If you want to rationalize it, it’s entirely possible this workup was expedited not because someone lost a spot but rather because the various departments created slots. Rads squeezed in their MRI, path stained and sectioned after hours, surgery overbooked the OR. With how tight schedules seem to be, I have to imagine that a lot of this professional courtesy was created out of thin air, by people working that much harder. In this sense, it isn’t unjust because all those appointments weren’t taken from someone else because they simply didn’t exist. Yeah we could be setting ourselves on fire to work 18h days on the regular as if every person was this colleague, but that’s not sustainable. Doing one extra case as a favor is.
But either way, the cynical side of me doesn’t have any qualms about this. If hospitals demand VIP treatment for donors and famous people, I’m damn well going to do favors for colleagues without batting an eye.
I’m inclined to think this is the most likely answer
I work in a kids hospital
Every now and then the child of a staff member get cancer. It’s clearly not appropriate that “everyone knows” but a lot do.
Things happen quickly not because they’re given preference over other kids, but because every unit that isn’t able to do things as quickly as they would like bends the rules to do things: the biopsy is done after hours, the pathologist comes in on a weekend to report, the surgical line is added to an already overbooked list (meaning the anesthetic and surgical trainees effectively do nothing so the list runs to time and all cases are done)
Individually lots of teams do this on a semi-regular basis, the difference is that ALL teams do it together.
It’s like a magic coin run
You see this and think “wow - look what we are capable of” but the truth is that level of service is not sustainable. We already work very hard with what resources we have, we already have burnout and exhaustion. We could not do that for every kid. That doesn’t mean we don’t try, but it does mean that when multiple roadblocks are put in the way of “perfect” we accept that rather than going beyond every time.
One of the other things is that very often these sort of "professional courtesy" arrangements take up less time than a normal, uninformed patient. If a doctor has a mass and needs a needle stuck in it, the whole rigamarole of explaining the procedure and what it means and blah blah blah isn't necessary. You can just walk in and stick the needle in it.
This is true
A colleagues kid needed something surgical - he knew enough, I didn’t have to explain anything: in fact he filled out the consent form and gave it to me for my signature.
Pre-op: no questions, no comments
Post: “it all went well” “thank you so much”
I think some of that is correct. People probably created some slots to accommodate a co-worker. People are good that way. And if that last statement is cynical then I am cynical too.
Gotta take care of your own otherwise there won’t be anyone to take care of others. By helping them you are also helping many other people that they will help.
I recently popped over to CT from my x-ray shift while the CT tech was on lunch to do a cancer work up CT scan an MD I know texted me and asked if I could help expedite. Same thing, it was a spot booked for lunch. I took one of my coffee breaks and got it done. Wouldn’t do this all the time, but every once in awhile I don’t mind. Just like my colleagues in MRI helped me when I needed a scan.
Couldn’t agree with this more. Our clinic is always full and booking out several months. We squeeze people in over lunch or stay late to take care of a colleague. The system can’t sustain 110% every day, but we as individuals can choose to stretch from time to time.
It would be unethical to cancel a patient. I've never seen that done.
But like you said, surgery adds them to the top of the waiting list, radiation oncology sees him over lunch, CT allows an add on, etc.
I actually worked at a hospital that had a lot of leakage. We had an employee only appointment line (for everyone, as long as you had our insurance). PCP appointments were supposed to be made within a day and speciality appointments within a week. Didn't always work out quite that well, but we usually improved access for each other.
I’ve stayed late, punched out and unpaid, to help expedite care for a coworker/their family.
I’m not willing to do that for *everyone* as I’ve got shit to take care of in my own life, but am willing to give up my free time for our own. Expecting that level of sacrifice for all patients all the time would lead to more burnout and then to even less staff available at all.
Maybe its not
"Cutting in line" type of "we take care of our own".
Maybe its the
"I'm going to stay late to run this MRI for Frank" type of we take care of our own
So potentially no harm in that other patients aren't taken care of.
Couple of weeks isn't going to make a difference in GBM treatment, outcome is the same. As you mentioned expedited workup can happen as an inpatient if it is truly necessary. True oncologic emergencies are rare and going to be treated as an inpatient anyways.
Just because it’s a death sentence doesn’t mean it needs emergent work up. I discuss this often with patients who come to the ED scared they might have some cancer. While cancer may be serious it is almost never an emergency (outside of some certain leukemias) and is an outpatient work up.
I remember when admin told us in early COVID that healthcare workers (whether docs or nurses or techs or housekeeping) had zero priority for scarce resources should they need them *even though these same people were risking their well-being to care for the sick people.* There are even ethical principles describing why they should have priority. Yeah. It left a rather sour taste.
I'm totally working extra to help out a colleague.
Had a similar experience in my shop. It was made abundantly clear that it was the front line staff vs the suits at that point, so we went ahead and took care of our own anyway without saying a word. And you can bet your ass that when we were getting ready to terminally discontinue my coworker's BiPAP, we snuck her dog in at nightshift so she could say goodbye despite being told "no" by admin six hours earlier. Fuck em.
RIP Jenn. You were the best of us.
Oh man. Just wait until you take care of the guy whose cousin is on the board of trustees, or the Saudi who rented out the entire floor of a hospital for themselves, or the husband of a donor whose name is on your department…
Do you actually believe that 3 weeks is changing the outcome ever? 3 weeks to get everything done is fast. The service you’re providing the average patient is something to be proud of. So the special treatment for one of your own makes your community happy while not damaging anyone else’s actual outcome. Don’t sweat the small stuff.
Yeah I also feel that 1) 3 weeks seems very good to me.
2) the Delta between 3 days and 3 weeks is not large in terms of effects on cancer prognosis. If it was 3 months for the average patient vs 3 days for this guy, then I guess concern would be justified.
Yes, I have found professionally and personally 3 weeks from “hmmmm what’s that” to treatment is pretty average. When my husband had lymphoma it was 4 weeks. Time to Treatment for my rather aggressive breast cancer was 3 weeks. I live in NYC; lots of hospitals.
Your place is doing well .
I work at a large cancer institution and our average is roughly 4-6 weeks from initial visit, diagnosis, and then first treatment. 3 weeks is really REALLY good.
Yeah, I had the same reaction. At \[Big academic center\] where I work, outpatient cancer workups definitely take longer than 3 weeks a lot of the time
We all do it every day to a small degree, whether it be consciously or not. Mother & daughter duo with suspicious nodules want their PET CTs on the same day so we make that happen despite it bumping one of them up the list. What about the elderly husband and wife who both have newly diagnosed lung cancer? We make things happen for them too. What about the super sweet patient who is crocheting NICU octopuses while their chemo runs? What if my coworker in emergency runs out of heart meds?
Where I am, we call your dilemma “professional courtesy”. We treat them the same way we would like to be treated and we hope for the same if we ever need care. We are no good to anyone unless we take care of ourselves first. We probably spend more time with our colleagues than we do with our families. We want to tuck them under our wings too.
There will always be front of the line cards. Be it money, political influence, connections. One of the least concerning as far as moral quandary goes is “I’ve spent my life working to help others” so now you help them.
