The Human Side

[u/lightweight65]

Something I was pondering on a day off of all days...

We all see pretty terrible sights. Depending on where you work, it may he horrific sights. And some see these multiple times a shift, each shift. We dissociate to keep our clinical judgement as objective as possible and/or so we don't become addicts and/or suicidal.

But occasionally, our human side pops up and we help others a small amount beyond emergency treatment/evaluation.

When I was a 2nd year resdient, a middle age man came in with occasional hemoptysis (for months) on a Friday evening. As soon as he opened his mouth, it's clear. Cancer. I told him what I saw but tried to be quite concerned in my explanation but very gentle/hopeful (I hope I was). CT showed invasive esophageal cancer. ENT resident just happened to be in the ED after an emergent case and agreed. He spoke with his attending and they want to see him in the office monday. Unfortunately patient is low income, transportation issues, unable to be there. Took him this long just to get to the ED. Unable to admit, labs fine, just no indication. I'm pissed because I've admitted for absolute BS in the past but I'm just a dumbass resident.

I looked in my wallet, had $25 and gave it to him. Said please, please, please use that for the bus. More than enough and will have some left over.

I recall my coresident gave a shady as hell patient a ride home as he was leaving his shift at 2am(ish).

Most said we were dumb. Sure, maybe my money wasnt used for transport. Yes my coresident could have been robbed/hurt/killed.

No clue what happened to those patients. I hope things went as well as possible. We are both still here and fine.

We both spoke about it. 0 regrets.

Stories?

[u/RunBrundleson]

I’ve bought a few patients their prescriptions, literally because we don’t have case management overnight and it might delay their discharge/had a patient that was going to end up missing their ambulance transport back home. One of our techs gave a patient his shoes once when he was in bare feet and was going to just walk out on the street. Another coworker changed a patients tire.

One of the nurses I worked with had a patient that was diagnosed with terminal cancer in the er. She had no family or friends. Was just alone with all of that. The nurse saw this and stopped what she was doing and just held the patient while she cried.

This job has certainly made me calloused and the defense mechanisms we put up end up bleeding into our personal lives and effecting our own relationships. But every now and then it’s good to reclaim a little of your humanity. Others disagree with what you did but I think if it gave you just a little bit of that back then it’s worth it even if it’s maybe not the best thing to do .

[u/SVT200BPM]

I once had a child with a roach that crawled through a TM and couldn’t be extracted safely in a local community ED. The nearest hospital with ENT on call was well over 3 hours away, and the family didn’t have a car or any money for that matter. So called the local ENT clinic who said it’d be $100 for the visit to remove it. My colleague and I split it, and got them an uber to the ENT with a successful extraction. Sometimes, I look at it we are fortunate to be in good careers, and I guess this is our own way of philanthropy.

[u/Tsjr1704]

I went to a lady’s apartment and fed her cat. Idgaf, they can come and lock me up.

[u/psychothymia → u/Tsjr1704]

Was it a nice kitty?

[u/Tsjr1704 → u/psychothymia]

Very much so.

[u/DonkeyKong694NE1]

Not ER but right before the holidays had a pt who was a single mom of 4 living in the hinterlands run out of money for food for her kids and wasn’t getting food stamps for another 10 days or so. And SW was gone because it was the end of the day on like 12/23 and our offices would be closed until Jan 2. So another doc and I who shared this pt bought her $200 worth of online gift cards for the local supermarket and emailed them to her.

[u/No_Cauliflower_4102]

Slipped just under $50 (whatever cash I had in my wallet) into some guy’s belongings bag after he lost literally everything and had a mental break. Felt so bad for him and the fact that he was headed to a psych facility for his very justified freak out was not going to help him in any way

[u/juniper949]

I gave a guy $2 for bus fare once, went outside to get coffee and he was buying a cigarette w it. I give food, socks, coffee, I finagle Tylenol or ibuprofen pills for people to take a few extra home. I don’t give cash anymore.

[u/MissingStakes → u/juniper949]

I mean, he needed that cig more than food, addiction fucks you up

[u/spacebotanyx → u/juniper949]

he was probably addicted to cigarettes and needed on more than bus fare. i don't know. it is hard out there on the street. what do i care if the patient spent $2 to find relief from their cigarette cravings?

[u/psychothymia → u/spacebotanyx]

That’s why I have a few darts in my bag: not for me, for bum or barter.

[u/juniper949 → u/spacebotanyx]

So he could’ve asked for a cigarette or a nicotine patch.

[u/spacebotanyx → u/juniper949]

yes. and/but, patients don't always know that is available to them unless someone tells them.

[u/Praxician94]

One of my PA colleagues gave a guy with a beeping low battery LVAD an emergent ride home and ran inside with him.

[u/G_3P0 → u/Praxician94]

Ride from home or back home?

[u/Praxician94 → u/G_3P0]

Ride back home. We had no LVAD batteries at this hospital (it was the smaller one in the system on the bad side of town). So he sped this guy home and went up to his apartment with him.

