About Doc's but certainly applies to PAs as well

[ventana]

https://www.washingtonpost.com/national/health-science/dinner-party-diagnosis-the-occupational-hazard-of-being-a-doctor/2016/08/29/6e34e1f2-5fd7-11e6-8e45-477372e89d78_story.html?wpisrc=nl_rainbow&wpmm=1

 

(SÉBASTIEN THIBAULT FOR THE WASHINGTON POST)

By Caroline Wellbery August 29

T here’s not a doctor on this planet who hasn’t given out free medical advice to family, friends and even total strangers. It’s happened to me twice just as I’d arrived in a foreign country. The first time, after a passport control officer asked me what my job was and I’d responded, “I’m a physician,” he launched into a query about his arthritic hip. The second time, a uniformed young man suspended his passport stamp in midair, asking: “Oh, you’re a doctor? If a pregnancy test is negative, how long do you have to wait to be absolutely sure there’s no baby?” ¶ Usually, doctors are happy to help out in such situations. But that’s not always the whole story. Here’s what’s actually going on in the doctor’s mind when people ask for informal advice.Mary Kiehl, an internist at Washington University in St. Louis, says that giving casual consultations is part of her social obligation. In a way, she says, it’s payback for the privilege of being a doctor. “I am so grateful to have received a wonderful public education in the state of California — thanks to the taxpayers of my home state. As trainees, we’re the recipients of tremendous time, effort and resources. I think that privilege brings with it an obligation to be generous. If someone wants me to listen to their medical problem, I’m almost always happy to do it.”

Yalda Jabbarpour, a family physician at Georgetown University Medical Center, puts it more bluntly: “As a doctor, you’re always on.”

Truthfully, there are times doctors don’t want to be on. The reasons can vary.

I remember in medical school when one of our professors, a well-known dermatologist, described the challenges of being a skin doctor at a cocktail party. Everyone always seemed to have a blister, bump or bruise they’d want him to look at. One man turned around and pulled down the back of his pants to reveal a rash at the top of his gluteal cleft.

“What do you think, doc?” he asked. The dermatologist knew right away what the problem was. “That’s herpes,” he said, embarrassed — but maybe not as much as the man who’d asked.

 

CONTENT FROM CSXHeads up: Why civic engagement matters

A better tomorrow is contingent upon our involvement today.

 

Ranit Mishori, a colleague of mine at Georgetown University School of Medicine, describes a group hiking trip she recently took in the Alps. On learning she was a doctor, one of her fellow hikers launched into the details of his medical saga for the better part of an hour. He had weakness that turned out to be a viral infection, but it hadn’t been diagnosed until he’d been to three specialists, each of whom performed a slew of sophisticated tests. And that was it — one hour of Mishori’s vacation spent in medical consultation for no discernible reason.

Understandably, patients find their experiences with illness infinitely interesting, but they can be all too commonplace to the physician, who has seen similar cases hundreds of times. Paradoxically, the last thing we physicians would wish on our friends is that they be an “interesting case.” An interesting case is usually one that is unsolvable or, worse, suggests a serious or even fatal condition.

[The best of Washington Post’s Medical Mysteries]

So, yes, when we hear about some bowel symptoms or excruciating dental work (the details of which we are often treated to even though we aren’t dentists), we are much relieved to know the humdrum nature of the experience but equally relieved when the story is finally brought to a conclusion.

Being “on” at all times can also mean being available in other, more dire ways. It’s not unusual for doctors to have to respond to public emergencies. Many doctors will sheepishly admit that when they are on a plane heading to some well-earned beach time, they cringe when the flight attendant calls for a doctor.

Mishori, a family medicine doctor, tells the story of just such an experience as she and her husband were flying over the Caribbean. Responding to a request for a doctor, she headed nervously toward the back of the cabin, not knowing what dramatic maneuvers she might have to perform. So she was quite happy to see another doctor already at the scene. Unfortunately, that doctor was just as relieved to see her. “What kind of doctor are you? I’m just a psychiatrist!” he said.

Helping out in an emergency isn’t really a choice. We do it even if we don’t feel well equipped to pitch in. Kiehl recalls being at the scene of a traffic accident where several people were already dead, including one of the drivers, a woman whose skull had cracked open on impact. While Kiehl was tending to the woman’s husband, he kept shouting at her: Why wasn’t she treating his wife? The memory of that agonized plea haunted her for months. But another time, while cheering on friends at a marathon, she performed CPR on a runner who’d had a heart attack, saving his life.