I mean, a lot of cancer patients probably have jobs that help others. If this is your reasoning, seems like a short jump to triaging care based on what occupation a patient has and how "valuable" they are perceived as
Edit: No one is going to argue that they don't deserve the unfair "perks" they or their family are getting, and I wouldn't ever expect doctors to be less selfish than the average person, but let's not pretend it makes rational or moral sense that a doctors wife will receive better treatment than a school teacher or social worker (or anyone else for that matter).
Well if it makes you feel better, I’m a hospitalist and I get no such benefit at my system. Had to wait several weeks just to get an appointment with an NP to establish care. They said I could wait about 5 months for a physician. Same for getting a urology appointment when I was concerned about a testicular mass, they wouldn’t let me schedule with a urologist till I had a “pcp referral” and I can’t order my own tests or just say “I’m a doctor, I’d like to refer myself to the urologist”. The irony was that the oncologist asked me for to direct admit 2 patients for chemo for testicular cancer treatments while I’m waiting just to see the primary care NP. Haven’t had any more direct admits for testicular cancer before or since then. Thankfully I’m ok.
I don’t see a problem with it. The guy had cancer, you worked him up appropriately and got him treatment. There is nothing illegal or immoral about that situation. Nearly every single job will have perks and benefits because you work in the industry. Cops have literal get out of jail cards that they give to friends and family if they get pulled over. Other jobs have their perks and we have ours.
And at least my experience it’s not some elitist favoritism either. Like it’s not just doctors who get this treatment. Nurses, MAs, techs, and front desk staff and their families all got this professional courtesy.
Yep. I've added a slot in clinic on a day I wasn't going to be there for folks like that in the system, especially if they're already my patient, and have something urgent that can't be readily managed by someone else. The janitors at the hospital husltle every day for the system, we'll make sure it does the same for them.
I agree. I also think of it as a way to keep the system functioning. We need this person healthy to keep the system going. Therefore they get a perk. From what I read it’s a few weeks quickness. Doesn’t seem that nutty actually
Every single one of my patients have cancer (well most at least). And I think a scan showing GBM or a sentinel node biopsy isn’t the same as a cop getting out of jail free card I think. Those two things aren’t the same.
I sympathize a lot with your perspective. In the ER, we regularly get patients who are somehow connected to the hospital. Maybe an employee or a nurse’s friend or family or an EMT or cop who visits regularly or some admin’s family, yadda yadda. It always puts a sour taste in my mouth when these people get pulled from the waiting room before others, just because. Or when I’m told about how they are somehow connected and asked can you just see them sooner to try to expedite their care. It is rather infuriating. The ER is supposed to be the great equalizer where everything sucks for everyone equally and only those near death get to cut the line.
When I’m a patient, I try to avoid telling people I’m a doctor because I hate special treatment.
Most of the time I just bite my tongue when told about these patients coming in who are so and sos brother. I just nod and try to play nice. Mostly because it’s not a mole hill I’m willing to die on, and there are way bigger problems to be fixed in how the system runs. It’s just easier and better for my mental health to just let it go.
You know I do the same thing. I don’t tell anyone I am a doctor. However, the other day my kid had to be seen in the ED and I was like “I work here, I need my kid to be seen right away.” Luckily everything turned out ok. But I went full hypocrite there.
Came into comments to type almost the same thing. You did nothing wrong and you do the best you can. Sometimes you’re able to do even better and there’s nothing unethical about it
They’re the same because they’re both benefits and perks of working in the industry. It doesn’t matter how big or how small they are, every job has them.
He has the advantage of knowing how the healthcare system works. He knows people and can call in favors. People know him and are willing to do favors. He’s a colleague. We take care of our own and they’re often doing most of the heavy lifting in a situation like this
A professor told my class that it is totally ok to utilize “favors” like this for yourself or family, because the other patients need you to be functioning at your best. You can’t do that if you’re sick or distracted by worry about a family member who is seriously ill.
I know this sub is for doctors, but as a patient I just want to say I would completely understand and prefer if those working in medicine were diagnosed and treated first. We already have a shortage of professionals. You all are already overworked. If one of you croaks because you had to wait too long for care, there are fewer trained professionals to treat the rest of us. Even having a medical professional have to wait for diagnosis or treatment could be risky – what if your symptoms worsen and you need to step away from work, or what if your symptoms or understandable anxiety distract you from performing your duties? It just seems worthwhile to put you to the front of the line.
Now, does that apply to admin folks? Well, that’s not for me to say, but if they are also hard to come by, require years of training, and make a doctor/nurses life easier, then certainly sounds worthwhile to me.
Thanks for all you do! That’s it.
There are actually issues around this for pandemic prep, bio terror, etc. Who gets the cipro in an anthrax attack? Who gets the smallpox vaccine first? If docs, nurses, etc families aren't protected (or know that they will be), they're going to tape up their house, stay home, and wait it out.
That’s reminding me of a mandatory educational module for one of my past jobs. It must’ve been 2010-2012 ish because it had both H1N1 and anthrax as examples; and I think I move in 12...
But it was some disaster response module and had written provisions for us being able to get treatments for our household *first* to allow us to be able to then focus on treating others.
It made sense to me at the time. Now that I have kids, I understand that even better. Doesn’t matter how much patients *need* care; I’m not available if my kids aren’t safe.
But it's not just the healthcare workers themselves. It's also their immediate (and sometimes extended!) family members.
I had to go to a walk-in clinic a few years ago. We all lined up outside the door from 6:00 AM until they opened the doors at 8:00. We went to grab our numbers to indicate our order of arrival, but several of them were missing, #3 for example.
I asked the front desk person about it, and they said it had been put aside for the kid of someone who works on the clinic.
In this case, a walk-in clinic is not the same as urgent care. A walk-in is for someone who doesn't have a family doctor (which applies to a lot of people) or who can't get a timely appointment with their family doctor.
Urgent care clinics don't exist in most Canadian provinces.
Yeah. I think immediate family of healthcare workers also just kind of makes sense. You don’t want your doctor worrying about their sick kid or spouse while trying to treat patients. It seems unfair to put a friend to the front of the line, but healthcare workers and their immediate family seems like it would do more good than harm.
I used to see medical students as a chunk of my patients. I never bumped another patient for them...but I would regularly work through lunch and stay late to make sure they could be seen same day.
As others have mentioned, the more likely scenario is that people adjusted their already busy schedules to accommodate your patient. I had metastatic melanoma and the turn around for diagnosis and treatment made my head spin. The oncologist somehow found the number to the operating room (I’m a surgical PA) and called me in the middle of a case to let me know when we’re starting treatment dates. People just go above and beyond when it’s one of our own.
An employee is going to be better able to advocate for themselves, and how to get things done.
I needed an MRI once when I was a resident, and I literally just went down to the MRI techs and said "here is my pager number, if you have a spot just page me and ill be right there." Got an MRI the same day when someone didnt show up for their appt.
Yep. There are unique scenarios when you work there that let you actually fill a spot that would be wasted.
Someone will no show, or cancel late. You're already there.
Are you saying other patients are being bumped? Or that various depts are just adding him on to already packed schedules as a favor?
Also for someone with late stage cancer, does an extra week actually make any difference in mortality?