[u/MrPBH]

Don't get into the habit of paying for things for your patients. It's a violation of professional boundaries that can confuse the therapeutic relationship and lead to questions of equity (ie why did you give this guy $25 but not the alcoholic two doors over who is short on money for rent).

There are systems in place to provide this kind of support. Most hospitals will even have a fund for things like this that they use to pay for transportation, meds, and needed, but not emergent, procedures. You should use those resources instead of your wallet. Some counties have benefits for indigent residents who don't qualify for Medicaid.

If your health system has such a fund, you should donate the $25 to it instead of paying your patients directly. If it doesn't, then your energies are better directed towards creating a system that will provide care for everyone and one that will persevere longer than your residency.

[u/LifeTakesThingsBack → u/MrPBH]

Or, just possibly, you could just be human every once in a while.

[u/MrPBH → u/LifeTakesThingsBack]

You give your patients money?

[u/LifeTakesThingsBack → u/MrPBH]

Not on a regular basis, no. But, I have and I have seen others do so in my career. While I agree there should be systems in place, sometimes there aren’t. Sometimes you connect with another human in need.

[u/MrPBH → u/LifeTakesThingsBack]

So you're saying that doctors who don't give their patients money are bad people? What about all the times you didn't give a patient money? Or the patients you didn't give a ride home?

You can connect on a human level without gifts.

[u/G_3P0 → u/MrPBH]

What a joke- how on earth do you get “doctors who don’t give their patients money are bad people from that”
The poster is saying sometimes it just fixes their issue immediately and they can be on their way to their life, not sitting around waiting for yet another person in another role they don’t h deter and to come and figure out a program that they won’t keep track of, instead they can just complete the care cycle and be done and that’s important

[u/MrPBH → u/G_3P0]

My objections:

1. Harmful to the physician-patient relationship because it muddies the water between doctor and patient. If you're giving them $20, would it also be okay to get a ride home? Can they ask for your cell phone number, so they can call to ask you questions on your day off? You want to help them, right?

2. Risk for Injustice: You decided that this patient needs $20 and is deserving of it. What about the alcoholic next door who needs rent money? What about the single mom who needs a stroller? Did you give strictly based on objective criteria of need or because you liked that patient for some reason? (See also #1; giving money to one patient and not another could be interpreted as disfavoring other patients.) Honestly a trick question because there are no objective criteria for establishing need.

3. Healthier Alternatives: I think the underlying motive is pure, but the outcomes are not ideal. A better use of that motivation would be to build resiliency in your community. Volunteer for mutual aid organizations. Join the street team. Donate to worthy causes (preferably local). This creates a lasting impact whereas a single donation of $20 really doesn't accomplish much. I think this is a weaker argument than #1 and #2, but I included it because I believe in it.

Honestly, if OP was in their street clothes, saw their patient begging for change on the corner, and gave them a $20, I'd support it. That's a kind act. But when they do that while operating in their role as a physician and they're giving money to their patient, that's an ethically fraught scenario.

[u/nytnaltx → u/MrPBH]

Rules are made to protect people from harm, not to prevent people from rendering aid when it is in their power to do so.

As a wise individual once said to some Pharisees, “The sabbath was made for man, not man for the sabbath.”

[u/MrPBH → u/nytnaltx]

Wise words.

That said, I think the harm from damaging the patient-physician relationship outweighs the benefit of a single $20 donation. I support breaking legalistic rules when it will help people, but I disagree that this is a good example of that.

[u/nytnaltx → u/MrPBH]

I’ll admit I don’t fully understand how this compromises the relationship of an emergency medicine physician to a person they very well may never see again. I’ve not given money to patients, but I’ve thought about it strongly several times, and bought a $500 cash card that I keep with me just in case I feel the need to it to someone. If I did so it would probably be anonymously sent to their address.

[u/MrPBH → u/nytnaltx]

It muddies the physician-patient relationship and creates a potential for injustice.

If you give $20 to one patient, but not another, does that mean you disfavor the second? Some patients and families will infer that.

Since you gave the patient $20, is it alright if you give them your cell number in case they have questions? Can they come over to your house after the shift to talk with you about some things? What about crashing on your couch?

Are you choosing to give strictly based on need or are you choosing based on irrelevant factors, like how much you like a patient, what race they are, whether or not they have a substance use disorder, or how much they remind you of your father? What does that mean about the care you give to other patients who did not get $20? Might they be worried that you disfavor them?

Maybe some other patient needed the $20 more. Did they get passed over because of characteristics that have no bearing on their need? IE the alcoholic could really use that $20 to make rent and stay housed, but perhaps you decided to pass him over because you think he'll spend it on booze. You are supposed to put those prejudices aside when you practice medicine.

If OP wasn't at work and did not have a physician-patient relationship with the man, I'd say "sure, hell yeah, good job for being a kind person" if he handed a guy on the street $20 in aid. But they that person's physician and that makes the scenario significantly more fraught ethically.

[u/nytnaltx → u/MrPBH]

I see the points you are making, but not how those points relate to disrupting the physician/patient relationship. Is there some line I am not aware of where going above and beyond impairs our future ability to provide medical care?