 

Mostly, though, the medical situations doctors deal with outside their routine settings are low in drama. I’ve often checked the ears of my neighbors’ kids when their parents were worried about colds. Not too long ago, I examined a neighbor with Parkinson’s to help diagnose his abdominal pain. (My suspicion that his problem was caused by constipation spared him an emergency room visit.)

Another time, I went over to a neighbor’s with a scalpel blade to help “Grandpa” with a nail infection. I drained the pus that was gathering around the nail of his index finger. The next day, he stopped by and showed me his finger, bending the top part down so it looked like a stump. “Look,” he joked, “it fell off.” In fact, his infection was healing well.

The possibility of a bad outcome is certainly a liability when treating people outside the office. But most of what patients want isn’t treatment; often they’re just looking for a sympathetic ear.

That’s why giving friends and family advice isn’t a burden, according to Kiehl. “It’s less of a burden to me than actually caring for my own patients; I don’t assume responsibility for the issue. I just listen and offer gentle guidance, reassurance or empathy.” With patients in your office, you have to follow up. You’re responsible. But when you’re just another guest at a Fourth of July picnic, all you’re being asked for is supportive conversation. “It’s the rare person who expects to approach me casually for a definitive diagnosis or treatment,” Kiehl says. “And that’s not something I can provide in a social context.”

If anyone needs proof that we’re happy to offer advice freely, here’s this: We don’t ask for anything back. Of course, sometimes people find ways of expressing their gratitude. “Grandpa,” the neighbor I treated for a finger infection, showed up again a few days after his nail had healed, carrying a brush and a can and a roll of some sort of vinyl. It turned out he’d come to repair the linoleum in my kitchen. In fact, he’d never been in my kitchen, but word must have gotten around that there was a tear in my floor. And he fixed it so perfectly, you couldn’t see it had ever been ripped.

You never know where gratitude will show up. When Kiehl performed CPR on the marathon runner, the police deliberately chose not to include the doctor’s name in their report. They were respecting the “good Samaritan” concept that bystanders who are trying to help in an emergency should be protected from legal action if anything goes awry. So when the ambulance came for the man whose life she’d saved, Kiehl never expected him to contact her. But he always wanted to tell her how grateful he was. One day while buying sneakers (he was up and running again), he told his story to a saleswoman at the store. It so happened that she’d heard about his resuscitation from a friend. “Oh, I know who you mean,” she said. “That’s Dr. Kiehl!” And so the man was able to write the doctor a letter and thank her.

Those are the sorts of outcomes of our off-duty existence that we doctors find particularly gratifying.

But there are certain informal patients who can make my physician colleagues uncomfortable:

● Someone who is angry about an interaction with a doctor or a poor outcome and wants us to confirm they received poor care.

● Related to this, people who tell us things that reveal other doctors’ errors or problems in the health-care system.

● People who want a firm second opinion off the cuff.

● People who pick an indelicate time or place for the conversation.

● People who are involved in a lawsuit and want to draw us into their dispute.

● Friends and relatives who send texts with pictures of weird lesions from indecipherable body parts.

Most doctors agree that if all a person wants to do is fascinate us with the sordid details of their seemingly interesting story, they should keep it to themselves. In such situations, we have little concrete help to offer.

On the other hand, if patients want some direction on what to do about a symptom or illness, most of us welcome their inquiries. Especially if someone wants:

● Advice on whether they need to check in with their doctor or whether they can just ride out their symptoms.

● Clarification about something their doctor told them or about a medicine they are taking.

● Ideas for home remedies for minor problems.

● A little TLC for self or family.

Within reason, we’ll even take a peek at a rash or inside an ear, as long as the requesting individual is prepared to get what they asked for: our honest opinion.

Read More:

Doctors dismissed his pain as migraines. Then they said he had 24 hours to live

Years of mysterious ailments had her feeling like ‘an alien had invaded my body.” A primary care doc finally figured it out.

[mgriffiths]

I'm currently a PA student (graduating in just a few months!!) and can say that this is already happening.  Even when people don't know what a PA is, as soon as I tell them it's, "Oh, you're like a doctor, well I've been having this...."  I enjoy it, but can definitely see how after many, many, many, many years/encounters it can get exhausting...but I agree that it is or social duty.

