Those of us who work in emergency care are often deemed insensitive by others. When we rant about the situations we see, sensitive people genuinely believe that we’re cold, uncaring, or burned out. I have been accused of ultraconservatism, right-wing lunacy, being judgmental (the worst insult a post-modern can muster, by the way) and of being a greedy, Mercedes-driving doctor. (I drive a pickup.) Someone even said my newspaper readers should ignore my opinion about medical finances because I was just “po’mouthing,” a Southernism that implies I was making my situation sound dismal when I was actually quite well off.

While I’m sure that a few physicians are, in fact, cold and uncaring, most of the docs I meet are anything but. What they are, however, is possessed of the remarkable clarity about humans that can only come from working with actual people rather than theories or ideologies. It’s an insight that cannot be achieved in the purely academic world, nor is it attainable in Internet chat rooms, but it isn’t, as I long suspected, just doctors who deal with reality.

I often speak about our struggles with a dear friend and fellow church deacon who is a manager in a local grocery store. My friend is as kind a man as you’ll ever meet. Devoted to family, friends, and God, he volunteers at a local elementary school, spending time with at-risk children. He comes to church early to pray for the many things that burden his heart. He would literally give you the shirt off of his back. And he’s fed up with the abuse he sees in his grocery store.

He told me, “Ed, I see people using food stamps to buy food I could never afford. And I have a good job!” He recently held forth about a woman using her WIC (Women, Infants, and Children program) card to buy six gallons of milk at once. When he half-jokingly asked what she did with all of the milk, she pointed to a toddler and said, “She drinks all of it.” Later, leaving the store, the customer was heard to say, “What does he care? He ain’t payin’ for it!” Except, of course, that he is.

My friends who are deputies and highway patrol officers feel the same, as do many of my friends whose work as attorneys puts them in contact with the welfare and social services systems. They are often frustrated by the abuses they see, by the parade of bad decisions, and by a bureaucracy that almost seems to encourage and reward the abuse of benefits and services while rarely elevating anyone.

One of my own favorite gremlins is disability. Many of my patients seem to see disability as a career goal. A friend of mine is a school counselor. When she recently asked a young high school student what his post-graduation plans were, he never missed a beat. “Guess I’ll get disability for my nerves, like the rest of my family.”

The thing that makes those outside our circle think we’re bitter is that stories like the ones above drive us crazy. Just like patients who come to the ED for routine pregnancy tests, who ask for prescriptions for Tylenol, and who seek Family and Medical Leave Act forms for ankle sprains. In the same way as the diabetic who refuses to get a $4 prescription at Walmart but regularly goes to McDonald’s before coming to the ED.

There are doubtless well-meaning people who will read this and still marvel at our insensitivity. So I was doing a little reflection on what it is about these situations that frustrates us. Is it, after all, about the money? Are we just mad because we aren’t being paid? Well, that can’t be it. My disabled and Medicaid patients all have insurance. I’m paid for seeing them! Maybe not a full market value, but something is better than nothing.

Is it elitism? Do I consider myself better than these folks, who are often poor and uneducated? Probably not. My faith teaches me that we’re all the same in the eyes of God. And my own grandparents were laborers and small business owners as well as subsistence farmers. I have no animosity toward those who struggle.

And then it hit me! Those who struggle! I like it when people struggle, not in the sense of hopelessness or crushing misery, but meaning those who try, who set goals and go through life trying to be better, happier, more successful, more resourceful, more independent. I’m happy to help those who try, and happy to help those who are actually in need. I’ll gladly give care to the truly sick. I’ll stay late, bend over backwards, beg and borrow to do whatever it takes to help them. For those who try? Anything. If they’re trying to do what’s right, trying to get healthy, trying to rise out of generational poverty, trying to recover from an accident or mistake, a prison sentence, or a disabling injury, I’m honored to be there for them.

What bothers me, what bothers us collectively, is not that people need us. It’s not even that people need us for free. It’s that they have begun to worship at the altar of incapacity and what wise men of old called sloth. We are an overmedicated, undereducated nation bent on proving that we cannot, rather than showing that we can. Having inverted the ethics of our forefathers, our goal is no longer autonomy, but dependence.

We have abandoned the sense of guilt that in the past made our citizens try to achieve on their own to avoid being burdens. We have, in fact, abandoned the entire idea of guilt in exchange for a kind of social lovefest, where anything goes as long as we want it.

And nowhere do we see the results of this experiment more clearly, more painfully, than in the emergency department. Young and old alike swamp our departments, convinced that someone owes them money and compassion for their own dysfunctional life choices and beloved incapacity.

It isn’t that we’re burned out. It isn’t that we’re cold. It’s just that we understand better than most what it means to try. No one told us that not trying was an option. And we’re just weary of being responsible for an endless parade of patients who believe we owe them something and who consistently refuse to do anything for themselves.

So don’t let anyone call you bitter, shallow, greedy, or anything else. Gather your friends, business people, police officers, and social workers; collect their stories and pass them on. Explain that you aren’t the only person frustrated with our deteriorating social situation.

And be proud that in a world of epidemic and voluntary incapacity, you remain capable and proud of it.-Dr. Edwin Leap