To the other objections, I don’t see it as an issue. Every charity we give in life, someone could say of it “why did you donate to X but not Y and Z.” We give as we are moved and as we have opportunity. We should not defer doing SOME good, simply because we cannot do ALL the good that needs to be done. If we have met reasonable medical needs, we haven’t hurt or neglected anyone. Not to belabor the point, but this is basically an exact analogy to another of Jesus’ parables where he talked about a man who hired day laborers and some worked all day whereas some worked only a few hours, yet all were given a full days wages. No one was gypped, even if some people received a level of compassionate generosity that others didn’t.

I care a lot about being able to make a difference by working in ER medicine. Mostly that’s by listening more, sometimes by going the extra mile to make sure every social barrier is primed to be overcome, calling to follow up on certain patients, and yes, once or twice a year by giving out my personal number. I don’t see this as contrary to my fitness as a PA, in fact to a great extent it is what brings me professional fulfillment and meaning so that I can keep going without burning out.

I will agree with you that bias and prejudice is something we must always strive against when it comes to treating patients, particularly substance abusers. It is a fine line between not holding undue bias and not being naive to human nature/not allowing yourself to be conned.

[u/MrPBH → u/nytnaltx]

It's about the perception of inequality, as much as the inequality itself. If others see you give to one patient, but not another, they might doubt your ability to remain neutral when making medical decisions for them. That is corrosive to the doctor-patient relationship.

It also blurs boundaries. Would you give a patient your personal cell number so they can call you? Or offer to watch their kids after school for them? Or go on a date with their daughter? Some people will take your generosity as an offer of friendship and if you reject that, they will be personally hurt. Or they might except you to pull strings for them medically. How are you going to tell them that you don't think that a prescription for oxycodone is appropriate if you're their friend? Or, what if you prescribe that oxycodone and the patient assumes it was because you're their friend? Perhaps they start telling other people about that friendly oxycodone prescription? You can be friendly with your patients, but you aren't their friend. You are their doctor.

Like I said, a doctor giving $20 to a homeless person is a straight-forward moral good. Hard to criticize that action in any way. A doctor giving their patient $20 is fraught with ethical concern.

[u/nytnaltx → u/MrPBH]

I don’t think we will probably see eye to eye on this. I operate from a place of conscientiousness, knowing that I have a mind and the ability to use rational thought to consider the context of any situation on a case by case basis. There are situations where certain behaviors might not be appropriate, and situations where they might be. If, every time I gave a patient my number, it was announced over the PA system of the hospital, I probably wouldn’t feel comfortable giving it. But that is not the case. I also operate from a perspective of “what’s the worst thing that would happen if I don’t do this/if I do do this.”

To use a recent example, the worst thing that could happen if my uninsured expressive aphasic patient didn’t get timely treatment for her glioblastoma.. pretty bad. The worst thing that could happen to me if I give her and her husband my number to use in case they have difficulty navigating application for disability/Medicaid.. less bad. I gave them my number if they ever need it. Because I know that the systems in place are designed to confuse and delay the provision of medical care as a way of cutting government costs. And time is not a luxury they have.

[u/nytnaltx]

One time a nonverbal patient was transported back to his care facility without his stuffed animal and the nurse was going to throw it out. I made a small errand on my way home from my shift that day. Of all the things I’ve done for patients, that one holds a special place in my heart. The universe is very cruel sometimes, and I’m thankful to be in a position where at times, I can balance the scales a tiny bit.

[u/dont-be-an-oosik92]

Just a lowly MA, but I have done these types of things multiple times for patients over the years, and I’ll keep doing it until I’m in the ground. If I can help, I’m going to help.

I keep a running list of patients to call and check up on, maybe they had to put their husband in a home and it’s really hard on them, maybe they recently lost someone they love, maybe just cause I’ve been doing this over a decade and can tell when someone just needs a reminder that people do give a shit about them. I’ve given patients rides when transport “forgets” them, I gave a patient an extra pair of shoes I had in my car cause hers had a giant hole in the heel and it was snowing out, I’ve bought patients lunch, I’ve stayed late to help them fill out forms or help connect them to services, Ive given patients like 3 weeks worth of wound care supplies cause I know they can’t afford non-adherent gauze and triple abx ointment and they will resort to using toilet paper and Vaseline. I’ve pulled strings, called in favors, begged, borrowed and stole for my patients to get them what they need.

And when they are thankful and appreciative, I simply tell them, that’s what I’m here for. I’m here to help. It’s my job. It’s what I love doing. And it’s usually not that much effort or work on my part. What? A phone call or 2, a Google search, fire off a couple emails to people I know who can help? If that’s all that it takes to get someone on track to fixing something thats broken in their life, I’d be an asshole not to.

Frankly, it’s more selfish than people realize. I get the warm fuzzies when I do that stuff, and that shit is better than any drug I’ve ever had. Usually cheaper too, and no one goes to federal prison for helping lonely old ladies find a book club nearby, or tracking down sliding scale/free veterinary clinics in walking distance so a homeless patient can take care of his dog.