Do you share the same respect for airline pilots, bus drivers, crane operators and all of the other occupations that can kill multiple people through inattention or ignorance?

I do respect those people, but the comparison to my profession is ludicrous.

Here's what happened just today at work for me:

Before noon, I received two patients in septic shock. Both required intubation and central lines. One required a chest tube. Early in the afternoon I had my finger directly compressing a carotid artery that was spraying across the room as my staff tried to call in the vascular surgeon. Around 1800 PM I got a rapid GI bleeder who died spilling blood out both ends. Because it happened within 24 hours of an admission, the medical examiner had to be involved. She was young. One other existing patient in the ICU died of septic shock around 2000. I stayed until well past midnight talking to families, putting out fires, dealing with loose ends and spending time with the floor residents to make sure they know how to handle events like this without having a breakdown (not that I've figured it out yet). I just got home and will have to go back in about 5 hours from now and face who-knows-what. My friend, a neurosurgeon, is still in the neuro-ICU at this hour (it's about 0100 local time). Oh and flu season is coming up; that's when shit really hits the fan.

I realize that isn't a typical day for most doctors (nor is it a routine day for me; but not a rare one either), but it is demeaning to suggest that the emotional impact of this kind of work or the relationships developed therein could be even remotely comparable to that of an airline pilot with his/her passengers.

Oh, and I don't get paid a dime extra for being there 18 hours and assuming a bunch of extra risk. If the patient who's neck bled all over after surgery at another hospital decides to sue, I'll get added to the lawsuit, even though we saved his life.

My point is not to demand "respect" or elevate myself above anyone else; I come from a pretty humble family and stayed that way for the most part. I simply don't think anybody has a comparable work environment, especially the emotional side, which is very hard to describe to other people.

As for the parent post: opioid prescribing is complicated and is going to get worse as our "performance" becomes tied to patient satisfaction surveys. Won't affect me much, but will be a very difficult balance for primary care doctors.

Paramedics/first responders save lives too, in scenes just as dramatic or more as yours. Is being a paramedic 'high status'? No it's not. Look I'm not here to tell you or anyone anything about how useful or stressful their jobs are; hell I mean I sit at a desk all day writimg code that'll be run by 10 people ever if I'm lucky. What I'm saying is that status doesn't depend on any of that, or on how hard you work, or on how hard you studied. I'm not making any claims about whether that's right or not either, just describing reality.

Or how about this - does your boss still do the things you describe? If your hospital is medium sized or bigger, he spends half his day pushing paper and the other half controlling petty infighting between the surgeons. Yet is his job lower status than yours? Would getting his job, for you, be a demotion or a promotion? Seems to me the answers are pretty obvious.

My hat goes off to you for working so hard and being so dedicated. It sounds like you had an awful day, and I'm sorry.

Please dont take this as criticism, because I respect everything you do. But consider this:

> I don't get paid a dime extra for being there 18 hours

Why do you have to be there for 18 hours ? What if medical school weren't so difficult to get into, that there were enough doctors for each of you to work 4 hour shifts ? You could then do 4 hours of intense-pressure, saving lives. An hour lunch break, return and do 4 hours of paperwork/damage control, etc. Then go home and relax like everyone else ?

For the amount of money those patients are being charged ($10k+ per night in ICU), there's adequate money going around to hire 5 more of you to allow 6 separate 4-hr shifts of trauma coverage.

I dont know where the bottleneck is. But I'm concerned that there's an artificial scarcity somewhere, perhaps in medical school. Perhaps in the board certification. Maybe there shouldn't be a 15-year educational requirement ? Maybe a nurse with 6 years' experience could be qualified for a "micro-practice" in a limited capacity ? No, not a PA (see, now we're dealing with status/prestige ), a doctor, responsible for pt's for 4 hours/day.

I dont know where the problem is, but maybe we are just over-regulated ? We put so much care into making sure the wrong people dont get in, that now we're overworking those who do get in. In that 18 hour shift you described, do you really think you are as alert at the end of the day as you were that morning ? Overworking people undoubtedly leads to lower quality, and a there has to be a breaking point where it's going to be better to let more people in than it is to burn out the few people who do make it past the barriers.

That's a lot of sepsis. How much of that was acquired during the stay in the hospital, one wonders?

How effective can you actually be pulling 18 hour days?

I appreciate that you feel like a hero, but everywhere else in the civilized professional world we've learned that keeping such hours and being in permanent firefighting mode leads to sloppiness and inefficiency.

Then again, when we're sloppy and inefficient, we don't kill anyone.

(I've worked on software for use in ICU and other clinical environments, and frankly am utterly unimpressed at the systems doctors and administrators allow to persist at the expense of patients so that they can either feel like heroes or retain talent.)

> My point is not to demand "respect" or elevate myself above anyone else; I come from a pretty humble family and stayed that way for the most part.

I think you can demand "respect". It's not about being humble.

Ask someone who served in Iraq about his time there, it would make your day look like puppies and sunshine. Should we defer to jarheads on all matters of domestic policy?

You don't think ICU nurses or PAs (especially at big hospitals) have a comparable work environment?

What causes that kind of rapid GI bleeding?

Almost certainly an ulcer in the stomach or duodenum, especially given her medication use. If the ulcer erodes an artery, it can be catastrophic. Just not common to see it someone as young as she was. About 5-10% of "lower" GI bleeds are actually rapid upper GI bleeds. Easy to miss.

Yikes. What medications are known to have this side effect and what early warning symptoms of it can one heed?