The System
One of the young doctors had had a hard day. "Last night some drunk came in," he said, "and I asked him what I could do for him. He said I could 'set his cock'. I got rid of him. I don't have to take that. Damn that other hospital! W hat they send us are not referrals; they are throw-aways. I had fifty people waiting in the Walk-In Clinic and one man came in with a prescription. He had a surgeon at that hospital but he'd run out of funds and came here to have the prescription filled . His doctor called. I told him that I had patients waiting for three and four hours. He said he didn't care, his son was some high administrator here. He called three times more until I filled it myself just to get rid of him.
He continued, "The system, you get in it to see what it is like, you coalesce and go along with it, or you get out. The technicians, the middle people can quote you rules on any subject; they control the whole operations: the Radiology Department a nd the laboratories hold up orders. 'Only four patients a day can get a gastrointestinal series.' You can have a man with gastrointestinal bleeding waiting around! There are too many complicated rules in a big medical center. They have 'instant' rules on any subject. At Mayo's, in one day all lab and X-rays can be done. We could have surgery the next day, if needed. The doctors will squeeze in the overload, but not the technicians."
Then the senior staff physician joined us. I greeted him as I
hadn't seen him since the time when I had worked at the private hospital's emergency room.
He said he was divorced now. He enjoyed working at the County where there were no decisions about whether or not a patient was to stay. I wondered if it is not contrary to being a doctor to have to
turn someone away. He seemed more relaxed now.
The cheerful relief seen in a smaller hospital is absent, that is, the time to enjoy solving problems.
The junior resident remarked that a woman resident from the private hospital phoned to say she'd like to transfer a case to County, which was no longer useful for teaching purposes and was using up teaching funds. He hung up.
Department of Emergency Medicine
