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Notes -
Two case studies in government waste:
As you can likely imagine right now a lot of people in medicine are sharing tales and taking sides in the great DOGE debate. Two that popped up on my radar and stuck out to me:
Some problems: -As an emergency room most of their patients have no insurance or Medicare or Medicaid, meaning the facility often get paid less than cost. They only stay open at all because of their state grants.
-Many of the patients are drug addicts or malingering (because of homelessness for example). Every day you’ll hear something like “you’ve been here every day for the last three weeks” or “have you considered stopping using PCP? You always seem to fight with the police when you do” and “here’s your follow-up appointment, will you go? No? Fuck me? Okay thank you have a nice day.”
-Many of the patients who do actually have mental illness are in denial about it, or have some sort of limitation that prevents them from attending aftercare appointments.
-The “best” solution is probably to violate patient rights and involuntarily commit them to make someone else be on the hook for making sure they go to their aftercare.
-In the meantime, the hospital has hired several additional staff to manage some of the administrative complexities associated with this change (for example hammer calling the patients to remind them to come to the appointment). They have also hired night staff whose job is to sit in an office overnight purely to schedule appointments with an outpatient program (otherwise no patient could be discharged overnight because they wouldn’t have an appointment to go to…).
Anyway, he dutifully completed his requirements in a timely fashion (which were all pointless! Ex: what is the motto of the VA???). So, months later his rotation is starting soon. He begins the process of emailing the education team once every 2-4 business days. You have to email them multiple times before they respond. The conversation goes something like this over the course of multiple weeks, “I think I’ve completed my onboarding do I have to do anything else?” “no” “okay is my onboarding done” “no” “okay when can I pick up my ID card” “when your onboarding is done” “I thought my onboarding was done” “yes” “okay what I am waiting on” “nothing.” I have seen the emails; it really looks like this.
At this point his program tells him to CC the chief of medicine at the VA hospital, at which point the person responds with “okay we put in a ticket for this a month ago, your training is complete but your training is marked as incomplete.” A screenshot has been attached that shows the request and an automatic response that says something about high ticket volume and that they will get to it at some point. The chief of medicine replies “….does the trainee need to do anything?” (we are here).
The resident will be able to rotate but will not be able to do any work without computer access.
It’s worth noting that the VA is paying for this resident to be there, despite the fact he will in fact not be able to do anything. At his last VA rotation (yes they go through this for every resident every time) he was six weeks into an eight week rotation before he got access.
As always, American doctors have it better. In the UK, the spectrum of duties for psychiatry residents includes pigeon-control.
Now, I can easily see a British trainee ending up stuck on a placement because they haven't been signed-off to do the work, but the extent of the dysfunction would include not being paid for that month.
I thought this was the med reg's job in the UK?
Is this scope creep?!?!
You call the med reg when you want a pigeon removed from the ward. You call the psych reg when you want the pigeon removed from existence.
(With your username, you're best off avoiding the UK like the plague.)
I remember when Canary Wharf (the secondary London financial district with the skyscrapers, for Americans who don't know) hired a falconer for pigeon control duties. If you decapitate or shoot them you have to kill an awful lot of them before the problem is solved, but pigeons have an innate fear of sparrowhawks and after the first bird-on-bird nomming incident les autres are effectively encouraged.
That said, if you hang around Trafalgar Square you will probably still be fed illegally by tourists.
And here I was thinking the London banding didn't nearly account for additional cost of living, I appreciate the culinary advice!
Unfortunately that offer is only good for pigeons.
Good enough for me!
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