ER Ethics

I’m running back and forth to the Alexandria hospital’s Emergency Room today (don’t ask why). It’s been at least 6 months since the last unpleasant visit, and something new has been added in the check-in area. It is a large sign warning that “aggressive, threatening or inappropriate conduct or language” will not be tolerated, and may result in refusals to offer treatment.

It was immediately evident why the hospital felt such a threat was necessary. The place was a disaster. It was obviously understaffed, and the staff members that were there were rude, distracted, slow and harried. I watched a 90-year old woman stand at the check-in window as the woman behind it left without explanation abandoning the potential patient who was literally whimpering as the minutes ticked by. “At least there’s no emergency,” I said to the angry lady. She was not amused.

As with so many other places in which professional, timely service is expected and once, before the pandemic gave them an excuse to go with skeleton staffing, was delivered, the ER was lowering its standards and telling people that they could like it or lump it, but they had better not complain or express frustration.

And life in the USA gets just a little bit shittier.

10 thoughts on “ER Ethics

  1. Signs like that have been the norm in municipal court in NJ for at least two decades, maybe three. Initially they were phrased “We did NOT park the car. We did NOT drive the car. We did NOT write the ticket. We will NOT take any abuse!” Later the last line was walked back to, “and we really do not deserve any abuse.” Especially in the cities and lower income areas (although not exclusively, wealthy area Karens were just as bad but in a different way), people coming into court, where they didn’t want to be, to fight or pay a ticket they didn’t think they deserved, often with bad consequences beyond a simple fine (suspensions, insurance surcharges), wouldn’t hesitate to tell court staff exactly what they thought of the system or of them. Occasionally you’d get some idiot who thought he could bully or intimidate his way out of a ticket, or some day-drinking Karen who would start screaming and shoving, but those folks almost inevitably ended up in the clink, having made a bad thing that much worse. Warnings against loutish behavior are also common in movie theaters, airports, train and bus stations, banks, and even libraries. I even remember seeing warnings in toy stores, when they still existed, warning that parents who failed to control their children would be asked to leave.

    The fact is that some people just don’t handle getting bad news, being told they have to wait, or being told “no” very well. It was already becoming an issue when rising standards of living allowed you to add water and get a drink or a meal immediately, turn on tv and get news instantly, or flash a card and get money instantly. Now we have instant communication, instant meals delivered by grubhub, instant groceries paid for by app and brought out to your car, instant almost anything delivered within 24-48 hours at the click of a mouse. We were getting spoiled. However, this was also cutting into the profits of those delivering these good or services. More goes into the profit column if you cut back on your numbers, cut back on your service, and blame “supply chain issues” or the pandemic, and maybe some customers will just shut up and deal with it if you tell them that they are acting spoiled if they press for their Peloton or HD camera lens to get here, already. The same attitude has presumably leached into health care providers, who will try to proactively intimidate patients into keeping their mouths shut and dealing with it rather than be sent home with no relief for that intense case of poison ivy that destroys their ability to concentrate, or that painful ear infection that keeps them awake, or that stubborn cold and cough that just will. not. go. away.

    I think “quiet quitting” also plays into it, as those still on the job see raises slow down or stop and benefits cut, although they’re doing the same damn work they were doing before, and in some cases more because no one seems to want to work and that desk next to them is still empty. Why should they go above and beyond or hustle when it’s not benefitting them even a little? Heck, why should they even try to turn square corners when cutting one here and there won’t change much?

    Yep, life in this country is getting crappier in many ways. The fact is, though, that those in charge really don’t care if life is crappy for ordinary people. After all, ordinary people should show gratitude that they took care of this pandemic, even if the general standard of living isn’t quite what it was in 2019. We ordinary folks will just have to learn to be satisfied with less. Just remember to vote blue in a month and keep those nasty neo-Nazis from returning to power.

    • Very well thought out Steve and you are probably correct. However, there needs to be some pushback from consumers of services when service is poor. Going about it half-cocked in a loud and boorish manner is not the way to do it.

