Saturday, February 19, 2005
Sometimes they don't need it;sometimes they do.
The first one was a young lady, two days post-op, who was totally unresponsive when I ran outside to see what all the commotion was about. She was spralled across the passenger seat, wearing nothing but an adult diaper (which was overflowing) and her husband said, "I think she's a little dehydrated." Fortunately, her father had gone to check on her an hour earlier and insisted that she be taken to the ER. Unfortunately, even that wasn't fast enough. Can you say sepsis? Hours later, the husband was still insisting that she "shoulda had some more water."
Number two was brought in (begrudgingly) by her son-in-law. "She says she's having an asthma attack," he says, "but she has them ALL the time." A little later, I overheard her grandson (Little Johnny) on his cellphone. "We'll probably be here a while...Dad says she's really putting on an act this time," he related. I could have approached it as a learning experience: "Hey Johnny!" I could have said, "can you spell V-E-N-T-I-L-A-T-O-R ? Why? Because that's what grandma's using to breathe right now. Instead, all I said was, "I don't really think she's faking it Johnny."
Third was a lady who drove herself to the hospital. Even though she had wrecked her other car a little earlier, she didn't appear to have a whole lot wrong with her at first. Five hours later, though, she looked awfully pale when someone finally noticed her. Now on a normal day things might have gone a little differently. Patients in the triage waiting area are supposed to have their vitals rechecked every two hours. But today, eight people called in sick, and that just didn't get done. It was kind of chilly today and she was all wrapped up in a sheet-- she could have been any other patient who waits for hours with big toe pain. Fortunately, someone did happen to notice her, and one transfusion due to a huge GI bleed later, she might just be OK. I wish I could say that for the other two, but I can't. We only batted .333 today. That's good for baseball...but bad for ER.
Saturday, January 29, 2005
I don't know...
"What's going on?" I asked.
"Well," she replied, "I'm from out of state but I go to college here. Is it OK if I'm seen here?"
"Sure it is," I said, "we take anybody, any time. What's the problem?"
"I'm pregnant and I was spotting last night, so I thought I'd come in today"
"How far along are you?"
"I don't know."
"Do you have any idea?"
"Well, I guess maybe...oh...three months or so."
"Did you doctor tell you when you are due?"
"Oh...well..I haven't actually been to the doctor yet...but I'm here now."
Thinking back on the past 20 years I realized that things haven't really changed that much after all.
"Will I have to wait long before I see the doctor?" She asked, meeky waiting for my reply.
"I don't know."
The Preacher Man
Sunday, January 09, 2005
Who's to Blame for Healthcare Costs?
You could probably say the government started it back in the 1940's if you wanted to. At a time when wages were frozen by the government, someone came up with the idea of paying for health insurance to lure in prospective employees. They couldn't give them more money, but they could give them benefits. Suddenly, any job worth having offered health insurance. People simply got used to this benefit and began demanding it, because they were somehow entitled to it. To this day, one of the first questions asked of prospective employers is, "What kind of health plan do you have?" Can you imagine what would have happened if they had decided to pay for your car insurance or house insurance back then as well. You can bet that people would still be demanding those benefits today. I wonder how much they would cost now.
Of course, the health insurance benefit wasn't a big problem at first, because people still had to pay a fair sized deductible and probably 20% of the charges after that. But, it covered catastrophic damages that they never could have covered on their own. You could blame the government again for their interference in the 1960's if you really wanted to. The decade of Medicaid is surely one that changed healthcare forever. Do you remember when the government said, "Why should you doctor's worry. We don't want to change the way you practice; we only want to pay the bills for the elderly. Why should you care where the money comes from?" Of course, we all know what happened next. People really decided to take advantage of this free healthcare and in no time the government couldn't afford to pay for it anymore; not without controlling what services took place and how much physicians would be paid. You couldn't tell the people to stop having those elective surgeries that the government volunteered to pay for, because, by then, the older people had a right to free health care, didn't they?
I guess you could blame the HMO's for the next phase of problems, or maybe you could still blame the government again, because it was really the government's price freezes to combat runaway inflation that brought HMO's to prevalence in the 1970's. I'm even guilty of overusing them myself. The first job I ever had paid for my health insurance, but I still couldn't afford to go to the doctor, because I had to meet a $250.00 deductible first. When they finally got and HMO plan, with a $10.00 co-pay, I went to the doctor every time my nose ran and still didn't spend $250.00 in a year. It was a godsend. After that, no other kind of plan was any good. After all, I was entitled to the cheapest plan, where I could pay next-to-nothing and still get quality healthcare, wasn't I?
