I’ve never blogged before. This is mostly because I’ve never had much to say, and I don’t want to waste people’s time reading a blog about nothing. Now, though, I’ve finally found a topic that’s worthy of your time. I almost feel it’s fate, because the stars aligned at just the right time.
I’m hiring a new doctor to work in my medical office, and it just so happens that one of Deadly Medicine’s main characters faces the same challenge. Hospital CEO Abby Rosen has to replace a sick ER director, and the topic is perfect fodder for my first blog.
When I started out in private practice, I needed doctors to work the few hours each week I reserved for my family. I relied on a few old friends to help me out. They were my mentors; I would have trusted them with my life.
How did you choose your family doctor? If you’re like most people, he or she came recommended by someone you trust, someone who had a good experience with them. When you needed your knee surgery, I’m sure you followed the same process, and looked around for someone “good”.
When you go to the ER, there’s no time for background checks . It’s an emergency, right? You’re relying on the reputation of the hospital. They’ve reviewed the doctor’s credentials. They’re properly trained, and a background check would have uncovered any issues, right? In Abby’s case, she’s relying on the company she’s hired to have done all of that. That’s their job.
You would think so, but that’s not necessarily the case.
Are you aware of how many ERs are staffed? Most often, a company bids on the ER contract for a hospital, and supplies doctors to staff it. Some of these companies own many contracts, in multiple states. Doctors don’t even know who their working for. How can companies know the doctors? Most often they rely on a resume. But just because someone looks good on paper, doesn’t mean they are.
And what happens when there aren’t enough qualified, emergency trained and board certified doctors to fill the schedule? Don’t forget, ERs run 24/7/365. They can’t close the ER. They must find someone to work.
So, how do these companies operate?
The turn to staffing companies, like the one Abby used. Or they hire local doctors. Anyone who is willing to try their hand at emergency medicine. Some of them might be competent, even qualified. Some are excellent. Some are not. You may find some family docs who are tired of the grind of private practice. They may be good at managing your blood pressure, but they have no formal training in trauma, and not much in critical care. Internists work the ERs too, but most have zero experience in pediatrics, orthopedics, trauma, and gynecology. Those cases account for about half of ER visits.
Does an Ob-Gyn doctor working weekends in the ER sound crazy to you? It does to me too, but I’ve seen it.
Over time, these doctors may become proficient in the practice of emergency medicine. They take courses on cardiac arrest, and attend trauma conferences. When they’ve been in the ER for a dozen years, they’ve probably picked up the skills they need to do a good job. If not, to their credit, their professional colleagues will probably have them fired…and then, they’ll move on to another hospital.
What about the background check when they get there? It’s only as good as the people who supply the data. In the opening chapter of Deadly Medicine, Dr. Edward Hawk, our psychopathic villain, is terminated from his position. Although he’s suspected of murder, no one calls the police. They simply show him to the door. On his way out, though, he’s given a letter of reference for his next employer.
Sound unbelievable? It’s plausible. A doctor has to do something really awful, and have it witnessed by many people, for his colleagues to report him. Those minor things, we blow off. Give people the benefit of the doubt. After all, we’re all in the same boat. I don’t want someone to report me, right?
I once worked with a family doctor who killed a woman in the ER. He wasn’t a psychopath like my villain Hawk, he was just incompetent. The patient was about thirty years old, and healthy. What could be so bad? When she came to the ER, her complaint was a headache. Not just any headache, though. This was the worst headache of her life.
Ding! Ding! Ding! Ding! Ding!
The worst headache of your life is without question a subarachnoid hemorrhage until proven otherwise. Every ER doctor knows this. An aneurism in the brain has leaked, and if it isn’t repaired immediately, chances are good the patient will die. The only way to diagnose this condition is by lumbar puncture. Dr. Jessica Benson does an LP in Deadly Medicine, and she does it easily. She is a highly trained, very skilled emergency physician.
Instead of an LP, this patient’s doctor ordered a CT scan of the brain. As is often the case with brain hemorrhage, it was normal, and she was discharged with pain medication. A few days later, the aneurism ruptured, rendering her instantly unconscious. This time, the CT scan was positive. Her brain was flooded with blood. She was placed on a ventilator, but with no evidence of brain activity, her husband pulled the plug.
The doctor who originally treated her had never heard the legend of The Worst Headache of Your Life, even though it’s taught to all ER residents, on or about the first day. His training did not include a basic procedure that would have saved this woman’s life. Yet he was hired to take care of her, and all the other unsuspecting people who ventured into the ER, because the hospital needed someone with a medical license present in the ER.
This story is not fiction. I witnessed it, and too many other incidents to count.
In parting, I will give you a piece of free medical advice, my little thank-you for reading my first blog. When you go into the ER, or the urgent care, or whenever you are under the care of a doctor you’re meeting for the first time, ask a simple question. How long have you been here?
If they’re wearing a diamond chipped watch for ten years of service, you’re probably okay. If they still can’t find the cafeteria, ask a few more questions.