[Maverick87]

Not to be a Debbie downer (or overly paranoid), but there's potential liability in giving off the cuff advice.

 

Unless the person is a good friend or family member, when asked, I say simply "There's no way I could answer that since I don't know your history. Follow up with your PCP."

 

I know someone that was named in a lawsuit for giving this kind of advice.

[True Anomaly]

The paradox to me is that while doctors are expected by society to provide good advice when not working/on duty, a lawyer isn't.

[moestown1016]

Such a fine line. Once I started working in emergency medicine some of the more common ailments weren't as big a deal to me (previously in cardio). Now if my family member has sinusitis, simple laceration or lumbar strain I give them the same care I would give someone else that walked into my department (except for controlled meds of course). I love being able to help friends out that maybe don't have great insurance (or no insurance) and just by knowing what questions to ask or in which way to direct them I've helped move them along in the right direction. Like a friend of mine had what sounded like benign vertigo. I called a vestibular clinic and asked what they charged for self pay patients and a therapist talked to me and then was willing to discuss it with my friend who was close to going to the ER on her own. Saved her like $500 just by going through me she found out who she needed to talk to. These are just examples and no need to go through the ins and outs of every situation. I try and always give everyone a disclaimer and I've advised "go to the ER" as well.

 

Example: my mother to me "granny is having epigastric pain and shortness of breath should we give her an antacid or ibuprofen". Insert eye roll. Omg go to the ER.

 

I've also been abused in this way. I was working my part time job at a cardiac stress lab and one of the nurses was friends with another person from another department and she tried to rope me into their conversation about how he wasn't feeling well and all his bp meds. I don't know him from Adam. I sent them a few "hmmmms" and "not sures" his way and agreed he should probably called his doctor. Fast forward an hour. I was called in to another test. I saw someone walking on a treadmill so I went into the room. Wrong room. The newly graduated RN had taken her friend and coworker from another department who was experiencing high blood pressure and now chest pain and put him on the treadmill for her own stress test. Guess she figured she could save him some steps. Soon as I walked in the room and realized what was going on I knew I was liable. I asked him a few questions. He mentioned brugada. He mentioned his cardiologist. I saw EKG changes. Yes he was still having chest pain. I stopped the stress test and he questioned me why I stopped it. I told him "you're having chest pain. I see EKG changes. I am not comfortable with this. If you are still having chest pain go check into the ER" then I looked at the nurse who by then knew I was madder than a hatter and said "and if you want you can go show one of the cardiologists his ekg". So in essence I feel like I took all of the responsibility off of myself and put it back on both of them.

 

Didn't want her fired because she is truly just a very much naive very very caring person so I reported the situation on to someone full time that realized the implication and fragility of the situation and took care of it. Next time we worked together she profusely apologized and we don't talk about it any more. I told her we were fine and that I didn't the she realize she was risking both of our licenses.

 

Word vomit. I'm still a little upset I guess haha

 

 

Sent from my iPhone using Tapatalk

[ventana]

The paradox to me is that while doctors are expected by society to provide good advice when not working/on duty, a lawyer isn't.

 

yup this mentality has got to go away...

 

no longer are we the small town health provider "doc"

 

We are moving towards a more defined employment situation, and when we are "off" we should be "off" except for emergencies ie in flight...

[rev ronin]

We are moving towards a more defined employment situation, and when we are "off" we should be "off" except for emergencies ie in flight...

... And in those emergencies, we should be compensated appropriately and fairly.

[sk732]

Party and social curbside consults will stop when people start looking at the person concerned and say "Since I'm liable for any advice I give you, and I'm off work and I don't work for free - my after hours per patient rate is $XYZ.  Would you like to continue this conversation in private?"  I'm willing to bet most lawyers would do the same or give them a card and tell them to drop by for an appointment since they'd consider it billable time...for some reason we get the four headed alien look when we do that.  I used to hate that when I worked in a small town - I'd say Hi to someone in the store on my lunch hour or somewhere and make the mistake of saying "How's it going?" - and the whole Monty Python head empties all over, despite being around people that can hear everything...I now never use the line "How's it going?" to people that might have remotely been patients of mine in public.  This little town in particular was bad, but people in general these days don't understand boundaries about this sort of thing and sometimes need that "Look, this isn't the time or place - book in and we can talk about this in the office". 

