Dr. Douchebag

I dropped this article off on the desk of one of my medical partners the other day. I first got wind of it via Kevin Pho at KevinMD.com. My partner came in to my office and with an awkward expression and asked if it was a joke. It wasn't. The article came from a throwaway called Emergency Medicine News. Recently, we met up with one of our former partners who went from family medicine to emergency medicine. He is a board certified FP and in the past couple years has worked his way up to the ER director. He was put off by this article as well and he has experience in both worlds. Here is just some of the comments made by Dr. Jonathan Glauser:

• Say what? Fund physicians to promote primary care? Why throw good money after bad? If ever there was a group that has failed in providing care, it is our primary care system. To fund such a venture for groups that are singularly inept at performing anything of value to society is pure folly and a waste of precious health care dollars.

• Or how about having the diagnostic and therapeutic skills to intervene in some way when the acutely ill patient does show up? Or caring for patients regardless of their ability to pay.

• How could we as physicians ever allow a doctor to call himself primary care when he can't manage simple chronic illness, cannot definitively treat acute illness or injury, often has no skills to save lives and no access to equipment if he had the skills, and does not even see patients at their own (the customers') convenience?
  

• I would posit that many of the failures of our health care system are exactly the failures of and by the primary care system

Now, I have been accused of being harsh in my comments before. Usually what I write is tongue-in-cheek but I know every joke starts with a kernel of truth. In other words, I understand what I write can hit hard or even be hurtful. I don't take that responsibility lightly and usually hold back on a lot of things I say (scary). Dr. Glauser, however, is just an idiot. He reminds me of Douglas Neidermeyer from Animal House: "You're all worthless and weak. Now drop and give me twenty". He calls primary docs failures, worthless, valueless and inept. I am blown away by this. The problem is that he rants without giving evidence. He uses anecdotal examples of primary care doctors sending patients to the ER for ridiculous complaints. The funny thing is that I could go on and on with similar examples. I have been called to come to the ER in the middle of the night for :

• a patient with an INR of 6 and the ER doc hasn't even attempted using vit K


• a young paraplegic drug seeker who does not want to go back to the nursing home because everyone there is old


• "intractable" back pain in a young person with a normal MRI who has been sleeping comfortably in the ER

Do the above examples mean that all ER docs are idiots? No. Okay, some of them are but there are always a few bad apples in every specialty. The point is that Glauser is clueless. I agree that the re-branding of primary care into "medical homes" is ludicrous and just fluff but to say we are not needed is just plain moronic. He wants patients to be seen in a timely manner so that they don't come to the ER. We want to see them in a timely manner as well. I personally keep 12 acute visits open each day to accomplish this. Is it possible that patients go to the ER on their own volition? Is it possible that I still get filled up and can't fit anymore in? Is it possible that there is a shortage of primary care doctors and that's why these patients roll into the ER? Is it possible that some patients have been triaged appropriately to wait a day or two for their not-so-acute illness yet decide on their own to go the ER only to find out that we were right? It is like Glauser is a bitter, burned out doctor who is just mad at the world because he focuses on the few negative things he sees. His pomposity is outrageous. Wait a minute, he is Douglas Neidermeyer.

Here is the worst part. Dr. Glauser is an assistant professor of medicine at Case Western Reserve University and attending staff faculty in emergency medicine at the Cleveland Clinic Foundation in Cleveland. Oh my god! This guy is teaching students! I wonder if he is helping to promote primary care? Not.

For all his ridiculous comments and hateful statements, I, the King of Medicine, dub Jonathan Glauser M.D. as Dr. Douchebag. So let it be written. So let it be done. As for us primary care docs, I say "let my people go".