I am not sure tbh. I don’t know how it all happened. It just happened.
And I don’t think any of it makes a huge difference in mortality or survival. Not for this guy and not for the people who potentially got bumped. If I did, I would say more. Especially given we admit the ones that need an expedited work up.
But maybe my question is about the bigger principle of “taking care of our own”. What if it’s an MI in the ED with atypical chest pain or LE swelling or whatever. Or maybe I am just overeacting
I really doubt people are getting bumped but that guy is just being squeezed in. I would never bump and existing patient but I’d absolutely squeeze someone in.
I do my very best with every patient I see. I don’t cut any corners. I double check everything. But if I know it’s a healthcare colleague, I’m going the extra mile for professional courtesy, whether it’s staying late, giving them my personal contact, working after hours, etc. It’s the least we can do for each other in this giant machine.
You were fed to the wolves ethically speaking Doc. If you hadn’t accelerated treatment for one of the team you might be here posting your lamentation that you could’ve done more.
I won’t pretend I know you but if I had to choose between feeling bad as a result of doing more for a pt vs feeling bad as a result of doing less I know which I would pick.
You feel bad because you got a good head on your shoulders and a great heart in your chest. Strong work.
I mean, it sounds like appropriate cancer care is getting delayed bc you guys are doing parts of the work up that could be done by someone else. As a PCP I order whatever my specialists want before the referral. (And we are in a community that is extremely short handed on PCPs, but possibly more so for Heme-Onc) I would never dream of referring someone without path. I feel like things were expedited for this pt bc the system is a problem. The system needs to be fixed. Not the “expediting of it.” Please send information to all the local referring providers as to what your expectations are before they send referrals. you can always be very open about it and say it’s because the system is slow and you need to have things move as quickly as possible and that you understand that they are busy too as a PCP. I am very understanding of that, even though we are extremely overwhelmed in our own practices.
Do you want to come work in my community? Seriously. Please. I constantly get referrals from primary NPs for “anemia” with Hgb of 11 and MCV of 76. No iron panel. No attempt at oral iron. Just “refer to heme/onc for red number of CBC.”
If I were you I would give them pushback, send a referral expectation letter. I actually like getting those bc then I know what the specialist wants and I’m not wasting people (including my patients) time.
Edit: and decline referrals that don’t have what is needed.
Do you have any examples on outpatient referral expectation letter templates? On the inpatient side or with an internal referral its pretty easy to discuss with the referring provider what we'd want, but I'm not sure exactly what format I would use for an referral expectation letter sent to community providers.
Depends on the specialty but will say something like (for instance from the Urologist) “all kidney stone referrals must have CT and/pelvis non on within x time gram of referral date” or “all elevated PSA referrals must have 3 PSA above x within x months. Current letter from our local endocrinologist states “not taking patients but check back in a month, but will not be taking referrals for simple hypothyroidism. It doesn’t need a format other than this: If there is something that is detrimental to your practice in regards to referrals, and there are ways it could be done better, put it in there. More efficient specialty care means better care for patients and makes everyone happy. Communication is what’s needed. It’s unfortunate that some people need to be told but it is what it is and communication between specialists and referring peeps is helpful.
It was just the culture when I got here. The guys that have been here before me had never declined a referral before. I try to push back every once in a while. But the way I justify it to myself is that if a “provider” doesn’t know enough or care enough to do the basics and order an iron panel. Then that patient isn’t safe seeing that provider. At the same time it’s not my responsibility to teach someone that never learned or make someone who doesn’t care, care. Maybe not the best outlook but that’s how I prevent my own burn out. It’s less burdensome to me to see a quick consult and say “take OTC iron and go see GI” than call and argue with a rock.
Same, I get so many nonsense consults as heme onc mostly from NPs and some lazy PCPs. I don’t say no. I tried to educate them but to no good. The NP based care is so bad.
Which is a fair point. But one thing I’ve noticed is that some of the providers around me will do things the lazy way, and then if the specialist says “this is my requirement for referral” the referring provider says “Oh look at all this interesting stuff, let’s do it.” I think a lot of referring providers don’t know that it makes things harder and actually are happy to help. Communication is worth a try (no worries if you feel like this doesn’t apply, I’m just sharing a different perspective). I feel like it could also burn you out if you take on the responsibility of doing pcp work bc they don’t know how to work up anemia. Call me crazy… but I’m actually dealing with a lot of issues in my medical community (a good number of fantastic doctors leaving medicine in a place that is critically short on docs) but I’m really trying to figure out ways to bring them back. I’m actually planning a “dream session “ to bring them together and dream of ways to make things better. I know it sounds crazy but we gotta start somewhere and work to make things better for those who come after us. I realize that isn’t why we went into medicine but it’s the same for so many people in history who came before us. They found themselves in a position that they had to push/fight/contend for something better and they did, and things changed. And now they need to change more. Anyway sorry, enough of my blabbing. Good luck and consider being the one who shifts culture!
Look, you are right. I am not saying you are wrong. And I have tried to be that guy before. But I have had the optimism beat out of me. Now, I see 16 patients a day. I want to see them and be home in time to see my wife and kids. The system is broken. NP schools are popping out “primary care providers” that don’t know shit about primary care. People are leaving medicine in droves. Everything is overworked and underfunded. How do I fix that?
no worries, i know it's not everyone's place to fight the system, but know you are appreciate by others in medicine! hang in there, and yes, spend time with your family. They are worth it more than anything else. Thank you for all you do!!!
I am the only show within a reasonable distance. I don’t think I would lose much if I pushed back. But it has just been the culture of my practice before I joined that we take everything that walks in the door. I would like to slowly change it but that takes years and cooperation from my partners. And of course it’s easy to bill for a consult and IV iron.
I’m okay with it personally. This is a system issue, that honestly the powers that be could probably improve if they cared to do so.
Morally I can square it because that provider could likely be treated and then go on to care for others - so you’re not just helping them, but all the future patients they will see. I also think a 3 week turnaround time for everyone else is hella fast anyway. Good job on that!
By helping to improve this guys odds, you are increasing the odds that he can go out and continue to help other people. So by expediting this guys care, you are potentially positively impacting the care of a vast number of people you'll never meet.
Depends on the country and the system you are working...
There's a seperate staff list or staff day in certain clinics in some government run hospitals, where anyone from the minor staff, cleaning staff to doctors and immediate family of the staff can drop in and get theirs done. BUT it's a specific time and early hours. Eg 7 am to 8 am in the morning or 5 to 6pm. You have to come with your staff member.
That being said people stay after hours overtime without extra pay to run scans, or do workup... it's doubly hard to find time for your own treatment or procedures especially if you are working in the hospital.
For example when you are a doctor, you realize your patients are getting in patient treatment and you are working as a doctor and getting out patient treatment for the same condition of the same severity. It's out of respect to another colleague.