 

SK

[LT_Oneal_PAC]

Not that I'm against being fairly compensated, but I never thought I would see the day when healthcare professionals would say they want to be more like lawyers. The statement leaves a bad taste in my mouth.

[newton9686]

This is why my favorite professor constantly says don't work where you live. You are less likely to get hit up for free medical advice when no one knows you are a medical professional.

[BruceBanner]

I have a different view than the author. Every other licensed professional on this planet charges for their time and services. And so should we.

 

I'm not talking about the duty to act in a medical emergency, but for routine social 'consults', we are under no obligation to either A) listen to the whole story, or B) offer advice or treatment.

 

The thing is, people dont value free advice or services as much as paid advice and services. They are less likely to take it seriously, and they learn to expect this of you and other professionals in the future. It's like "oh a doctor/PA? let me just take some of your free time without your consent and get some free advice".

 

No. Not only is it inconsiderate, but it's also a potential liability. Do you prescribe to your friends and family? Occasionally maybe, but many here on this forum admittedly wont even consider an out of clinic Rx. So I think you should treat medical advice the same way.

 

If I am not comfortable with the concern or if I just dont want to listen to someone's problem when I'm not at work, I tell them "see your PCP", or "you are welcome to come see me in clinic for an appointment". And you known what, they almost never do.

[sk732]

Not that I'm against being fairly compensated, but I never thought I would see the day when healthcare professionals would say they want to be more like lawyers. The statement leaves a bad taste in my mouth.

 

I look at things this way - anything remotely resembling advice beyond "Go see your family doctor" leaves you liable.  As such, you should be ensuring you document this conversation, etc, which, if it's on MY time, is now considered billable.  If I give out advice at work, I'm being paid to be there and it's not MY time that's being utilized...and I know for certain my liability insurance covers me.  As much as I feel there should be a separate and special circle in Dante's Inferno for lawyers, I would be willing to bet any "advice" they give will be on billable time...unless they belong to a religion that insists on "x" amounts of charity hours or dollars in a given time frame.  There is no reason why, as a professional, we shouldn't be compensated for advice given when off the clock, since that advice is now on OUR "ME" time...I only work for free in situations that are "Good Samaritan" in nature.  It's why I work ER only now (except my military Reserve job) - I go to work and go home at the end of shift.  If I'm asked to do overtime, I'm renumerated for that.  Work never ends in family med, and I wasn't being recompensed for time above and beyond my 8 hour day.  My "me time" is pretty important to me these days, so I don't want to be doling out "free" advice when I'm in the grocery store or whatever.  I honestly think it's rude that people seem to feel that it's ok to accost you like that.  Goes back to clinical/ethical boundaries which have to be set and maintained by us, since a lot of the population don't understand their necessity and are quite happy pole vault over them.

 

There was an interesting talk on EM-Rap last month about work life balance...pity this didn't come up in it.

 

$0.02 Cdn

 

SK

[LT_Oneal_PAC]

I look at things this way - anything remotely resembling advice beyond "Go see your family doctor" leaves you liable. As such, you should be ensuring you document this conversation, etc, which, if it's on MY time, is now considered billable. If I give out advice at work, I'm being paid to be there and it's not MY time that's being utilized...and I know for certain my liability insurance covers me. As much as I feel there should be a separate and special circle in Dante's Inferno for lawyers, I would be willing to bet any "advice" they give will be on billable time...unless they belong to a religion that insists on "x" amounts of charity hours or dollars in a given time frame. There is no reason why, as a professional, we shouldn't be compensated for advice given when off the clock, since that advice is now on OUR "ME" time...I only work for free in situations that are "Good Samaritan" in nature. It's why I work ER only now (except my military Reserve job) - I go to work and go home at the end of shift. If I'm asked to do overtime, I'm renumerated for that. Work never ends in family med, and I wasn't being recompensed for time above and beyond my 8 hour day. My "me time" is pretty important to me these days, so I don't want to be doling out "free" advice when I'm in the grocery store or whatever. I honestly think it's rude that people seem to feel that it's ok to accost you like that. Goes back to clinical/ethical boundaries which have to be set and maintained by us, since a lot of the population don't understand their necessity and are quite happy pole vault over them.

