I have plenty of respect for the medical professions. Some of the finest peeps in our society.

That said, we waist hundreds of millions, specifically in doctors favor.

I'm informed that here in Calgary for example, that there are commonly 1.5 to 2 hour periods in the time-frame leading up to the off-going ER doctor's end of shift and his/her replacement, where not a single new patient will be seen - everyone and anyone in the waiting room will simply, wait.

This is apparently because any work the off going doctor does on you, before they hand you over to the incoming doctor, goes unpaid; it's the new oncoming doctor that will be paid the fee for your assessment/treatment. Essentially the doctor who releases you, is the one that gets paid, for your visit to the ER...

It is for this reason then, that if you show up in the 1-2 hour window before the end of the outgoing doctors emerg shift, you will not be seen, until the new incoming doctor takes over.

This, is simply unacceptable; but of one example of gross inefficiencies in our health care system. But we have a system whereby it is pretty much left to doctors to govern themselves, or not so much

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Charge Nurses, rotate.

So, in our system, the lead Charge Nurse on any given ER shift, are not static; You'd think it would be the most senior 3-4-5 nurse in any given hospital that would be meritoriously promoted into this esteemed position; and you be wrong.

It's a rotating thing, whereby often this weeks. or shift's Charge Nurse is a different nurse.

This has a number of negative outcomes:

• So you often end up with nurses as 'Charge', who
  • don't necessarily even want the job today, tomorrow, or ever. After all, responsibility is 'work'
  • do not possess the leadership 'parts' to lead, task, oversee, supervise, follow-up, mentor or council the other nurse on shift they are responsible for
  • do not have the experiential 'backbone' nor kahonnas to stand up to doctors, when they need to be stood up to; This, despite the fact that yes, the doctor is ultimately in charge.
• It's the case whereby you need two components, for a ER to run efficiently - If one of these is lacking, the ER does not run efficiently and patients ultimately suffer and our tax dollars are grossly wasted:
  • well organized nurses, properly supervised by a meritoriously selected Charge Nurse to ensure all are pulling their weight and supporting each other as a well functioning team; 2nd
  • a competent doctor with a strong work ethic, who absolutely puts the collective public's and individual patients well being to the fore.

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The more tests a doctor orders, the more they make; so you see some ordering a full blood testing workup, when you've just stubbed your big toe; This, usually occurs in the month leading up to that particular doc's tropical vacay...... | Coincidence...I think not. And no-one seems empowered to call them on it...

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I'm aware of a doctor who spends a significant amount of her time on shift, crying; she is apparently unable to hand the stress as an ER doc. When she's not crying, another 3rd of her shift is spent on her cell phone [is that a work call?].

Other docs that are so lazy/inefficient that again our dollars are wasted.

And where are the mechanisms and oversight to engage in these cases, to ensure:

• the outgoing ER doc is seeing patients, right up to the end of their shift?
• jacking up the one's Face-Booking on shift?
• crying in the supply room because they can't take the pressure of the job?

It occurs to me that as long as no one inadvertently dies of incompetency on your watch, you can be as ineffective ans you'd like and the supervision/accountability, certainly in the smaller centers, just is not there.

So in a profession as important as medicine, where the hell are the mechanisms to ensure we get out tax dollars worth? It seems to me that 'we' have organized the health care profession to allow lazy nurses to laze, fully complementing the pace of the slowest doctor on shift. And patients pay.

It's that old tale: a certain number of doctors, have to have had finished in the bottom 25% of their class.

So while I absolutely admire the stellar nurses and doctors out there, 'we', like many other segments of society, have encouraged and fully allow for - sloth.

And doctors are laughing all the way to the bank.

BTW, if anything I've said here is in gross error, please do speak up and correct me. Peeps want to know where their hard earned tax dollars are going.