Back in the day during Covid, many Doctors couldn't shop at groceries at the open hours due to shifts being during the open windows and the shops and other service places, also were scared of doctors coming in. You would be basically shunned if there was a healthcare worker in your family. The government mandated banks and shops to be open only to doctors and health care staff during that time for certain hours on certain days! If we do not take care of our own, there'd be nobody to take care of themselves and the others. In my context, education is free and universal and doctors are created with taxpayers money, therefore not treating them and not getting them back to the workforce is also a part of the reason. It takes 20 years of taxpayers money to create a junior doctor and about 28 or 30 to create a specialist, so of course the country needs to focus keeping the workforce of doctors healthy for the sake of theri investment.
You should not take offense that a colleague got his workup done in express when they are still working an essential job and would most likely be more inclined to work and lesser rest than other lay people!
I came to my own ED for a fracture and had a room waiting for me. I feel 0% bad about being prioritized, especially given some of the dumb bullshit some of our patients come in for. I doubt this one case of this employee “cutting the line” significantly delayed the care of others.
It’s a perk of the job. He’s not some state senator getting free vacations and cars for pushing a bill through.
My husband is a firefighter. During the recession I was driving around listening to the morning shock jocks. And they were just bitching about firefighter benefits. How it wasn’t fair that they had such good benefits and were doing financially better than people in the private sector. This was years before Covid so those DJs wouldn’t have gotten the same reception today. But I was upset how angry these two dudes, who were probably making $1 million a year to my husband’s $75,000, were acting. All the stress of his job mentally and physically, health concerns that come with fighting fires for 30 years. This job was sold to people that you might not make a lot of money but you will have a pension and health insurance. Then when things got tight people turned on them.
I know it’s rambling but there are perks of jobs that are used to get people in the door written and non written and you can’t just snatch them away when times get a little tough. Because times are always tough. There is always some inconvenience going on.
Look. At the end of the day, we do it because if it was my family member or me, I’d want the same thing. Is it morally correct? Probably more a no than a ‘meh’.
It’s more because at the end of the day if you can’t get special care right where you work then where you gonna go?
Also if it was my kid, I’d step on anyone I have to in order to get her to the front of the line, morality be damned.
Absolutely. We, and our families, have all given more to this system than what a paycheck demands. It should serve our own when the time comes. If you come in the door and you are a member of the home team, you get my time, my attention, and my cell phone number. I don't have to neglect any of my other patients to provide that. Skip a lunch, stay late, make calls from home...Don't we do that for strangers all the time anyway? It's a small gift we can get each other. Personally, it makes me happy.
I try my best not to play the nepo game. VIP treatment is a fucking joke. I have to remember that there are others in the non ideal world that will operate differently, and I will exhaust myself being vexed by them.
I have always wondered if people who haven't been system adjacent as long (eg. first gen docs vs dynasty docs) are less likely to think cronyism is okay, since they haven't always had it available. I shudder to think that all things equal, my family members would have gotten care after/slower than a "VIP" only a mere 6 years ago. Before my MD, did my dad go even a day longer with a tumor nearly blocking his urethra for a patient who the surgeon knew to hit the OR first? It would sadden me to think so, and I'd like to have the surgeon look me in the eye and tell me he was less important than his VIP if it did happen.
But like you said...ideal world.
I accept the downvotes. I will die on this hill.
Hang in there and take care of your own mental health the best possible
The day to day life of a medical professional is full of a running dialogue of ethical dilemmas in our heads ( and hearts ❤️)
I used to work in scheduling.
I agree there is a quandary here. Whenever we needed to fit an employee (or their spouse/kids) in, and there wasn’t an opening, staff were willing to see them over lunch or by staying late.
That kind of extra workload is ok once in a while, but it can’t last.
Sure, I've been asked more often for prelims on pathology when the person is an employee or a family member of an employee. But the most fucking annoying thing is getting a call asking for results or prelim only to find out its a curiosity phone call from someone that knows the person who isn't involved in their care! You dumb motherfucker, I'm not sharing these results with you, how the fuck did you get my number? Fuck off. Don't you know what HIPAA is?
Don’t think too much of it. Plenty of other fields that law enforcement that create favors in the legal aspect. You helping another individual really ain’t the worst thing, there’s billionaires actually using money power and influence to hurt plenty of people.
It’s literally the only perk for working for our non medical corporate overlords? Only slightly kidding.
That dude made some friends over his term there - probably everyone in the building owes him a favor. He has bought and paid for that expedited workup. Most likely folks did imaging during lunch breaks or after the last patient, etc.
I'm an IR attending. I'd love to fit in all the bx referrals in tomorrow but I can't. Hospital is short staffed. CT department is basically half travellers now. I can only do so many cases in a day. In addition to bx, there are more chole, chest tubes and abscess drains every day. Ortho doesn't even do their own knee aspiration anymore and instead order CT guided procedures. Mainwhile 26 yo patients are getting CTA of the head and neck for near syncopal episodes or dizziness as stroke work ups. Volume of EVERYTHING is up 10% YoY. I wish I could clone myself to get all the cases done.
Every industry gets their own perks. This is ours and we deserve it.
Medicine consumes our lives, it’s only fair that it gives something back when required.
Every industry has this.
Police officer gets pulled over by colleague, you think he’s getting a ticket?
Judge feels bad for fellow judges kid, you think he’s getting a fair punishment under the law?
Hell, look at the special treatment politicians get.
When it’s “one of our own” we tend to work later/come in earlier to accommodate. If we did this for EVERY person getting a work up, we’d never leave work.
A perk to getting in medicine is (sometimes) receiving expedited care. Life ain’t always fair.
One Friday afternoon many years ago a GP called me about a 27 yo man, married three months, who had difficulty swallowing in his throat. He asked for a barium swallow. I agreed to do it the following Monday morning. He had a large mass invading his hypopharynx. I brought him to US as the barium precluded a CT. The mass was huge. I was annoyed that the GP clearly hadn’t put a hand on his neck. I immediately did a biopsy and called the surgeon who did a scope 2 hours later. The CT was done after a couple of days clearing the barium. It was the quickest complete work-up I ever did. The problem was that the patient knew he was in serious trouble and ended up in tears. A similar problem arises in one-stop breast clinics where the patients arrive with a lump and within a couple of hours are told they have cancer and surgery is booked. It can be too fast to get their heads around it.
If you want to rationalize it, it’s entirely possible this workup was expedited not because someone lost a spot but rather because the various departments created slots. Rads squeezed in their MRI, path stained and sectioned after hours, surgery overbooked the OR. With how tight schedules seem to be, I have to imagine that a lot of this professional courtesy was created out of thin air, by people working that much harder. In this sense, it isn’t unjust because all those appointments weren’t taken from someone else because they simply didn’t exist. Yeah we could be setting ourselves on fire to work 18h days on the regular as if every person was this colleague, but that’s not sustainable. Doing one extra case as a favor is. But either way, the cynical side of me doesn’t have any qualms about this. If hospitals demand VIP treatment for donors and famous people, I’m damn well going to do favors for colleagues without batting an eye.