 

There was an interesting talk on EM-Rap last month about work life balance...pity this didn't come up in it.

 

$0.02 Cdn

 

SK

I guess I'm just old school, small minded, or simple. I grew up in a small town where the everyone did stuff to help each other out. That went double for my father, a physician. One could make the argument he did all that nice free stuff as advertising through word of mouth so people would come to his clinic, but that was never what he related to me as the reason. Just the right thing to do in his mind. People always helped us out in return, including lawyers. In 40 years of practice he's never been sued. Despite all the free care and advice he gave, he's richer than I'll ever be. Probably because he still drives an '96 Camry.

 

I'm not saying anything about y'alls character or anything. Don't take it the wrong way about my opinion. I'm just not of the Ayn Rand persuasion and I'm not convinced that I would be happier in that mindset. I'm going to keep on doing it the small town way.

 

Now if someone was stalking me outside the subway or calling my house for free advice all the time, sure, I'll tell them to come in. I also never provide a script or anything outside the office. If we are just passing each other at the store though, I don't mind helping out.

[rev ronin]

I guess I'm just old school, small minded, or simple. I grew up in a small town where the everyone did stuff to help each other out. That went double for my father, a physician. One could make the argument he did all that nice free stuff as advertising through word of mouth so people would come to his clinic, but that was never what he related to me as the reason. Just the right thing to do in his mind. People always helped us out in return, including lawyers. In 40 years of practice he's never been sued. Despite all the free care and advice he gave, he's richer than I'll ever be. Probably because he still drives an '96 Camry.

 

I'm not saying anything about y'alls character or anything. Don't take it the wrong way about my opinion. I'm just not of the Ayn Rand persuasion and I'm not convinced that I would be happier in that mindset. I'm going to keep on doing it the small town way.

 

Now if someone was stalking me outside the subway or calling my house for free advice all the time, sure, I'll tell them to come in. I also never provide a script or anything outside the office. If we are just passing each other at the store though, I don't mind helping out.

I wish we still lived in that sort of a world.  I think it would be a lot better than what we have now.  Unfortunately, the hospital corporations and insurance providers are our employers, directly or indirectly, now, and they won't tolerate such an "inefficient" system continuing.

[Reality Check 2]

The overwhelming majority of my patients have been considerate outside of work. 

They have seen me in Home Depot- dirty, no make up, pony tail - obviously fixing something at home and have been kind and just said Hi.

 

One showed me his rash over the produce bin in a grocery store and I said - "well, we should look at that under better light in the office. I have to pick some stuff up on my lunch time. Give us a call after 1 and I'll see you" and then walked away. I didn't leave much room for discussion in that one. 

 

My best friend and her kids call me a lot and I don't mind. I am basically the kids' aunt and it comes with the territory. I won't write Rxs and she doesn't ask anymore after I gave her the state article about a PA I knew getting cited for rx'ing an inhaler to a family member. She respects that.

 

The soccer coach looks to me to hit the field if a player is really down and hopefully not one of mine.... One of the dad's on the sidelines is my former ortho partner and we tag team most things. Triage, ER or UC or RICE. We just kind of know we will be called on and err on the side of UC/ER just as we would on the phone. We have stabilized an open fracture and then EMS came to get him - out of town kid. No one has asked for our card or our name or license number.

 

I am not bothered by anything so far but wouldn't hesitate to cut someone off or speak more strongly if boundaries are crossed or I feel violated.

 

I don't want to charge anyone. I still want to be a good neighbor and have a cup of sugar or some milk if you are out.

[sk732]

I guess I'm just old school, small minded, or simple. I grew up in a small town where the everyone did stuff to help each other out. That went double for my father, a physician. One could make the argument he did all that nice free stuff as advertising through word of mouth so people would come to his clinic, but that was never what he related to me as the reason. Just the right thing to do in his mind. People always helped us out in return, including lawyers. In 40 years of practice he's never been sued. Despite all the free care and advice he gave, he's richer than I'll ever be. Probably because he still drives an '96 Camry.

 

I'm not saying anything about y'alls character or anything. Don't take it the wrong way about my opinion. I'm just not of the Ayn Rand persuasion and I'm not convinced that I would be happier in that mindset. I'm going to keep on doing it the small town way.

