Comments on: Another patient dies while waiting for ED care

By: ERnursey

ERnursey — Sun, 04 Nov 2007 00:22:32 +0000

Thanks for the plug, Thanksgiving and Christmas are coming up and the kids (that is right, no matter what you think about the war these are kids we are talking about) are a long way from home and loved ones. The appreciate knowing that we are thinking of them. They especially enjoy magazines, newspapers, DVD’s, CD’s, cards and letters. Everything you send is enjoyed by the whole base. Thanks again.

By: vh

vh — Fri, 02 Nov 2007 17:10:24 +0000

I resent the statement that as a working stiff who has insurance I don’t understand how much medical care costs. I certainly DO know that the cost of the emergency appendectomy I finally managed to get after visiting not one but two ERs exceeded 20 grand, and I certainly DO grasp the concept that my insurance rates are sky-high because hospitals have to provide free treatment for the indigent and for people who work in jobs that provide no insurance.

When I went to the ER of one of the major hospitals in the sixth-largest city in the nation with acute lower right-quadrant pain and vomiting, I sat outdoors on a cold stone bench for four hours with exactly NO attention. Next to me was a young woman who had been there longer than that; she was miscarrying a baby. She also had received no medical care.

Finally along about two in the morning I called some friends and asked them to come pick me up. The floors were two filthy to lay down on, and because the pain was so intense I could no longer sit upright. I might die at home, but at least I would die in a bed.

At dawn I called my doctor’s office at the Mayo. The doctor on call told me to dial 911 and have them take me to the Mayo hospital. I said I did not think they would take me to the hospital of my choice. She said they had to. When the 911 crew showed up at my door, they proposed to take me right back to the place where I’d languished for hours with no attention. They flat refused to take me to the Mayo, which is no further from my house than the hospital in question and in fact, because it can be reached by a freeway rather than over the surface streets, is actually a shorter drive in terms of time.

I sent them away and had another friend drive me to the Mayo. Finally–after 23 hours of suffering acute appendicitis–I got some attention; at the Mayo I was promptly carted into surgery. I was 60 years old at the time…those of you who are medical doctors undoubtedly understand the implications of this set of conditions.

The message here is that if you have lots and lots of money and you can afford to go to the Mayo Clinic, which is serves a part of the city where middle-income earners cannot even think about living, you can get decent medical care. The rest of us slobs can go to places where doctors think we’re faking when we say we have acute belly pain, where the check-in staff gives you a dirty look when you can’t help throwing up, and where some doctors evidently think everyone is so stupid we don’t even know what medical care actually costs.

By: scalpel

scalpel — Fri, 02 Nov 2007 16:08:35 +0000

When everyone is on driveby, nobody is on driveby.

By: jb

jb — Fri, 02 Nov 2007 10:18:13 +0000

Thanks for the clarifying remarks, WC.

According to Wikipedia, the USA spends 1.7% of GDP on military related affairs; the percentage devoted to healthcare is roughly 15%. The trend for the former, despite the current shooting war, has been downward in recent years, and upward for healthcare. As PJ O’Rourke has said, “if you think healthcare is expensive now, wait until you see what it costs when it’s free.” He may have been thinking of costs in dollars, but some people, including the 2 that you highlight in your post, pay with their lives. Why anyone would think that the US government would do a good job running the medical system is beyond me. It started innocently enough as a payment program, but it inevitably morphed into the people who make the rules. Now that everyone gets everything for nothing, there isn’t enough to go around in some cases. As the guy who runs the lab says, “When everything is stat, nothing is stat.”

By: WhiteCoat

WhiteCoat — Thu, 01 Nov 2007 22:33:00 +0000

My war comment wasn’t intended to blame everything on Dubya. I apologize if it appeared that way. I’m not a political person. I greatly respect the man, but I disagree with some of his decisions.
My intent was more to point out my belief that our country’s priorities are misguided. No one will ever know whether this 33 year old man would have died even if he got straight back to a room and the MI was diagnosed immediately.
When we cut services and cut payments because our priorities are focused somewhere else, all of a sudden our infrastructure ends up a shambles. I am very concerned that these people who have bad outcomes because they can’t get timely care are “canaries in the coal mine” representing the tip of a very large iceberg.
Funding for essential services is going to make or break us and it is drying up for medicine - especially emergency medicine.

By: Nurse K

Nurse K — Thu, 01 Nov 2007 18:18:52 +0000

Our urgent care area (3 beds) oftentimes turns into a monitorless chest pain holding area for EKGS….

By: jb

jb — Thu, 01 Nov 2007 17:55:54 +0000

Sorry Phyllis, we don’t have it even a little bit wrong. Hospitals advertise their profit making services so that they can have some cash flow to cover the cost of all the free care they are required by federal law to offer in the ER. Most hospitals have urgent care clinics very close by; they compete with the hospitals for paying patients who have relatively minor problems. Unlike hospitals, they are not required to provide unlimited free care to anyone who shows up, so all the freeloaders will continue to go to the hospital ER. Many hospitals do have integrated urgent care centers, and all that does is make it more likely that the occasional person with a significant problem and will be triaged to the urgent care area, leading to delayed care and increasing the risk of lawsuits.

That ought to straighten things up.

By: Phyllis

Phyllis — Thu, 01 Nov 2007 17:37:50 +0000

I think you ALL have it ALL wrong! If the hospitals would STOP advertising to the public how wonderful they are and put their dollars where they are most needed, we might be able to ease the problem in the ER’s. Also, every hospital should open up an urgent clinic adjacent to the ER’s so that critically ill patients ONLY are seen in the ER and all others are seen in the clinic. That ought to straighten things up.

By: Mark

Mark — Thu, 01 Nov 2007 17:17:17 +0000

My initial thinking on this subject was that we need an explicit national discussion on these issues without rancor. I agree with the idea that the current system is in trouble and that we do not appear to have the will to fix it. Of course, the alternative to fixing it is to learn to like the current system.
I don’t think that we can devise a system where no 33 year olds drop dead of an unexpected problem somewhere in the country a couple of times a year. No matter how much we spend. And certainly, every dollar spent on preventing chest-pain associated death in 33 year olds is a dollar taken from some other equally desirable outcome.

By: scalpel

scalpel — Thu, 01 Nov 2007 16:01:03 +0000

And despite the seemingly endless nature of our recent intervention in the Middle East, eventually that expenditure will be greatly reduced, unlike the establishment of yet another Socialist Ponzi program which would only increase ad infinitum.