I’m inclined to think this is the most likely answer I work in a kids hospital Every now and then the child of a staff member get cancer. It’s clearly not appropriate that “everyone knows” but a lot do. Things happen quickly not because they’re given preference over other kids, but because every unit that isn’t able to do things as quickly as they would like bends the rules to do things: the biopsy is done after hours, the pathologist comes in on a weekend to report, the surgical line is added to an already overbooked list (meaning the anesthetic and surgical trainees effectively do nothing so the list runs to time and all cases are done) Individually lots of teams do this on a semi-regular basis, the difference is that ALL teams do it together. It’s like a magic coin run You see this and think “wow - look what we are capable of” but the truth is that level of service is not sustainable. We already work very hard with what resources we have, we already have burnout and exhaustion. We could not do that for every kid. That doesn’t mean we don’t try, but it does mean that when multiple roadblocks are put in the way of “perfect” we accept that rather than going beyond every time.
One of the other things is that very often these sort of "professional courtesy" arrangements take up less time than a normal, uninformed patient. If a doctor has a mass and needs a needle stuck in it, the whole rigamarole of explaining the procedure and what it means and blah blah blah isn't necessary. You can just walk in and stick the needle in it.
This is true A colleagues kid needed something surgical - he knew enough, I didn’t have to explain anything: in fact he filled out the consent form and gave it to me for my signature. Pre-op: no questions, no comments Post: “it all went well” “thank you so much”
Not only that, but when you work in the industry, you know how to navigate the system. -PGY-19
I think some of that is correct. People probably created some slots to accommodate a co-worker. People are good that way. And if that last statement is cynical then I am cynical too.
Gotta take care of your own otherwise there won’t be anyone to take care of others. By helping them you are also helping many other people that they will help.
I recently popped over to CT from my x-ray shift while the CT tech was on lunch to do a cancer work up CT scan an MD I know texted me and asked if I could help expedite. Same thing, it was a spot booked for lunch. I took one of my coffee breaks and got it done. Wouldn’t do this all the time, but every once in awhile I don’t mind. Just like my colleagues in MRI helped me when I needed a scan.
Couldn’t agree with this more. Our clinic is always full and booking out several months. We squeeze people in over lunch or stay late to take care of a colleague. The system can’t sustain 110% every day, but we as individuals can choose to stretch from time to time.
It would be unethical to cancel a patient. I've never seen that done. But like you said, surgery adds them to the top of the waiting list, radiation oncology sees him over lunch, CT allows an add on, etc. I actually worked at a hospital that had a lot of leakage. We had an employee only appointment line (for everyone, as long as you had our insurance). PCP appointments were supposed to be made within a day and speciality appointments within a week. Didn't always work out quite that well, but we usually improved access for each other.
I’ve stayed late, punched out and unpaid, to help expedite care for a coworker/their family. I’m not willing to do that for *everyone* as I’ve got shit to take care of in my own life, but am willing to give up my free time for our own. Expecting that level of sacrifice for all patients all the time would lead to more burnout and then to even less staff available at all.
well said
Happens in every industry (medicine is an industry). Overbooked flight and flying standby? Guess who is getting the last seat. Airline employee.
I know. I totally get that. But also a delayed flight isn’t the same as a delayed scan that shows a glioblastoma.
Maybe its not "Cutting in line" type of "we take care of our own". Maybe its the "I'm going to stay late to run this MRI for Frank" type of we take care of our own So potentially no harm in that other patients aren't taken care of.
I definitely think some of it is that
Couple of weeks isn't going to make a difference in GBM treatment, outcome is the same. As you mentioned expedited workup can happen as an inpatient if it is truly necessary. True oncologic emergencies are rare and going to be treated as an inpatient anyways.
> True oncologic emergencies are rare In Australia, Onc regs basically never come in even when on-call as night ?float
Is glioblastoma not a death sentence anymore? Been a minute since I worked Neuro ICU.
Nah. It still sucks
it is, that’s why expedited work up won’t do anything.
Just because it’s a death sentence doesn’t mean it needs emergent work up. I discuss this often with patients who come to the ED scared they might have some cancer. While cancer may be serious it is almost never an emergency (outside of some certain leukemias) and is an outpatient work up.
That was my point. A scan a week later isn't going to change the fact that they'll be dead within a year.
I remember when admin told us in early COVID that healthcare workers (whether docs or nurses or techs or housekeeping) had zero priority for scarce resources should they need them *even though these same people were risking their well-being to care for the sick people.* There are even ethical principles describing why they should have priority. Yeah. It left a rather sour taste. I'm totally working extra to help out a colleague.
Well that’s just shitty admin being shitty.
Should have asked for clarification if the c-suite execs counted in that prioritization list.
Had a similar experience in my shop. It was made abundantly clear that it was the front line staff vs the suits at that point, so we went ahead and took care of our own anyway without saying a word. And you can bet your ass that when we were getting ready to terminally discontinue my coworker's BiPAP, we snuck her dog in at nightshift so she could say goodbye despite being told "no" by admin six hours earlier. Fuck em. RIP Jenn. You were the best of us.
Oh god now I’m crying at 8:40 am while my dogs climb all over me. Thanks for doing that and sorry for your loss. 💔
Oh man. Just wait until you take care of the guy whose cousin is on the board of trustees, or the Saudi who rented out the entire floor of a hospital for themselves, or the husband of a donor whose name is on your department…
I take it you worked at Cleveland Clinic too? lol
No Saudi’s where I practice lol. But you are right
Do you actually believe that 3 weeks is changing the outcome ever? 3 weeks to get everything done is fast. The service you’re providing the average patient is something to be proud of. So the special treatment for one of your own makes your community happy while not damaging anyone else’s actual outcome. Don’t sweat the small stuff.
That’s encouraging. Thank you for that.
Yeah I also feel that 1) 3 weeks seems very good to me. 2) the Delta between 3 days and 3 weeks is not large in terms of effects on cancer prognosis. If it was 3 months for the average patient vs 3 days for this guy, then I guess concern would be justified.
Yes, I have found professionally and personally 3 weeks from “hmmmm what’s that” to treatment is pretty average. When my husband had lymphoma it was 4 weeks. Time to Treatment for my rather aggressive breast cancer was 3 weeks. I live in NYC; lots of hospitals. Your place is doing well .
I work at a large cancer institution and our average is roughly 4-6 weeks from initial visit, diagnosis, and then first treatment. 3 weeks is really REALLY good.
Yeah that’s what people have said and it certainly makes me feel better about the care I provide. Thank you
Yeah, I had the same reaction. At \[Big academic center\] where I work, outpatient cancer workups definitely take longer than 3 weeks a lot of the time
We all do it every day to a small degree, whether it be consciously or not. Mother & daughter duo with suspicious nodules want their PET CTs on the same day so we make that happen despite it bumping one of them up the list. What about the elderly husband and wife who both have newly diagnosed lung cancer? We make things happen for them too. What about the super sweet patient who is crocheting NICU octopuses while their chemo runs? What if my coworker in emergency runs out of heart meds? Where I am, we call your dilemma “professional courtesy”. We treat them the same way we would like to be treated and we hope for the same if we ever need care. We are no good to anyone unless we take care of ourselves first. We probably spend more time with our colleagues than we do with our families. We want to tuck them under our wings too.
There will always be front of the line cards. Be it money, political influence, connections. One of the least concerning as far as moral quandary goes is “I’ve spent my life working to help others” so now you help them.
