I lost my job because a clean bill of health was never enough. (Emergentology: “When a Clean Bill of Health Isn't Enough,” EMN 2015;37:30; http://bit.ly/1HhgxCj.) I started at Kaiser Permanente on the island of Oahu fresh out of emergency medicine residency in 1997. I took a locums posting because I had come home to Hawaii to care for my ailing mother.
After multiple renewals of my contract, I was considered one of the most efficient docs, and I continued to work there for the next 18 years. Then came Obamacare and the PSAT-based government reimbursements along with it. The patient load increased, and my time spent with nonsense visits was diminishing. I always felt that as EPs we should be prioritizing our time to emergent patients and expediting the “sniffles” to their appropriate caregivers with reassurance and guidance. Physical space for patients had always been an issue, and with the primary patient complaint being waiting time, it just made sense to me that rapid disposition of patients who were not sick was prudent. Chronic pain patients, for example, would get a reasonable dosing in the department and then discharged with appropriate, timely pain management follow-up.
The mother of the 3-year-old brought in at 3 a.m. with a single episode of emesis (now joyfully playing with his mother's iPhone) would be reassured and asked to call her pediatrician's office when it opened in five hours. I would gently reassure the frequent patients who said they “just came here for nothing” that they came because of indecision and in search of professional opinion and reassurance.
Ah, but a clean bill of health was not enough. I was failing Kaiser's standard of patient satisfaction. My consulting colleagues loved me because they were never called inappropriately. The nurses loved how I could clean out a constipated department. But, alas, I was doomed by my high school mates' shiny new health care plan.
The most frustrating part of the whole thing is being pegged as uncaring. I care for my patients like my family, like I did for my mother during her last painful 10 years of life. I became a physician after being a paramedic for eight years because I care. I would go in on my days off just to follow up on worrisome patients and call to see how they were doing. I care! And now I'm without a job in my small hometown paying exorbitant COBRA coverage premiums and living with the dreaded “low patient satisfaction” label.
Timothy E. Marnie, MD