 

Now if someone was stalking me outside the subway or calling my house for free advice all the time, sure, I'll tell them to come in. I also never provide a script or anything outside the office. If we are just passing each other at the store though, I don't mind helping out.

 

I hear where you're coming from and I take no offence.  Just so you know where I'm coming from...I'm currently in my 31st year of service in the Canadian Forces - 23 years Regular, and 7ish Reserve.  I was a First Aid/Medical First Response volunteer in a number of communities I was posted in with the St John Ambulance Brigade, both at Provider, Supervisory and Instructional levels and used to donate a fair bit of spare time for event coverage, CPR instructional blitzes and the like.  I'm a Member of the Order of St John - an order of chivalry that dates back to the Crusades - as a direct result of working with this organization.  I was volunteer member of the Public Hospital Foundation near one of my previous postings.  I've done an awful lot for the communities I've lived in, and try to help out how and when I can.  I know and understand service.  I also know that there are times when I'm off the clock and just need to not think about work for a bit - in fact it's happening more and more these days because of how messed up our health care system is in my region right now.  I just think people are more and more rude these days when it comes to thinking my/our time off is any less valuable than their's, not to mention it's not exactly good social manners to bring up every health problem you have, fishing for what you want to hear, in a public forum. 

 

Let's look at things from a military side - a soldier wanders up to you or into the clinic outside of Sick Parade hours for a trivial thing...do you deal with it or do you deal with them?  You're at a mess dinner, where I'm sure you know there are a great number of social faux pas' that are not discussed over dinner, when someone starts off about treatment they're receiving or thinks ought to receive, fishing for something from you...how do you deal with that, since discussing work (at least in Canadian Army mess dinners, and many of the ones I've attended in the US) is strictly verboten, and this would be work in our case?

 

I'd never charge someone for advice (private billing is still technically illegal here under the Canada Health  Act, though there is a court challenge ongoing)... however, odds are I'd be more tempted now to not give out advice outside of work for a number of reasons - unable to document and ass cover, the whole thing of treating friends/family, which I'm strongly on side with, and frankly, if I'm off on a walk with the dog or going through the mall, I'd like to leave work at work.  Having had a huge issue of work/life balance in the past, I really need to leave work at work.  If someone wants upset that balance, they need to be told in no uncertain terms that they've stepped over a line - saying fees for off hours consults are $XYZ lets people know that your time is valuable and that they've crossed that social line.

 

SK

[mmiller3]

The paradox to me is that while doctors are expected by society to provide good advice when not working/on duty, a lawyer isn't.

 

I take it you don't know any attorneys.

[LT_Oneal_PAC]

I hear where you're coming from and I take no offence. Just so you know where I'm coming from...I'm currently in my 31st year of service in the Canadian Forces - 23 years Regular, and 7ish Reserve. I was a First Aid/Medical First Response volunteer in a number of communities I was posted in with the St John Ambulance Brigade, both at Provider, Supervisory and Instructional levels and used to donate a fair bit of spare time for event coverage, CPR instructional blitzes and the like. I'm a Member of the Order of St John - an order of chivalry that dates back to the Crusades - as a direct result of working with this organization. I was volunteer member of the Public Hospital Foundation near one of my previous postings. I've done an awful lot for the communities I've lived in, and try to help out how and when I can. I know and understand service. I also know that there are times when I'm off the clock and just need to not think about work for a bit - in fact it's happening more and more these days because of how messed up our health care system is in my region right now. I just think people are more and more rude these days when it comes to thinking my/our time off is any less valuable than their's, not to mention it's not exactly good social manners to bring up every health problem you have, fishing for what you want to hear, in a public forum.

 

Let's look at things from a military side - a soldier wanders up to you or into the clinic outside of Sick Parade hours for a trivial thing...do you deal with it or do you deal with them? You're at a mess dinner, where I'm sure you know there are a great number of social faux pas' that are not discussed over dinner, when someone starts off about treatment they're receiving or thinks ought to receive, fishing for something from you...how do you deal with that, since discussing work (at least in Canadian Army mess dinners, and many of the ones I've attended in the US) is strictly verboten, and this would be work in our case?

