What's he complaining about? Hospitals maintain ERs because they're the biggest money generators that they have.

Yes, some people behave badly in the ERs. I doubt, though, that it is contributing to the high cost of medicine or it is the "core" problem. For years now, patients have been instructed and encouraged to become "proactive" in their healthcare, to question and ask about treatments. The "core" problem with this is that at the same time, doctors haven't been instructed and encouraged to listen to the patient.

Just as an aside, for every "bad patient" that demands testing there is usually one patient that is refused testing or testing is not ordered and dies because of it. This is becoming especially acute for women who go to emergency rooms presenting with chest pain and are sent home because it's "all in their head". That accounts in no small part for the death rate of women with heart attacks.

I have a slightly different take after reading the doctor's complaint. He can see and sum up the problem, but, perhaps understandably, he's still stuck inside the box and can't see the forest for the trees to offer the correct solution and blames the wrong party. Here's his conclusion:

Ultimately, the American sense of entitlement, so long appeased and encouraged by our commercial culture, is what is poisoning the healthcare system.

Doc, it's that our health care is part of our commercial culture is the problem, not that Americans have a sense of entitlement. Smart business people everywhere who sell goods or services to "customers" everywhere in the world know the rule for success is "the customer is always right." Customers everywhere have a sense of entitlement, that's the game in commerce. Until medicine becomes a profession again rather than a seller/customer relationship, he will continue to get this.

Meanwhile, as long as we have a seller/customer relationship for health care in this country, I'm one of those bitchy people. I don't have much experience in emergency rooms, but I do have significant experience in what goes on in ICU's, inpatient and outpatient as a family member with many chronic illnesses over a 13 year period. I feel I've got enough experience at life/death hospital situations, and stories told in and of hospitals by other families, patients and friends, that I will glady advise anyone this when dealing with a hospital in this country:
The squeaky wheel gets the grease! Don't be afraid of being a bitch or bastard, don't be polite. This is not a normal situation, if you aren't vigilant and demanding, your family member may die.

I don't have the time to explain in detail the problems I know exist with our hospital system, I will just point out two. It wants to be a customer/seller type business (heck, look at any hospital's P.R., they sell sell sell certain clinics or services, whether for profit or to inspire donations) but it is woefully dysfunctional as to doing that.

The shortage of nurses is the number one main problem. It is so bad that it is clear that many of the nurses that are working are deeply unhappy with their job and can't cope. Chances are just as great that you get one that is ready to quit, doesn't care and doesn't give a fuck as you get a good one. It's like 50/50, so much that when you get a good one that's a saint and is still managing to do a good job, you really really notice the difference. Chances also are that you have poorly trained nursing aides doing a lot of important stuff.

A second problem is the specialist doctor system, how they work in hospitals. First how like all kidney doctors in a single hospital are in like a cartel which acts as one agent, you aren't really getting an independent opinion. And how the different specialists communicate about the patient and don't work as a team unless you are a real demanding squeaky wheel. And how the hierarchy works in a hospital with the big shot doctors that can draw paying patients, like a heart surgeon that is known for doing a special technique. If you can get one of those on your side, rooting for your patient, he can really make things happen that weren't happening before.

There are other problems...those are just two examples.

Ask anyone who has spent a lot of time as the family member in a hospital and chances are you will hear the same thing from them: you have to be a bitch or bastard to get the best care.

Apart from the few fancy places like Mayo, they are understaffed and poorly organized, always desperate for funds, and they know it.

I think it is so bad and complicated that I hesitate to say that changing our health insurance system will fix it all. Certainly it wouldn't change the nursing shortage problem, or the primary care doctor shortage problem in many areas. I think the specialist doctor thing is something that many systems are struggling with, it is about status in the medical profession, and how practicing medicine as an art and a profession, wholistically, is no longer prized, but rather innovation in new techniques and technological progress as to specific parts of the body.

Anyone who has read Sullivan's views on healthcare throughout the years would know that he is a major apologist for the industry. He is open in his gratitude toward the pharmaceutical companies which create the anti-retroviral regime he takes, and he has often stated that his experience shapes the belief that expensive technological innovation in medical treatment is the underlying inflator of medical costs in a country whose citizens demand the cutting edge.

