As I walked into the room and gave a tired smile and introduction, I saw the mother of the small baby girl start to relax. “Yes, I believe you are right. She probably has croup,” I said after listening to the mother’s history while watching, then listening to the child breathe. “But I think she is going to be fine. There are several things we can do tonight to help her out. But I promise you, we will not send her home until you feel comfortable that she has improved enough to be safe.” It was then that I finally heard her breathe her own long exhalation while the worried wrinkles smoothed out of her young face.
“Well, that’s another life saved,” my charge nurse said as I left the room.
“Don’t be so cynical,” I chided. “She’s a young mom. She loves her baby. She just doesn’t have the experience we have. We’re holding the safety net. It doesn’t matter how high they’re jumping from. We’re selling the security that ‘it will be OK.’”
“Are you selling your knowledge or your gray hair…or lack of it.”
“Hey, watch it. I work very hard to make my hair gray. And I pull my hair out nightly trying to work with you guys.”
“Touche’,” he said smiling.
“You know there are a lot of things to worry about in the world,” I said to the charge later as we watched the satisfied mother and sleeping child exit the ED. “People are being burned alive on TV. You can’t send your child to the park alone. People are not sure they will have a job next month. People have a lot to worry about. The last thing they want to worry about is their health, or worse, their child’s health. We’re selling more than just medical knowledge and skill. We are selling security and safety.”
“But doesn’t that make you feel like you’re working at some McER or something?” he said. “Patient satisfaction isn’t everything. We’re not here just for the worried well.”
“Actually we are here for all of the worried, well or sick. Have you ever wondered what makes the safety net, well, safe?”
“Well, we’re always here,” he said with a tired smile.
“Yep, we’re available,” I said with a yawn that belied the hour. “But it’s more than the fact that we are open 24/7/365. We will take ANYBODY,” I said slowly.
“Don’t you wish we didn’t have to take the crazies and drunks?” he asked. “I mean, sometimes I feel like we are the garbage can of the world.”
“Hey, don’t get me wrong. I don’t like seeing those folks anymore than you do. I don’t like getting pissed on, swung at, cursed at, you name it. But it is what makes us the safety net of the world. And I’m proud of that. You know what? That mom who was just here would probably preferred to have her baby seen by her pediatrician. But he probably sent her here because we are open and will see anybody at any time. And we took that worried mom and sent her home happy. That’s something to be proud of.”
“And what’s more,” I continued, “we’re the safety net because we’re good.” I did my best bobblehead swagger. “I mean, it’s no safety net if it’s full of holes. People have to feel like they can have confidence in what we tell them and what we are doing here. It’s no knock on Doc-in-the-Boxes, but how many times do we see patients who have just been there and end up on our door because they don’t have confidence in the answers they got there.”
“You’ve got me going on this now,” he said. “Here’s something that makes us the safety net. People don’t have to worry about money.”
“Thanks for reminding me!” I huffed.
“No, really, even if the bills they get from us are outrageous, they don’t get them until after they leave,” he laughed. “Nobody is turned away for lack of ability to pay up front like some places.”
“Sometimes I wish that wasn’t the case. But I see what you mean. It does give people a sense of security to know that they can get help first and figure out how to pay for it later. I do feel guilty about the humongous bills we send out though.”
“You shouldn’t feel that way, Doc,” he said. “The ED is a tremendous value to the community, at whatever the cost.”
“I agree with you there,” I conceded. “But I still think we can do better on the cost of how we do business. I’d love to see us leverage technology to lower the cost.”
“What do you mean?”
“We all know that a lot of people come here who really don’t need to be here, if you know what I mean. If they could just talk to a knowledgeable person on the phone who could give them some real advice, they’d be fine with staying at home or going to the pharmacy for over the counter meds or whatever. But right now we don’t have a good way to really help that patient with their concerns. We are so afraid of liability that we just tell them all to come to the ED, which is a waste of their time and ours. We need the laws to change to make it easier to do telemedicine.”
“And we need to get the lawyers from second guessing everything we do,” he said, sounding a familiar refrain.
“But you know what is the most important aspect of this safety net?” My friend paused. “People know that whatever hour of the day or night, if they have a problem, there is someone here who cares enough to try to find a solution.”
“I really could do without being the final solution to the world’s problems some nights,” he said with a sigh.
“I know what you mean and ‘I feel your pain’,” I said in my best Bill Clinton voice. “But deep in your heart, aren’t you proud of the fact that when people are at the end of their rope – or maybe they are just near the end of their rope – and there isn’t anyone else who cares enough to be there for them, we are here? We don’t always get it right. But we do care enough to be here. We care enough to do our best to solve their problem. While everyone else talks about caring we really are doing it.”
“Are you two going to get off your butts and go sell some more safety?” our old clerk chimed in. “We have someone in triage.”
“Hey, what did I tell you,” I joked. “If we weren’t here, no one would feel safe to go to sleep.”
“Well they aren’t all asleep. They must not know about you being here,” the charge returned to his cynical voice. “It looks like the waiting room is starting to fill up again.”
I appreciate the sentiment. Perhaps we can put the middle men to work in the middle of the night to answer all the middling questions. God forbid they carry any liability! If only we could remove those middle men to reduce the exorbitant health care charges, then we could once again practice fearless medicine, and reassure without risk.