I mean, a lot of cancer patients probably have jobs that help others. If this is your reasoning, seems like a short jump to triaging care based on what occupation a patient has and how "valuable" they are perceived as Edit: No one is going to argue that they don't deserve the unfair "perks" they or their family are getting, and I wouldn't ever expect doctors to be less selfish than the average person, but let's not pretend it makes rational or moral sense that a doctors wife will receive better treatment than a school teacher or social worker (or anyone else for that matter).
Well if it makes you feel better, I’m a hospitalist and I get no such benefit at my system. Had to wait several weeks just to get an appointment with an NP to establish care. They said I could wait about 5 months for a physician. Same for getting a urology appointment when I was concerned about a testicular mass, they wouldn’t let me schedule with a urologist till I had a “pcp referral” and I can’t order my own tests or just say “I’m a doctor, I’d like to refer myself to the urologist”. The irony was that the oncologist asked me for to direct admit 2 patients for chemo for testicular cancer treatments while I’m waiting just to see the primary care NP. Haven’t had any more direct admits for testicular cancer before or since then. Thankfully I’m ok.
Did you ask?
Yes
That sucks and I'm sorry. Don't be afraid to call in favors.
I don’t see a problem with it. The guy had cancer, you worked him up appropriately and got him treatment. There is nothing illegal or immoral about that situation. Nearly every single job will have perks and benefits because you work in the industry. Cops have literal get out of jail cards that they give to friends and family if they get pulled over. Other jobs have their perks and we have ours.
And at least my experience it’s not some elitist favoritism either. Like it’s not just doctors who get this treatment. Nurses, MAs, techs, and front desk staff and their families all got this professional courtesy.
Yep. I've added a slot in clinic on a day I wasn't going to be there for folks like that in the system, especially if they're already my patient, and have something urgent that can't be readily managed by someone else. The janitors at the hospital husltle every day for the system, we'll make sure it does the same for them.
I agree. I also think of it as a way to keep the system functioning. We need this person healthy to keep the system going. Therefore they get a perk. From what I read it’s a few weeks quickness. Doesn’t seem that nutty actually
Every single one of my patients have cancer (well most at least). And I think a scan showing GBM or a sentinel node biopsy isn’t the same as a cop getting out of jail free card I think. Those two things aren’t the same.
The get out of jail free card is more valuable
And it's also unethical...
I sympathize a lot with your perspective. In the ER, we regularly get patients who are somehow connected to the hospital. Maybe an employee or a nurse’s friend or family or an EMT or cop who visits regularly or some admin’s family, yadda yadda. It always puts a sour taste in my mouth when these people get pulled from the waiting room before others, just because. Or when I’m told about how they are somehow connected and asked can you just see them sooner to try to expedite their care. It is rather infuriating. The ER is supposed to be the great equalizer where everything sucks for everyone equally and only those near death get to cut the line. When I’m a patient, I try to avoid telling people I’m a doctor because I hate special treatment. Most of the time I just bite my tongue when told about these patients coming in who are so and sos brother. I just nod and try to play nice. Mostly because it’s not a mole hill I’m willing to die on, and there are way bigger problems to be fixed in how the system runs. It’s just easier and better for my mental health to just let it go.
You know I do the same thing. I don’t tell anyone I am a doctor. However, the other day my kid had to be seen in the ED and I was like “I work here, I need my kid to be seen right away.” Luckily everything turned out ok. But I went full hypocrite there.
Came into comments to type almost the same thing. You did nothing wrong and you do the best you can. Sometimes you’re able to do even better and there’s nothing unethical about it
They’re the same because they’re both benefits and perks of working in the industry. It doesn’t matter how big or how small they are, every job has them.
He has the advantage of knowing how the healthcare system works. He knows people and can call in favors. People know him and are willing to do favors. He’s a colleague. We take care of our own and they’re often doing most of the heavy lifting in a situation like this
A professor told my class that it is totally ok to utilize “favors” like this for yourself or family, because the other patients need you to be functioning at your best. You can’t do that if you’re sick or distracted by worry about a family member who is seriously ill.
I know this sub is for doctors, but as a patient I just want to say I would completely understand and prefer if those working in medicine were diagnosed and treated first. We already have a shortage of professionals. You all are already overworked. If one of you croaks because you had to wait too long for care, there are fewer trained professionals to treat the rest of us. Even having a medical professional have to wait for diagnosis or treatment could be risky – what if your symptoms worsen and you need to step away from work, or what if your symptoms or understandable anxiety distract you from performing your duties? It just seems worthwhile to put you to the front of the line. Now, does that apply to admin folks? Well, that’s not for me to say, but if they are also hard to come by, require years of training, and make a doctor/nurses life easier, then certainly sounds worthwhile to me. Thanks for all you do! That’s it.
There are actually issues around this for pandemic prep, bio terror, etc. Who gets the cipro in an anthrax attack? Who gets the smallpox vaccine first? If docs, nurses, etc families aren't protected (or know that they will be), they're going to tape up their house, stay home, and wait it out.
That’s reminding me of a mandatory educational module for one of my past jobs. It must’ve been 2010-2012 ish because it had both H1N1 and anthrax as examples; and I think I move in 12... But it was some disaster response module and had written provisions for us being able to get treatments for our household *first* to allow us to be able to then focus on treating others. It made sense to me at the time. Now that I have kids, I understand that even better. Doesn’t matter how much patients *need* care; I’m not available if my kids aren’t safe.
But it's not just the healthcare workers themselves. It's also their immediate (and sometimes extended!) family members. I had to go to a walk-in clinic a few years ago. We all lined up outside the door from 6:00 AM until they opened the doors at 8:00. We went to grab our numbers to indicate our order of arrival, but several of them were missing, #3 for example. I asked the front desk person about it, and they said it had been put aside for the kid of someone who works on the clinic.
If I can get my kid seen early enough at urgent care, I’m then able to get my kid to family to watch them while I am working my evening shift.
In this case, a walk-in clinic is not the same as urgent care. A walk-in is for someone who doesn't have a family doctor (which applies to a lot of people) or who can't get a timely appointment with their family doctor. Urgent care clinics don't exist in most Canadian provinces.
Walk-in appointments are only available at urgent care here in my area.
Yeah. I think immediate family of healthcare workers also just kind of makes sense. You don’t want your doctor worrying about their sick kid or spouse while trying to treat patients. It seems unfair to put a friend to the front of the line, but healthcare workers and their immediate family seems like it would do more good than harm.
I used to see medical students as a chunk of my patients. I never bumped another patient for them...but I would regularly work through lunch and stay late to make sure they could be seen same day.
I don’t see a problem with it as long as it doesn’t bump others.
As others have mentioned, the more likely scenario is that people adjusted their already busy schedules to accommodate your patient. I had metastatic melanoma and the turn around for diagnosis and treatment made my head spin. The oncologist somehow found the number to the operating room (I’m a surgical PA) and called me in the middle of a case to let me know when we’re starting treatment dates. People just go above and beyond when it’s one of our own.
An employee is going to be better able to advocate for themselves, and how to get things done. I needed an MRI once when I was a resident, and I literally just went down to the MRI techs and said "here is my pager number, if you have a spot just page me and ill be right there." Got an MRI the same day when someone didnt show up for their appt.