These assertions do not pass the laugh test nowadays, but they have driven Sullivan's narrative for years. I'll leave it to observer2 to dissect Sullivan's absurdities, but I merely wanted to point out that this is the context in which Sullivan performs this hitjob on ER patients and attributes to them a sense of entitlement. He really does not believe that the exorbitant costs are unjustified; he attributes them to patients wanting healthcare the way they want their whoppers, "when you have it your way, it tastes better."

All in all, Sullivan's agenda is no surprise to those familiar with him, but it is unfortunate that anyone should embrace Sullivan's obvious doctor cherrypicking in his habitual pro-industry hitjob on patients in order to push a sour grapes attack on the average American who has to put up with disgraceful ER services.

Back to the man who irresponsibly claimed that the AIDS epidemic was over due to pharmaceuticals, though, one must address the great fallacy he commits in extrapolating his medical condition's ensuing costs to the general population. The truth is that treatment for HIV easily exceeds $100K annually per patient, not only in drugs but in frequent costly labs for treatment assessment and treatment related toxicities, which occur every three months, and for drug resistance, as well as for drugs for the treatment for the toxicities of antiretrovirals. In sum, it costs a million dollars a decade to treat Andrew Sullivan and other HIV positive patients. This is unfortunate, but Sullivan should be careful before extrapolating the stakes of HIV treatment to the needs of an elderly patient who has the misfortune of falling and breaking her hip. They are apples and oranges, and the distinction should be made when he pushes his policy viewpoints.

All good points Destor. Add to it, that these are simply the kinds of things that go with the non-minimum wage territory of being a doctor. If he thinks people in the ER (who typically have a reason to be cranky and in a bad mood)I wonder how he's like working at some $7/hr. job serving the public? If I were a doc it would take a whole helluva lot for me to complain about such things when they are ver minor in comparison to the workplace complaints of others.

Also, about patients demands. It's hard to see how insurors, especially, and the medical profession, too, can complain about requests or demands for specific treatment. We are bombarded ceaselessly on television by pull strategy marketing, mostly pharmaceuticals, but nevertheless they tell you to ask your doctor for _fill in the bland_. It's all around us.

First, reality check - if I got to a hardware store, a "commercial venture", and demand a sandwich or anything not obviously a hardware supply, I won't get any sympathy. I may get some help if I ask for something out of the ordinary, but to a limit. And the prices are quite will laid out, so I know what I'm paying, they know what they're selling for. With health care and hospital ER rooms, this is entirely opaque. No one who goes in knows what the operating costs are, what's picked up by insurance and government, how non-critical demands affect resources for critical ones, etc.

Second, the complete non-recognition of the ER physician as a human I see here is pretty sad. Most physicians didn't join up thinking, "I want to become a tool of the pharmo-medical complex" - they got into the field to help people. The pay-to-investment ratio (time and money) isn't terribly high vs. someone who went into banking and finance say.

Third, I have an idea that letters to the Review Board will come back to haunt physicians - the fear of malpractice lawsuits etc. have everyone erring on the conservative side, so sticking up for an employee is not as likely.

Fourth, the idea that the MD would complain if those sniffles got worse or dismissing his observations because of differences in personal tolerance? Hmmm, sounds like we're back to entitlement - treat me now, my tolerance level is programmed for immediate gratification/relief/reward.

Fifth, the physician specifically mentioned people requesting treatments that don't work, that aren't suitable for their ailment, that they need some placebo treatment out of the system, is dismissed. He/she's not talking about someone with a thumb twisted out 80 degrees or a bullet wound or seriously ill. And no one in these 2 threads discusses the horrible drain on resources that makes it harder to handle the truly emergency. That we have a screwed up medical system and people without insurance go to ER for trifles is laid at the physician's feet - "Suck it up, doc".

I could toss the same kind of arguments out about a school teacher - "suck it up, teach, I pay my taxes, I don't care if your classes are overcrowded, unions are making money and the education business is a racket, and I can't afford to stay home and babysit Susie with the sniffles so of course I'll send her to school with a 103 temperature, and how come she's not on the honor roll this semester, where'd you learn to teach anyway, K-Mart?"

Entitlement. Grab the nearest person with a name tag, whatever their position is, and demand they help you now. It's the American way. You paid for it, or at least someone will, however much it costs.