be reversed.

Seeing your primary care doctor should be free (and subsidized). Going to the ER should cost money. Everyone should pay a little bit of money to go the ER. Regardless of the complaint and your socioeconomic status. Why should health care be FREE, and everything else you pay for? It doesn't conceptually make sense.

The problem is that FREE clinics rapidly run out of appointments. That means the overflow goes to the ED. Also when you start making clinics "free" you get less of them, because the necessary reimbursement cuts needed to keep the system solvent means staffing goes down, or clinics close up. Regardless the end result is pushing more patients to the ED.

I think the best system would be mandatory free MSE done by a triage nurse. Once MSE is done by institutional standards, all liability is waived, and the patient can choose to be seen at cost by the doctor or midlevel, or just leave.

 

[thegenius]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

I'm not going to impugn you or your parents. That is not the purpose of the following. There are hundreds, if not thousands of free, federally funded clinics in America for those who are poor. And access is not terminally time-delaying...They can see patients usually within 24-48 hours. I direct people who come to the ER in these situations on a regular basis to several of these clinics in the city I work in here in NorCal.

I know because when I was in medical school in Chicago for the first year there my wife and our two kids were on govt assistance due to income and we had no problem accessing health care resources. We had our son's rectal prolapse taken care of on a timely basis, his recurrent ear infections resulting in TM tubes, T&A done, etc. And my wife who did most of the schulping of kids back and forth to the clinics was initially fearful of being on govt assistance but found it generally a pleasant experience.

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex.

Bad times Bruh. Everyone should be nice when dealing with other people. Saying thank you is general courtesy regardless if you are rich or poor. You gotta watch what you write.

 

[thegenius]

Why do we even treat fever as a "disease" and as if it's harmful? I instruct all parents I see that the fever is just their child's immune system reacting to environmental stimuli, and that ALL kids get a lot of fevers and that it's normal.

Because it's passed down from generation to generation going back 100s of years. There is a relationship between morbidity and mortality and the presence of a fever. 500 years ago, if a bunch of kids in a village get a fever, maybe 5-10% of them die.

The Cultural History of a Fever

Physician's Perceptions of Fever in Children: Facts and myths

(the links below do not validate what I just wrote about death...that's just me)

 

[Birdstrike]

You'll never convince the public at large to stop panicking over fevers, so don't even try. It's futile. Even if they see 999 people with fevers get better on their own, with no treatment, all it takes to override your "see I toldja so" is one person to die suddenly and they hear, "Well, it all started with a fever. Everyone told him it was nothing. Now he's dead! And they're saying he was 'septic' and that 'you shoulda brought him in sooner!'"

Fevers are the shark bites of medicine. 99.99999% of the time you won't get bit, but all it takes is one bad one to scare the **** out of everyone until the next one.

 

[RoyBasch]

Also just so you know every minute we spend taking care of non emergencies is less time for those patients with real life or death emergencies. There's only so many of us with limited time and resources and misusing the emergency room absolutely hurts and even kills people.

I know I'm preaching to the choir i here, but there is a real absolute cost by those who abuse emergency services for non emergencies. @ Dr.Bruh, some day your necessary life saving care may be delayed and you may possibly even die as a result of that delay because of people like your parents saturating ERs with low acuity visits.

 

[Lexdiamondz]

This is some next level out of touch cringe right here. Nobody owes you gratitude bc you treated them. Get over yourself dude. Nobody is obligated to honor your God complex. Especially when many of these people are sick or at least in a socioeconomic position where appeasing your feelings is the last thing they should care about. Growing up I never had a primary or pediatrician. My parents had to take me to the ER everytime I got sick wth an ear ache, fever, etc. that’s all they could afford. Is it a misuse of the ED? Yeah, but don’t get mad at them. Get mad at the system that forces their hand to use the ED that way.

Since when was poverty an excuse for bad manners?

I never had a primary or paediatrician either...because my country had very few doctors. When we were lucky enough to see one, we said thank you. It's not that hard.

 

[thegenius]

My wife is a pediatrician and did this at every appointment in clinic in residency.

So much of general pediatrics is education and anticipatory guidance. They spend a lot of time educating families.

It's futile.

It's funny I say something like this to families all the time.

"I don't understand why people believe there is treatment for common viral infections. We didn't have a treatment 1000 years ago, 500 years ago, and today. But why hasn't that been passed down from generation to generation? You just have to wait."

I say that 3 times/shift

 

[VA Hopeful Dr]

It's funny I say something like this to families all the time.

"I don't understand why people believe there is treatment for common viral infections. We didn't have a treatment 1000 years ago, 500 years ago, and today. But why hasn't that been passed down from generation to generation? You just have to wait."

I say that 3 times/shift

Because doctors who are sick of hearing about it (like me) give out antibiotics for colds/12 hours of sore throat/just in case before a trip.

 

[thegenius]

The problem is that FREE clinics rapidly run out of appointments. That means the overflow goes to the ED. Also when you start making clinics "free" you get less of them, because the necessary reimbursement cuts needed to keep the system solvent means staffing goes down, or clinics close up. Regardless the end result is pushing more patients to the ED.

Well yea...FREE s&^t gets abused. Doesn't matter if it's the office or the ER.