So, I sit here now and look at the escalating costs and wonder whose fault the current situation is. The truth, however unpleasant it may seem, is that it's me. I'm responsible for the problem, and so are you. Why? Because of our attitudes. We have somehow come to believe that free healthcare is a right in this country. We still have catastrophic insurance on our houses and cars, but we know that regular, routine maintenance is up to us. Yet, we demand free regular and routine maintenance of our healthcare plan. We got greedy with Medicare too. We were not willing to give up our newly acquired rights to any procedure we desired, even if the government couldn't afford it, but someone had to pay for it. Guess who that was. It was we...We the People of the United States of America who don't seem to care where they money comes from, as long as it's not from our own pockets. The only problem with that theory is that it's exactly where the money does come from...eventually.
Saturday, January 08, 2005
One Malpractice Solution is...
The lawyers have said a few things that make sense. They put up the money for these big cases, spending their own hard-earned dollars while taking a gamble that they will win. If they lose, they get nothing. So, shouldn't they expect to get a big part of the windfall? The problem as I see it, is the gambling thing. If they want to gamble their money, I'd much rather see them put it in the stock market. Then, they could take the cases that really do deserve to go before a judge. Unfortunately, the current system allows them the possibility that they might make millions. Take away that possibility and you take away the incentive for lawyers to choose cases based on possible large financial gains. The one thing that you don't take away, though, is the financial gain of a legitimate victim.
So, just how do you do that? Never let it be said that I didn't bitch and moan about something without proposing an alternative. Each possible case should be brought before a panel consisting of one judge and two medical professionals. Those that have merit will be assigned to a court-appointed attorney, and they will be reimbursed at a rate to be determined by the state. The courts must also approve expenses for each case (including expert witnesses, etc.). All lawyers will be required to serve in this capacity at some point in time, as will all physicians. It will be considered a part of their duty to their fellow man. Cases will still be tried, witnesses called, juries convened, and awards made. But, the financial incentive to pick cases based on money, rather than justice, will be eliminated.
Now for the last point-- before you get all huffy and start screaming about how silly this is, how it could never happen, and condemning it for its faults-- why not propose your own solution? It's easy to scream about how awful someone's proposal is; it's a lot harder to bring one of your own.
Saturday, December 18, 2004
No Good Way to Tell Her
Unfortunately, his time ran out. Somewhere between "ball up your fist" and "you'll feel a little stick now" his heart decided to stop cooperating. It's a little unusual to hear a code called from that part of the building, and the response was fast, but by the time he got to the ED he was long gone. Meanwhile, his wife fluttered around, passed from one employee to another while folks behind the scenes scrambled to "set things up." You see, you just don't walk out into hallway with the "We did the best we could do" speech like you see on TV. We have to put the family in a nice little room, filled with councilors and shoulders to cry on, but...all of those rooms were already taken. So, it took a good forty-five minutes to find an unused space and set up some new place for the family to go. To top it all off, this woman was a hospital employee-- not from the medical side, but a "big whig" in the accounting department. So, the entire administration wanted to be on hand, offering their condolences. That means it had to be a a nice, big, and politically correct place as well. The whole thing started getting so big that I would not have been surprised if they had ordered in some food and waited till that got there to tell her. And all that time she sat lonely and afraid, tears streaming from her face, wondering why on Earth no one would tell her anything. I felt a little like the desk clerk at the hotel, because I wanted to say, "I'm sorry ma'am, but your room's not ready yet."
Sunday, December 12, 2004
How to make your life easier...
Viola!!! All my concerns were over in a flash. Now, laundry time is my favorite time of the week. Unfortunately, it doesn't last long enough now and I sometimes have to wash clothes twice a week. Who'd have ever believed it!
Thursday, November 25, 2004
Mary [not her real name] lives forty miles from the ER. She works weekends as a prostitute, but doesn't have transportation into the city, where the johns are, so she uses the next best thing...the EMS system. On Friday mornings, she inevitably has a sickle cell crisis, and calls EMS for transport to the city. After several hours of moaning and groaning, when it gets near dark, she heads out to the streets and hooks for the weekend. Then she gets a ride back home-- sometimes from her grandmother-- but if it's been a good weekend, she'll hail a cab. Did I mention that Mary is still a teenager?
Bobby [another fake name] comes in on Fridays as well. He tries his best to get admitted for the weekend, but he's more than happy to sit in the back hallway waiting area and watch TV for a day or two. IN fact, he has his own dedicated seat. He's used it so often that it is molded to shape of his butt, and no one else can sit in it comfortably. But, to Bobby, it's fine. And if he doesn't get admitted he still gets to eat, because someone is always jumping up when there name is called and forgetting the last few bites of his bacon double cheesburger. Nevermind...because Bobby will finish it up for you, and throw away the wrapper. You see, he doesn't like his room to be messy. I'll bet he's been like that since he was a kid.
BTW, what is it with food in the ER? All you have to do is make someone wait for fifteen minutes in the ER and they get incredibly hungry: