Javadi’s life is sooooo funny…. me when I rebel against my mom by *checks notes* being on the verge of getting my medical degree at her hospital but NOT!!! going into surgery like she wanted. and the really funny part is that it’s working her mom is Deeply Upset that her daughter (again. on track to get her medical degree at the exact place she wanted her to) Might go into emergency medicine instead. godspeed girl I believe in you
jack who always gets a little thrill of pride every time he sees the sticker slapped on robby's travel mug, "Omega Rights Advocate: If We Slick Together, We Stick Together", the sort of thing jack never witnessed a senior attending profess verbally when he was coming up, much less something any of his mentors would've felt comfortable or able to express on something they carried every day in front of patients and staff and strangers and god.
(it's purely pride, definitely not a shameful flush of pavlovian desire, his brain connecting robby and slick in reels of technicolor memory: robby at the start of another brutal heat, light-headed and lead-limbed with it, "all wet and ready for me; fuck, mikey, I can smell it." the pitch of robby's whines, low growly rumble at the back of his throat as jack slips a hand under the waist of his sweatpants, the ratty old grey ones cut off at the knee. "fuckin' slicked right through." sucking his fingers clean like a kid with a melted popsicle and going straight to the source for more. yeah, no; it's definitely just pride that makes jack warm under the collar when he sees that sticker.)
So I did some research online and from what I could find out the VA is federally funded and attended by people who have military benefits / military insurance and that those covers their bills.
(Or theoretically they should but they make people fight to get them / have long queues for equipment, but like, they are supposed to be).
So in that environment you can do the safe thing and have someone intubated for one hour for what turned out to be a simple removal of a broccoli / send someone up to an OR under general sedation to reduce a shoulder.
Which is great, but in the world of insurance bill that's gonna add a lot to their billing, which will drive down patient satisfaction in the long term and make people less likely to go back to PTMC, if they get humongous bills for going there.
They might get good Press Gainey scores (which are scored off surveys that are sent to the patient right after their visit, while the bills won't come for a few weeks or even months from what I've read) in the short term, but bad reviews on the long term for over-treating and over-billing, an uptick in lawsuits and a lower patient retention.
(Because who would want to go back to a place that's gonna make you pay more for things you might have not necessarily needed when you can catch an uber somewhere else that won't fuck up your bank account as bad? Not most people, I am sure. Or, as someone suggested to me in the Discord I'm in while we were talking about this, they might wait longer to go, to avoid that big bill and only get there when they are sicker).
That sort of thing really influences how you see patients and how you think about what is being done for / to patients.
I say this as someone who has never paid an hospital bill in my life and had to have it explained to her why my online friends wanted to do a fundraiser for me that time I was in hospital two weeks. I did not have to worry about hospital bills, so the fact that they did a whole battery of tests to figure out what was wrong with me did not phase me, but my online friends? The american ones? They were a bit panicky over what that would mean for my bank account, enough so that it panicked me and I went and checked with nurses and docs that I would not get billed for all of it.
(The tests included an endoscopy I spent a few days Nil By Mouth / No Oral Intake waiting for and very weird one where they had me breath mildly radioactive gas for contrast for a specific chest scan that meant I had to sign a disclaimer and promise that I would be careful to not be around potentially pregnant women or children for a couple of days afterward and I can't imagine what THAT would have cost in a system that did not foot the bill for me)
If you come from an environment where billing is not a problem because it's pre-covered, you're not going to think much of ordering procedures or prescribing things. However that can be seen as over-treating in the public American healthcare system and it can lead to lawsuits, either from the patient suing the doctor or from the insurance making the patient either sue the doctor or foot the bill themselves.
You can afford to have a shoulder reduction done in the OR under general anaesthesia plus the follow-up surgery, because that's not going to come out of your patient's pocket. In the VA, the government will cover that. It is an affordable strategy that is safer for the patient and the doctors treating the patient both. (Nevermind that I am one hundred per cent certain that Shamsi would have come down to personally take and spike Garcia and Robby's heads for tying up a whole OR for a shoulder reduction.)
I know we all cheered and appreciated Garcia's "I AM THE OR" line, but that's also very true. That's the whole reason she's there covering the surgical side of things. All the stuff she can keep from going upstairs because she can treat it in the ED she should be treating there and she's going to be held responsible and raked over the coals if she just sends people upstairs she could have handled herself down in the ED.
In the VA you can choose to give both roc and ketamine, put the patient under for at least an hour, intubated and bagged and kept on oxygen, when you are not sure if it's a piece of food stuck in or something worse, because that's not going to be billed to the patient. It's also the safest procedure, that is very true.
But in an ED that's going to get billed to the patient. The equipment, especially the things that are used once and then disposed of because they cannot be re-used due to infection and control, the oxygen they'll give you, the medications to keep you under, the staff involved to keep an eye on you, even the patient gown you'll be put into, etc. etc.
It all either gets covered by the insurance or comes out of pocket (I have seen plenty of people cautioned to request itemized bills from the hospital to contest charges so that the bill can be reduced or lowered enough that insurance will cover it). I have also found out VA doctors usually do not get sued because the government has their back, so there is less risk of getting a malpractice suit leveraged at you. Enough so that most malpractice lawyers won't even try to take on a VA doctor. In that sense, the VA looks to me like a very protected (even privileged) environment where you do not have to worry about things like 'how much is my patient going to pay for these procedures that yes, reduce risk but come at a hefty cost' or 'will my patient, or my patient's insurance through my patient, sue me for over-treating?' and that absolutely would affect a doctor's approach to how they treat their patients.
And that Baran Al-Hashimi was not sufficiently prepped for this difference, and forewarned to change the way she calculates what is best for a patient to fit the system she has now entered, is on the people who hired her and briefed her, aka Gloria and Upper Management / The Board / Corporate, however you want to call the admin types.
oh dana, poor traumatised dana. don't carry around scissors new girl, those can be used against you. here's an acronym to keep you safe, new girl, and you better remember it because everyone we treat is seconds away from being a threat. "punchy is my new baseline" because maybe if you hit first no one will ever get the drop on you again. oh dana. do those off-colour jokes make you feel safer? or is it just that the constant threat of abuse and violence and rage has burned the compassion out of you? poor, poor dana. "a trail horse always finds its way home" even if home is killing you?
Dennis and langdon having beef but for different reasons. Langdon is all angsty because he feels like dennis has replaced him as robby's protégé meanwhile dennis genuinely tries to explode that man with his mind every time he sees him because santos told him all about how langdon treated her on their first day.
Like from the outside it definitely just looks like two of robby's mentee's are competing for his approval but dennis is doing it for the honor of his lesbian twin flame.
WAIT a goddamn minute holy fuck the implication totally went over my head
You mean to tell me that, somewhere in the last ten months, Trinity decided that Robby was a safe enough man in her life that she disclosed her history to him to a degree that he's now out here encouraging her to go to a trauma therapist??
Holy shit??? The enormity of that??? And the SUBTLETY because this man genuinely falls back on sexist behavior sometimes but the most hurting, traumatized woman on the staff trusted him with the horrors of her life???
Robby never beating the Girl Dad allegations advocating for Javadi to make her own decisions, making Trinity promise to see a counselor, getting Mel to admit she's feeling anxious about her deposition and saying "someone must have been in a bad way to walk away from you, little one" while Samira bigs her eyes at him. Proud Dad of four beautiful princesses <3
I think it's even more glaring that upper management is trying to push Robby out.
By implementing someone for three months but oking massive changes? They didn't call him for a meeting to discuss it, but rather they sent him a package saying "this is what we are doing."
Baran herself might wish to discuss with Robby, but upper absolutely does not. And i suspect by going over him they're actively hoping he doesn't come back after the three months. Or if he does, he will be so angry over changes he will quit.
But the thing is Robby is NOT incompetent at his job. There is a reason he was hired to be chief attending.
But he's also vocal, which presents a problem. It's easier to hire someone outside, who isn't as familiar with the system, who won't push back as much because they haven't realized upper won't bat for them yet either.
It is not uncommon for minorities (specifically women and POC) to be hired after white men and are championed as "the big fix" to an already failing company, because then if they also can't fix the broken system then they ALSO get blamed. Rinse repeat.
Robby has also been in the position for 5 years, and has tenure. 20 years roughly of ED attending experience. Which mean's he's the highest paid staff on the floor. By removing Robby they actually save costs because they will pay Baran extremely less.
thinking about and rotating in my head how nobody has pronounced "baran al-hashimi" like how she has. it's b'ɹ̠ahn al-hahshími not bɒɾɒn al-háshimi. it's a wrong /a/ sound, the r is different (the r that it is doesn't exist in english so that can be more excused), sometimes the first /a/ in her first name is gone completely, and perhaps most noticeably NOBODY IS PUTTING EMPHASIS ON THE RIGHT SYLLABLE IN AL-HASHIMI. but then. beyond that. everybody just calling her "dr. al" !
it's something that happens a lot in monolingual anglo spaces (i cannot speak to if this happens in other monolingual spaces), like this decision that "actually i know how to spell your name right" and it's fascinating and frustrating and annoying as shit and i love that they included that in the show
yep they know how to spell it and that's it (but it's better in European countries even the UK)
there are two things here to consider:
first is no matter how many times they try they just can't pronounce it correctly, it's because the languages come from different families -- they ('monolingual anglo') simply don't have that sound, so the speakers' muscles were never trained to produce it --hence they just can't.
other times it's just ignorance and a lot of other things because they don't care. or worst, just racist
It's very realistic, and ultimately it's a compromise (just like in real life)
-- a. no matter how hard they try to learn it, it will never sound exactly like a native speaker (if they do not know that language at all or haven't spent a long time practicing it, that's expected) and in some culture that's a big issue, if one can't say it properly better not use it at all
-- b. a choice from the minority part to avoid awkwardness/hostility/racism
because people can be jerks and racists, concious or unconcious
But putting in the effort and trying to learn -- that's very important