However you want to slice it up...it should cost more to go to the ER than to the clinic. So if clinic has a co-pay, the ER co-pay should be more. It's the opposite now. The most expensive thing is free, the cheaper thing costs money. It needs to be flipped.

The point of this is I think people need to pay. Not insurance companies or the government.

I think the best system would be mandatory free MSE done by a triage nurse. Once MSE is done by institutional standards, all liability is waived, and the patient can choose to be seen at cost by the doctor or midlevel, or just leave.

We can do that now. MSE can be done by a qualified person that the hospital approves of. Problem is nobody wants to take liability for a mistake, and nobody really wants to tell the patient "you need to pay" to be seen. Patients will go ape s**t and the person will probably feel guilty saying it too.

I'm not opposed to helping out those who have little-to-no money. I don't expect a homeless person or an hourly McDonalds employee to pay $50-100 to see a doctor. I just don't want them to come to the ED (the most expensive place to get care) for this minor stuff.

Either this...or train ED docs differently and call them "Utility Docs" or something. Or staff the ER with pediatricians, orthopedics, internal medicine, etc along side us.

 

[thegenius]

Because doctors who are sick of hearing about it (like me) give out antibiotics for colds/12 hours of sore throat/just in case before a trip.

Yup!

And I do it too sometimes. We all do it.

 

[TooMuchResearch]

I can’t tell you how much this gives me the warm and fuzzies. Knowing this attitude is so prevalent is exactly what recharges my batteries after a hard day at work doctoring.

What, you don't call your mechanic, cosmetologist, or gas station employee a useless sh*tbag and threaten to sue them?

 

[TooMuchResearch]

So, you don’t want a simple, free, occasional thank you. You just literally want reassurance that Walmart bags full of Satan’s candy won’t be thrown at you in the ED by your patients anymore?

I’m sorry, but that’s not a realistic expectation.

Lol.

"I'm not asking for much. I'll take a 30% pay cut and sign any chart you want. But could I please just not get a bag of feces thrown at me on Christmas?"

Terminated on the spot without recourse.

 

[Birdstrike]

What, you don't call your mechanic, cosmetologist, or gas station employee a useless sh*tbag and threaten to sue them?

One time I had a patient, as he walked out the hallway after being discharged, say, "F--- you. I'm not even going to pay this bill ---hole?"
There wasn't even any conflict prior to that other than the fact that he was making some impossible demands for his girlfriend (the patient) that I couldn't meet, like demanding I admit her and call numerous consultants at 2 am on a weekend into the ED. I had already run every test possible (CT, labs, million dollar work up) all of which were normal and had essentially ruled out any and all possibility of her having anything seriously wrong with her. I politely explained that to him but he didn't care. And he made the comment so matter of fact, like it was the most natural thing in the world. He had the same attitude as the poster above.

 

[Birdstrike]

I could go on and on about the abuse I've taken from patients over the years and I have. It's back in the archives. But you've all lived it, so there's no point in rehashing all that. EMTALA is 99.99% of the reason. People know they can't do this in the outpatient setting because, 1) There's no law that forces it upon the staff, 2) They have to pay first which gives them skin in the game, and 3) They can get kicked out, permanently banned and arrested for doing it anywhere but the ED.

Although well intentioned, EMTALA should be renamed the "Free Healthcare on demand and license to abuse Emergency-Staff Act"

 

[GeneralVeers]

Although well intentioned, EMTALA should be renamed the "Free Healthcare on demand and license to abuse Emergency-Staff Act"

I disagree to some extent. If you are ambulatory, with normal vitals, and moving enough air to shout obscenities, you probably don't have an emergency and can be aggressively discharged.

 

[Birdstrike]

I disagree to some extent. If you are ambulatory, with normal vitals, and moving enough air to shout obscenities, you probably don't have an emergency and can be aggressively discharged.

Yes, but once you’ve done the mental work to determine that, they’ve already gotcha. You’ve fulfilled EMTALA, given them a clean bill of health (in relation to emergencies) for free, without even realizing it. It seems to me they’ve got you by the —-s the moment they walk in the door, but you’re technically correct.

 

[p1acebo]

Yes, they do. It's called being a normal person.

When I go to the doctor, I say thank you.

When I go to the dentist, I say thank you.

When I go to the mechanic, I say thank you

When I order a beer, I say thank you.

If the bar is crowded, I don't throw my glass against the wall and start threatening the bar staff. I don't tell and curse. This is because I would be arrested if I did. However, for some reason this behavior is tolerated in the ED.

Thanks for your insightful medical student perspective though. The adults will continue talking now.

This.

People become animals when they come to the emergency department, but this type of behavior isn’t accepted anywhere else in society. It is not ok to be rude simply because you had to wait.

 

[Tenk]

I don't expect gratitude. I do expect people to not throw their Wal-Mart bags filled with human feces (using them because they ran out of colostomy bags, she duct tapes them to her abdomen) at me when I deny requests for dilaudid for chronic pain

there is a gentle middle ground between someone kissing my ass for gratitude and getting a Wal-Mart turd bag thrown at me (fortunately this has happened exactly once, and she completely missed--10 pounds of crap hit the wall and the room had to be deconned).

I’m so proud of you.