There was blood.
There was guts.
There were handsome doctors, suffering patients, and villainous bureaucrats.
There was inspiration, frustration, and innovation.
Code Black, the independent film screened Monday by the attendees of MedCity ENGAGE in Washington D.C., managed to tell a true, exciting and emotional story about what it’s like to work in the emergency room of a county hospital. In ER language, Code Black means “holy sh*t” – there are patients everywhere.
Three ER doctors who attended the showing at the first night of ENGAGE said that it was an accurate picture of what it was like to work in an emergency department.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Aisha Liferidge, MD, is an emergency medicine attending physician and an assistant professor at George Washington University Hospital. She watched the movie and spoke as part of a panel discussion afterward.
“The movie shows that doctors really do care and that we have awesome jobs,” Aisha said. “And watching this movie makes me want to go to work!”
The movie told the story of how C Booth – a three-bed space in LA County Hospital – was born back in the 30s and then died in 2012 due to earthquake regulations. Emergency medicine started there, the doctors in the movie said, and the emergency room was initially staffed by any available doctor. As the specialty developed, the profession of ER doc was born.
“More people have died and more people have been saved than in any other square footage in the United States,” said attending physician Billy Mallon, MD.
In the old building, the hospital got waivers to operate because it was physically impossible – given the design of the physical space – to meet current privacy rules.
“When we moved, we moved forward two decades in time and in the new building the privacy regulations have come home to roost,” Mallon said.
There was a lot of nostalgia for C Booth in the movie. The doctors felt their work had changed forever and was no longer bad ass and sexy.
“We became doctors to be with our patients and the system is not letting us do that,” one resident said. “This is killing the team and killing the relationship. The passion for caring for patients dissipates into the computer.”
Physician Ryan McGarry directed the movie which opened in June. He has been touring the country and showing the movie at medical schools and to physician groups. There are showings scheduled through the end of the year.
The movie had an honest balance of despair and hope. The tone wasn’t preachy and there were no easy answers to the problem of our expensive and hard-to-access healthcare system. The people in the documentary felt true to life also with a realistic mix of virtues and flaws. Here are the ideas that stayed with me.
Heroes
The doctors were the only ones in this role.
Villians
This role was possibly overfull with HIPAA, LA county bureaucrats, for-profit hospitals that turn away poor people with no ability to pay, and EHR designers all coming in for scorn.
Both
The hospital administrator tipped back and forth between fighting the good fight for doctors and patients and then letting regulations win out over “ideal” patient care.
Also, nurses went back and forth between both roles. At one point, the charge nurse in the ER was foiling the innovative solution one of the doctors wanted to implement.
The doctor wanted to pull out the sickest people from the waiting room and examine them immediately, with no nurse examining them first.
The nurse said this was impractical from a work flow perspective and would change the patient/nurse ratio to make it illegal.
“I could lose my license over this,” she said.
The doctor seemed skeptical about this risk, and the new system – replacing beds with waiting room chairs – was put into place.
This change in the triage system cut wait times in the ER significantly and made all the doctors happy.
But then the hospital didn’t have enough nurses to staff the entire facility, so the administrator closed down several sections, including the one that the doctors had just redesigned.
Harsh realities
Only 2% of the hospitals in the country are county hospitals and they provide 20% of uncompensated care. One resident says that he often sees patients who have been refused care by for-profit hospitals because they are uninsured.
“These people are not seen as profitable,” he said. “Public hospitals become the only safety net these people get.”
In one truly shattering scene, a white woman who was a lawyer was at the hospital because of a broken foot. She had lost her business and was living out of her car.
“I’m 58 and I don’t know what I’m going to do next,” she said.
One of the residents explained what patients like her had taught him and his colleagues.
“What separates us from having everything and having nothing is one pink slip or one accident,” he said. “That was an education my peers and I didn’t count on.”
Several times the residents said that their work used to be exciting and now it was paper pushing. Their redesign project was meant to help patients, but also to regain the adrenalin rush that they used to have working in C Booth.
Do we owe doctors an exciting job? Does a physician have to feel like a bad ass to do a good job? Certainly I want the person who is saving an injured limb or reviving a heart to do excellent work, but the patient shouldn’t have to be in a place as crazy as C Booth to get that kind of care. Technology and new policies and capitalism are changing everyone’s jobs. Doctors have to accept that reality along with the rest of us. There has to be a way to balance patient needs and physician needs to get a healthcare system that works for both groups.