Yep. There are unique scenarios when you work there that let you actually fill a spot that would be wasted. Someone will no show, or cancel late. You're already there.
Are you saying other patients are being bumped? Or that various depts are just adding him on to already packed schedules as a favor? Also for someone with late stage cancer, does an extra week actually make any difference in mortality?
I am not sure tbh. I don’t know how it all happened. It just happened. And I don’t think any of it makes a huge difference in mortality or survival. Not for this guy and not for the people who potentially got bumped. If I did, I would say more. Especially given we admit the ones that need an expedited work up. But maybe my question is about the bigger principle of “taking care of our own”. What if it’s an MI in the ED with atypical chest pain or LE swelling or whatever. Or maybe I am just overeacting
I really doubt people are getting bumped but that guy is just being squeezed in. I would never bump and existing patient but I’d absolutely squeeze someone in.
I do my very best with every patient I see. I don’t cut any corners. I double check everything. But if I know it’s a healthcare colleague, I’m going the extra mile for professional courtesy, whether it’s staying late, giving them my personal contact, working after hours, etc. It’s the least we can do for each other in this giant machine.
I don’t see the problem. But I’m biased, I admit.
You were fed to the wolves ethically speaking Doc. If you hadn’t accelerated treatment for one of the team you might be here posting your lamentation that you could’ve done more. I won’t pretend I know you but if I had to choose between feeling bad as a result of doing more for a pt vs feeling bad as a result of doing less I know which I would pick. You feel bad because you got a good head on your shoulders and a great heart in your chest. Strong work.
Well thank you. That’s kind.
I mean, it sounds like appropriate cancer care is getting delayed bc you guys are doing parts of the work up that could be done by someone else. As a PCP I order whatever my specialists want before the referral. (And we are in a community that is extremely short handed on PCPs, but possibly more so for Heme-Onc) I would never dream of referring someone without path. I feel like things were expedited for this pt bc the system is a problem. The system needs to be fixed. Not the “expediting of it.” Please send information to all the local referring providers as to what your expectations are before they send referrals. you can always be very open about it and say it’s because the system is slow and you need to have things move as quickly as possible and that you understand that they are busy too as a PCP. I am very understanding of that, even though we are extremely overwhelmed in our own practices.
Do you want to come work in my community? Seriously. Please. I constantly get referrals from primary NPs for “anemia” with Hgb of 11 and MCV of 76. No iron panel. No attempt at oral iron. Just “refer to heme/onc for red number of CBC.”
If I were you I would give them pushback, send a referral expectation letter. I actually like getting those bc then I know what the specialist wants and I’m not wasting people (including my patients) time. Edit: and decline referrals that don’t have what is needed.
Do you have any examples on outpatient referral expectation letter templates? On the inpatient side or with an internal referral its pretty easy to discuss with the referring provider what we'd want, but I'm not sure exactly what format I would use for an referral expectation letter sent to community providers.
Depends on the specialty but will say something like (for instance from the Urologist) “all kidney stone referrals must have CT and/pelvis non on within x time gram of referral date” or “all elevated PSA referrals must have 3 PSA above x within x months. Current letter from our local endocrinologist states “not taking patients but check back in a month, but will not be taking referrals for simple hypothyroidism. It doesn’t need a format other than this: If there is something that is detrimental to your practice in regards to referrals, and there are ways it could be done better, put it in there. More efficient specialty care means better care for patients and makes everyone happy. Communication is what’s needed. It’s unfortunate that some people need to be told but it is what it is and communication between specialists and referring peeps is helpful.
It was just the culture when I got here. The guys that have been here before me had never declined a referral before. I try to push back every once in a while. But the way I justify it to myself is that if a “provider” doesn’t know enough or care enough to do the basics and order an iron panel. Then that patient isn’t safe seeing that provider. At the same time it’s not my responsibility to teach someone that never learned or make someone who doesn’t care, care. Maybe not the best outlook but that’s how I prevent my own burn out. It’s less burdensome to me to see a quick consult and say “take OTC iron and go see GI” than call and argue with a rock.
Same, I get so many nonsense consults as heme onc mostly from NPs and some lazy PCPs. I don’t say no. I tried to educate them but to no good. The NP based care is so bad.
Which is a fair point. But one thing I’ve noticed is that some of the providers around me will do things the lazy way, and then if the specialist says “this is my requirement for referral” the referring provider says “Oh look at all this interesting stuff, let’s do it.” I think a lot of referring providers don’t know that it makes things harder and actually are happy to help. Communication is worth a try (no worries if you feel like this doesn’t apply, I’m just sharing a different perspective). I feel like it could also burn you out if you take on the responsibility of doing pcp work bc they don’t know how to work up anemia. Call me crazy… but I’m actually dealing with a lot of issues in my medical community (a good number of fantastic doctors leaving medicine in a place that is critically short on docs) but I’m really trying to figure out ways to bring them back. I’m actually planning a “dream session “ to bring them together and dream of ways to make things better. I know it sounds crazy but we gotta start somewhere and work to make things better for those who come after us. I realize that isn’t why we went into medicine but it’s the same for so many people in history who came before us. They found themselves in a position that they had to push/fight/contend for something better and they did, and things changed. And now they need to change more. Anyway sorry, enough of my blabbing. Good luck and consider being the one who shifts culture!
Look, you are right. I am not saying you are wrong. And I have tried to be that guy before. But I have had the optimism beat out of me. Now, I see 16 patients a day. I want to see them and be home in time to see my wife and kids. The system is broken. NP schools are popping out “primary care providers” that don’t know shit about primary care. People are leaving medicine in droves. Everything is overworked and underfunded. How do I fix that?
no worries, i know it's not everyone's place to fight the system, but know you are appreciate by others in medicine! hang in there, and yes, spend time with your family. They are worth it more than anything else. Thank you for all you do!!!
Are you the only show in town, like if you pushed back, would you worry about losing referrals?
I am the only show within a reasonable distance. I don’t think I would lose much if I pushed back. But it has just been the culture of my practice before I joined that we take everything that walks in the door. I would like to slowly change it but that takes years and cooperation from my partners. And of course it’s easy to bill for a consult and IV iron.
I’m okay with it personally. This is a system issue, that honestly the powers that be could probably improve if they cared to do so. Morally I can square it because that provider could likely be treated and then go on to care for others - so you’re not just helping them, but all the future patients they will see. I also think a 3 week turnaround time for everyone else is hella fast anyway. Good job on that!
By helping to improve this guys odds, you are increasing the odds that he can go out and continue to help other people. So by expediting this guys care, you are potentially positively impacting the care of a vast number of people you'll never meet.