 

I'd never charge someone for advice (private billing is still technically illegal here under the Canada Health Act, though there is a court challenge ongoing)... however, odds are I'd be more tempted now to not give out advice outside of work for a number of reasons - unable to document and ass cover, the whole thing of treating friends/family, which I'm strongly on side with, and frankly, if I'm off on a walk with the dog or going through the mall, I'd like to leave work at work. Having had a huge issue of work/life balance in the past, I really need to leave work at work. If someone wants upset that balance, they need to be told in no uncertain terms that they've stepped over a line - saying fees for off hours consults are $XYZ lets people know that your time is valuable and that they've crossed that social line.

 

SK

Marines and sailors come to me outside of sick call. I deal with it then because if not I'll just be putting it off until tomorrow. If I'm outside the clinic and it's not emergent but actually needs treatment, I'll tell them my thoughts and tell them to come in during hours so I can write a note and put in a script or access the pharmacy locker. It doesn't happen often enough to bother me. At least it doesn't bother me any more than when they come into the clinic with something trivial. I do tell them they should see the corpsman first. I do that really though because of chain issues and the corpsman need to learn.

 

We aren't against discussing work at lunch and if someone wants to tell their business in public, well, that's on them.

 

I've been accused of putting my father on a pedestal, but that's the standard of what I compare my practice to. While he didn't do a full exam and work up for every sniffle and ingrown hair that someone randomly brought to him, I never saw him "off the clock." From hearing him speak about his childhood, I think he got that from his small town GP and believe that's who he emulates. It gives me a great swell of pride when I hear my patients and coworkers talk about me like I talk about my role models.

 

I will say I have the luxury of working in the military system and I don't see a dime either way. Maybe when I get out into the civilian world I'll change my tune.

[sk732]

My medical mentors were a Medical Officer and a PA who both believed in compassion AND tough love, depending on what you needed to hear from them at the time.  They were the people you wanted looking after you if your were sick, but if you were dogging it, they'd call you a malingerer to your face OR kick you in the ass if you needed assistance pulling your head out.  They'd both do this without raising their voices (well one time, the doc did raise his voice - scared the crap out of me, since he was generally a mumbler).  The tough love I've definitely carried over with me into my civilian career, as it's needed more and more these days I find.  I won't put up with people badmouthing anyone in the ER, yelling, screaming and being drama queens, etc..  I've also got no grief telling people that they might in fact be their own worst enemies and their problems won't be cured with a prescription pad but with hard work on their part...with a little help from the pad (more so when I get my "Exercise is Medicine" Rx pads).  My old family doc was a Scotsman who, though quiet and calm, didn't mince words and said what needed to be said. 

 

I try to take the good and leave out the bad of the folks I've worked for and looked up to over the years...some of the ones I made the mistake of looking up to I had to ignore totally, since they stabbed me or someone else in the back.  I tried not to put people on pedestals, since nobody is perfect...I tried to make sure I took in what I could from as many people as I could, and in turn, mentor those under me to try and make them good medics and good people.  I now have a few mini-Me's running around fixing people up the way I think they should be.

 

SK

[LT_Oneal_PAC]

My medical mentors were a Medical Officer and a PA who both believed in compassion AND tough love, depending on what you needed to hear from them at the time. They were the people you wanted looking after you if your were sick, but if you were dogging it, they'd call you a malingerer to your face OR kick you in the ass if you needed assistance pulling your head out. They'd both do this without raising their voices (well one time, the doc did raise his voice - scared the crap out of me, since he was generally a mumbler). The tough love I've definitely carried over with me into my civilian career, as it's needed more and more these days I find. I won't put up with people badmouthing anyone in the ER, yelling, screaming and being drama queens, etc.. I've also got no grief telling people that they might in fact be their own worst enemies and their problems won't be cured with a prescription pad but with hard work on their part...with a little help from the pad (more so when I get my "Exercise is Medicine" Rx pads). My old family doc was a Scotsman who, though quiet and calm, didn't mince words and said what needed to be said.

 

I try to take the good and leave out the bad of the folks I've worked for and looked up to over the years...some of the ones I made the mistake of looking up to I had to ignore totally, since they stabbed me or someone else in the back. I tried not to put people on pedestals, since nobody is perfect...I tried to make sure I took in what I could from as many people as I could, and in turn, mentor those under me to try and make them good medics and good people. I now have a few mini-Me's running around fixing people up the way I think they should be.

 

SK

Just because I give advice after hours doesn't mean I give in to malingerers and script seekers. I assure you I'm not meek.