YPS Article January/February

Marc D. Haber, MD FAAEM
Assistant Professor of Emergency Medicine
Baystate Medical Center, Springfield, MA
Vice President of YPS

Granted the “giving season” has just passed, but since this article is being composed in the peri-Chrismihanukkwanzakah atmosphere, I’d like to focus on the topic of giving. As a new parent, my wife and I have learned the importance of gifts. Sure, as kids we loved receiving. With utter joy, I still remember finding my Lionel train set on the last day of Hanukkah. As parents though, my wife and I have learned, or rather learned to respect, the act of gift giving. We know now to NEVER give any gift that requires batteries, has no “off” switch or cannot pass through the digestive system of the family pet. A number of my daughter’s more “flamboyant” toys have met an unfortunate end in the intestines of my golden retriever. I still have no idea how Cobi could pass some of those parts, I but am guessing it has something to do with his toy poodle-sized land mines he lovingly leaves for me in the yard.

Those who are both an emergency physician and a parent with young children, have further responsibilities regarding unexpected presents. Imagine returning home after a long shift, your daughter leaping into your arms overflowing with excitement, finally having her daddy home. You are relieved to finally be with the folks who love you unconditionally. The last ten hours were spent caring for a multitude of patients for whom you bent over backwards to arrange VNA services, an actual hospital bed OUTSIDE of the ED and arranging organ donation for the unfortunate bystander of a drug deal gone wrong. Ten hours of back-breaking work without one single word of thanks. But those negatives are out the window, because now you are truly experiencing a significant benefit of our profession, the lifestyle. Then, the hot tongue of your Cobi brings you out of your brief trancelike state. Looking down, you see your pet licking some, thankfully, unrecognizable pertinacious debris on your shoes. With horror you also remember the little kiddo with neck stiffness and fever you tapped in the beginning of your shift. Within five minutes, your daughter is soaped up in the tub and you and your clothes are being autoclaved. Lesson learned, never come home in work clothes or risk bringing along some unpleasant presents. Alternative lesson, don’t ever play kissy-face with your dog.

In reality, most of our patients appreciate our hard work. We are professionals; therefore, we empathize with the frustrations of our patients. Their frustrations become our frustrations. The 18 hour hallway stay of our 86 year old CHFer pains us as much as it does them. We cringe as we have to transfer a patient because our local ophthalmologist refuses to take call. Then on the way home we have to deal with the same drivers that must have caused that flood of MVCs midway through our shift. Arriving home, miraculously unharmed, that same three year old comes hurdling down the hallway towards her daddy. You feel the same elation, and this time you are changed and washed. Still though, three year olds are three year olds. A few hours later, it is nearly her bedtime. You have completed the Melissa & Doug puzzle three times, read Knufflebunny and Moon Plane five times, and thought about drinking that cold Sam Adams at least a half dozen times. Your patience tested, you remember this next gift you bring your family: the gift of leaving your work at work. Even without such a challenging job, three year olds are great at fraying that last nerve. It would be so easy to get angry with your child. But, thanks to a combination of taking the long way home and your XM car radio, you have had a chance to partially unwind prior to walking through your home’s threshold. Instead of creating a scene of tears, you buckle down for one last read of Moon Plane. And sure as that adolescent diabetic is to return again in a ketotic dream, before the last page, your baby is sound asleep.

Today’s over-stimulated kids would be amazed that we survived the ‘70s without video games more advanced than Pong. In fact, one rubber ball kept us entertained playing spud, 4-square and kick ball. Unfortunately, for the most part, these games have been replaced by Madden Football, Warcraft and other video games. Amazingly in our current society where we flood our children’s playrooms with the Doodle-bop's seizure-inducing videos and speedier versions of our childhood board games, we are shocked when they are riddled with attention deficit problems. While not a cure, perhaps there is one thing that can, at the very minimum, add to our children’s development. That action is spending one-on-one time with our offspring. As scary as that sounds, not only is it the cheapest gift, it is also the most rewarding. Yet as younger physicians, we are burdened with massive loans and rising mortgages. We need to work extra hours for extra cash, just to get by. Without this supplemental income, many of us would be financially wrecked. Somehow though, we have to balance our financial needs with those of our family.

If our collective compensation were higher, perhaps moonlighting would be more elective, rather than a necessary evil. Unfortunately, due to a multitude of reasons, many have argued that our salaries are artificially low. One reason is clearly due to the unfair business practices of contract management groups (CMGs). Unfair fee-splitting, restrictive covenants and the corporate practice of medicine have all contributed to an overall reduction in our yearly compensation. Compensation is often determined by looking at comparable groups. Therefore, even if one isn’t in a CMG, they can still affect one’s bottom line negatively. Perhaps the only way to change our profession is to legally force the CMGs to comply with fair business practices as proposed by AAEM. Another way is to encourage our colleagues and current residents to at least learn about these issues, if not join AAEM in the good fight. If you are reading this as a member of AAEM, I am preaching to the choir. Perhaps, though, your colleagues may not yet be members or perhaps you haven’t yet made the decision to donate to the AAEM Foundation. Please consider yourself asked!

So for this year’s wish list, remember to add hand sanitizer, a gift certificate to Banana Republic and a yearly subscription to XM or Sirius Satellite Radio (or a new car with this installed). Finally, perhaps the best part of the holidays, the giving. Please consider a donation to the AAEM Foundation. Help give you and your colleagues a greater voice in the business of emergency medicine and ultimately establish a better work environment.