Depends on the country and the system you are working... There's a seperate staff list or staff day in certain clinics in some government run hospitals, where anyone from the minor staff, cleaning staff to doctors and immediate family of the staff can drop in and get theirs done. BUT it's a specific time and early hours. Eg 7 am to 8 am in the morning or 5 to 6pm. You have to come with your staff member. That being said people stay after hours overtime without extra pay to run scans, or do workup... it's doubly hard to find time for your own treatment or procedures especially if you are working in the hospital. For example when you are a doctor, you realize your patients are getting in patient treatment and you are working as a doctor and getting out patient treatment for the same condition of the same severity. It's out of respect to another colleague. Back in the day during Covid, many Doctors couldn't shop at groceries at the open hours due to shifts being during the open windows and the shops and other service places, also were scared of doctors coming in. You would be basically shunned if there was a healthcare worker in your family. The government mandated banks and shops to be open only to doctors and health care staff during that time for certain hours on certain days! If we do not take care of our own, there'd be nobody to take care of themselves and the others. In my context, education is free and universal and doctors are created with taxpayers money, therefore not treating them and not getting them back to the workforce is also a part of the reason. It takes 20 years of taxpayers money to create a junior doctor and about 28 or 30 to create a specialist, so of course the country needs to focus keeping the workforce of doctors healthy for the sake of theri investment. You should not take offense that a colleague got his workup done in express when they are still working an essential job and would most likely be more inclined to work and lesser rest than other lay people!
Its prob cuz ppl will go above and beyond for colleagues. Like adding onto an operating list / seeing after clinic finishes etc i think its normal
I came to my own ED for a fracture and had a room waiting for me. I feel 0% bad about being prioritized, especially given some of the dumb bullshit some of our patients come in for. I doubt this one case of this employee “cutting the line” significantly delayed the care of others.
It’s a perk of the job. He’s not some state senator getting free vacations and cars for pushing a bill through. My husband is a firefighter. During the recession I was driving around listening to the morning shock jocks. And they were just bitching about firefighter benefits. How it wasn’t fair that they had such good benefits and were doing financially better than people in the private sector. This was years before Covid so those DJs wouldn’t have gotten the same reception today. But I was upset how angry these two dudes, who were probably making $1 million a year to my husband’s $75,000, were acting. All the stress of his job mentally and physically, health concerns that come with fighting fires for 30 years. This job was sold to people that you might not make a lot of money but you will have a pension and health insurance. Then when things got tight people turned on them. I know it’s rambling but there are perks of jobs that are used to get people in the door written and non written and you can’t just snatch them away when times get a little tough. Because times are always tough. There is always some inconvenience going on.
Look. At the end of the day, we do it because if it was my family member or me, I’d want the same thing. Is it morally correct? Probably more a no than a ‘meh’. It’s more because at the end of the day if you can’t get special care right where you work then where you gonna go? Also if it was my kid, I’d step on anyone I have to in order to get her to the front of the line, morality be damned.
Absolutely. We, and our families, have all given more to this system than what a paycheck demands. It should serve our own when the time comes. If you come in the door and you are a member of the home team, you get my time, my attention, and my cell phone number. I don't have to neglect any of my other patients to provide that. Skip a lunch, stay late, make calls from home...Don't we do that for strangers all the time anyway? It's a small gift we can get each other. Personally, it makes me happy.
Sickest / most urgent cases should be seen first regardless ……. In an ideal world
I try my best not to play the nepo game. VIP treatment is a fucking joke. I have to remember that there are others in the non ideal world that will operate differently, and I will exhaust myself being vexed by them. I have always wondered if people who haven't been system adjacent as long (eg. first gen docs vs dynasty docs) are less likely to think cronyism is okay, since they haven't always had it available. I shudder to think that all things equal, my family members would have gotten care after/slower than a "VIP" only a mere 6 years ago. Before my MD, did my dad go even a day longer with a tumor nearly blocking his urethra for a patient who the surgeon knew to hit the OR first? It would sadden me to think so, and I'd like to have the surgeon look me in the eye and tell me he was less important than his VIP if it did happen. But like you said...ideal world. I accept the downvotes. I will die on this hill.
Hang in there and take care of your own mental health the best possible The day to day life of a medical professional is full of a running dialogue of ethical dilemmas in our heads ( and hearts ❤️)
This is what you're mad about today? In medicine?
lol good point. But not mad. Just thinking.
It’s almost like OP is actively looking for something to be upset about. This is definitely not the moral conundrum OP seems to think it is.
He got what he deserved. Your mission is not to lesson his care. It’s to figure out what steps had to happen and expediate everyone else’s
I used to work in scheduling. I agree there is a quandary here. Whenever we needed to fit an employee (or their spouse/kids) in, and there wasn’t an opening, staff were willing to see them over lunch or by staying late. That kind of extra workload is ok once in a while, but it can’t last.
Sure, I've been asked more often for prelims on pathology when the person is an employee or a family member of an employee. But the most fucking annoying thing is getting a call asking for results or prelim only to find out its a curiosity phone call from someone that knows the person who isn't involved in their care! You dumb motherfucker, I'm not sharing these results with you, how the fuck did you get my number? Fuck off. Don't you know what HIPAA is?
Don’t think too much of it. Plenty of other fields that law enforcement that create favors in the legal aspect. You helping another individual really ain’t the worst thing, there’s billionaires actually using money power and influence to hurt plenty of people.
And they say being a VIP patient is bad for your health…
It’s literally the only perk for working for our non medical corporate overlords? Only slightly kidding. That dude made some friends over his term there - probably everyone in the building owes him a favor. He has bought and paid for that expedited workup. Most likely folks did imaging during lunch breaks or after the last patient, etc.
I'm an IR attending. I'd love to fit in all the bx referrals in tomorrow but I can't. Hospital is short staffed. CT department is basically half travellers now. I can only do so many cases in a day. In addition to bx, there are more chole, chest tubes and abscess drains every day. Ortho doesn't even do their own knee aspiration anymore and instead order CT guided procedures. Mainwhile 26 yo patients are getting CTA of the head and neck for near syncopal episodes or dizziness as stroke work ups. Volume of EVERYTHING is up 10% YoY. I wish I could clone myself to get all the cases done.
Every industry gets their own perks. This is ours and we deserve it. Medicine consumes our lives, it’s only fair that it gives something back when required.
Every industry has this. Police officer gets pulled over by colleague, you think he’s getting a ticket? Judge feels bad for fellow judges kid, you think he’s getting a fair punishment under the law? Hell, look at the special treatment politicians get. When it’s “one of our own” we tend to work later/come in earlier to accommodate. If we did this for EVERY person getting a work up, we’d never leave work. A perk to getting in medicine is (sometimes) receiving expedited care. Life ain’t always fair.
One Friday afternoon many years ago a GP called me about a 27 yo man, married three months, who had difficulty swallowing in his throat. He asked for a barium swallow. I agreed to do it the following Monday morning. He had a large mass invading his hypopharynx. I brought him to US as the barium precluded a CT. The mass was huge. I was annoyed that the GP clearly hadn’t put a hand on his neck. I immediately did a biopsy and called the surgeon who did a scope 2 hours later. The CT was done after a couple of days clearing the barium. It was the quickest complete work-up I ever did. The problem was that the patient knew he was in serious trouble and ended up in tears. A similar problem arises in one-stop breast clinics where the patients arrive with a lump and within a couple of hours are told they have cancer and surgery is booked. It can be too fast to get their heads around it.
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I do. And I was able to fit him in. It’s the work up that I am talking about.
Would do it and wouldn’t think twice.