      A very public and appropriate rebuke of the organization in question will not have an immediate effect but it can cause others to add their voices. As the amplitude of the voices grows it gets management’s attention. Changing service levels in huge bureaucratic organizations is like turning an aircraft carrier around; it takes a long time and a constant push. Nonetheless, it can be done. When the hospital does a fundraiser make a point to publicly denounce the level of service and suggest people not contribute until changes are made. Another option if your hospital is planning an expansion, be at the public hearings that are held or send letters to the regulators voicing your opposition until services improve. Theoretically, if the hospital cannot afford enough staff to deliver quality and timely service any expansion will cause existing services to deteriorate faster as resources will flow away from its core mission.

      Unfortunately, the very reasons you cited are what will stop the public from effectuating change in these bureaucracies because they want immediate results from a single complaint. To be effective, a single complaint is but a mere snowflake but when a long building blanket of snow lets loose the avalanche has considerable power to change the landscape. In short, if you want change be prepared to work for it.

    • From my indirect observation, based on my fiance who currently works at a hospital as a phlebotomist and is about to change careers, a bigger issue than quiet quitting is actual quitting due to bad upper management, bullshit bureaucracy, and ever increasing workloads. They lost 3 phlebotomists at once, and management only let them hire one replacement. They had previously downsized the lab tech who handled some test tube spinning and such, and made a regular phlebotomist take over, now they all have to do it, because phlebotomists in small practices have to do it, therefore it’s ok to make them do it in a big hospital instead of paying more for increased duties. . They did stop doing the medical billing they never should have bee involved in at least. They still need to fight with doctors who refuse to follow guidelines on tests and how they enter and date them, and several of the doctors have quit recently. Burnout is rampant.

      • There’s something here. I am seeing an increasing amount of online chatter from people who claimed to have applied at places advertising as hiring but are never called back. Call it a conspiracy theory, but there may be a justified reason to believe that businesses are using the shorthandedness to their benefit by not hiring sufficient employees to replace the ones that have left only to shift the increased burden on the remaining employees who are quickly overwhelmed. The ready-made excuse – “Everybody’s shorthanded – seems to be tailor-made to those who don’t mind that their customers have to wait and their employees are burning out rapidly.

    • Add what has to be severely inaccurate labor force participation stats. There are still too many short-staffed employers publicly offering elevated pay scales for even low and unskilled workers for the official numbers to be accurate. Where are all the people who used to be in these jobs, pre-epidemic? Not THAT many died from it (or even from fentanyl overdoses).

  2. I am not being hyperbolic when I say I would rather die than try to get medical care from a hospital’s Emergency Room.
    I hope whomever is causing you to go to the ER gets well soon, as going to the ER for medical treatment is possibly worse than doing nothing until an urgent care facility opens.

  3. Jack wrote, “And life in the USA gets just a little bit shittier.”

    There is going to be a huge crisis in healthcare as baby boomers that have worked in health care for 30-50 years mass exodus retire. There’s not enough upcoming students in the health care education fields to actually fill the retiring positions plus, and this is a very big point, the quality of the students that are coming straight out of their education and into the healthcare professions don’t have any work ethics, their participation trophy kids that don’t know how to work hard, they’re snowflakes that can’t take any professional criticism, they have no commitment to sticking in any job and all these things cause the upcoming generation to jump from job to job because they’re basically lazy. There is a big difference between the upcoming generation and the last couple of generations. All this is happening at the worst possible time as the population continues to grow and that population needs healthcare, there is an influx of millions of illegal immigrants (and more on the way) that add to the population needing healthcare, and the number of retiring people needing geriatric health care is going to go through the freaking roof as the baby boomers age. We are heading straight for a massive healthcare tsunami and we only have 16 foot bass boats to rescue all the people. If you think healthcare is expensive right now, wait a couple of years when they have to start offering exorbitant salaries to attract and retain competent people for healthcare positions. The same kind of thing is going to happen all across the USA in healthcare, engineering, architecture, police, plumbing, electrical, building, repair services, etc, etc.

    There are so many signs that show us the shitty and expensive side of our future if nothing effective is done to improve the current trends. Remember when things are really, really shitty socially and culturally that’s when we will be the most vulnerable to being dominated by totalitarians. Totalitarians intentionally make everything shitty, then they blame everyone else and then they step in and offer to take over everything as rescuing heroes when they’re actually the evil villain’s that wanted the whole thing to turn shitty.

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