Saturday, May 12, 2007

Crisis

The American mainstream media operates in a perpetual crisis mode. The planet is sick, Anna Nicole dies, bombs here, bombs there, climate change, cell phones cause cancer, eat this, don't eat that etc... Nevertheless, as you can see from reading this and other blogs about Emergency Medicine in the United States today (most notably Charity Doc's "Fingers and Tubes in Every Orifice"), we feel we are at the breaking point. I do not work in a major trauma center anymore though I did train in one much like the subject of this article on MSNBC.COM. This article is a no holds barred window into the reality today in Emergency Medicine. It's hard to believe if you haven't had the bad fortune to be a patient in an ED lately, but one day you will likely get a peek into our world, and it is not pretty. Please click the link in the above text to read about Grady Memorial in Atlanta. This IS the reality at trauma centers, and, increasingly, at every single Emergency Department in the country. And to once again beat a horse, in the current health care debate there's lots of blame to go around, but the dirty little secret it that NO ONE dares to mention that patients themselves must be made to bear at least some responsibility, both financial and otherwise, for their own health care. Add that in to the equation and maybe we can get somewhere.

THIS IS A MUST READ!!!

20 comments:

  1. I started out in a place like that too, and I found the story and pictures presented in the article to be very accurate and insightful.

    The stats don't lie...ERs have indeed gotten a lot busier in the last 10-15 years. The majority of trauma cases seem to result from bad judgement of the "victim." The worse the trauma, the more likely the patient (or family) is to not pay anything for their care. And society doesn't necessarily want to pay for the care of what many consider to be the poor judgement and lifestyle choices of these patients. So the best trauma surgeons I worked with during residency and as a young attending went on to do fellowships in bariatric surgery and so forth. Where the big bucks led them.

    Paradoxically, however, when a nonpaying major trauma case does show up, the rest of the ER (even the paying customers) have to wait even longer to be seen. Some of them leave, making the negative cashflow problem even worse. They can't wait 12 hours to be seen, they have to go to work the next day.

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  2. Yet another slant on the bad situation...not only should patients be made to bear some responsibility, how about the families? I am so sick and tired of taking care of nursing home patients and doing every single thing modern medicine can possibly provide--only to save their asses and SEND THEM BACK TO THE GOD DAMNED NURSING HOME TO DIE!!!!!! WHAT THE *&^$##%^????? And it's the patients' families that insist on all of the resourses because 1. They feel guilty and 2. They are not paying (well, not directly anyway...if they saw where their taxes were going and how much was being spent, I dare say they might sign on to "voluntary transitioning.")
    I had the pleasure of meeting 2 RNs this past week who worked at Grady (before the articles came out.) The stories they told me made the published articles look like a joke. It really is bad...but I must ask...if the policy of an istitution is to make nurses wear all white (Grady) in a trauma setting, one must consider that maybe the administration is not making very good decisions in other areas as well, no?
    911DOC, you rock. Consider me a groupie, RN!

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  3. Until EMTALA is revoked or substantially changed, the problem will only get worse.

    Illegal aliens getting free medical care and birthing their new Gringos only add to the chaos. And the American taxpayer foots the bill.

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  4. harrumph. wonder what i'll do when i leave medicine?

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  5. You could try being a rock star. You've already got groupies, after all! And you do SO seem to love the gangsta-speak.....

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  6. I read that, and it was scary. And so true. And the solution to the problem seems so...well...impossible to imagine in the current state of affairs of this country. It just doesn't seem like humans are going to change their behaviors or suddenly start "bearing more responsibility" (much as that sounds rude of me to say.) I do have to admit that I feel rather hopeless about this stuff... But I have a much-criticized "optimism" and don't like to give up. Surely...surely there is a workable solution that can be found someday....

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  7. there is a way to change behavior, it involves making people responsible. ie. make them pay what they can, deny care for non emergent conditions. the word will get out in a hurry and people will adjust. they adjusted pretty darn quick to emtala.

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  8. 911 Doc, if the answer is to deny care for Non-emergent conditions then what really does that solve? So you don't treat them with a sinus infection, you wait until they get meningitis? Is that going to be cheaper to treat? If we keep refusing to give teh poor their needed blood pressure medication is lifetime treatment for stoke and rehab going to be cheaper?

    Its a no win situation.

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  9. no. denying care to the sinus infection patient or to the chronic hypertensive in the emergency department is appropriate. the sinus infection will go away in a few days and the hypertensive patient will have to decide whether they want to actually pay some money for their health care. if they choose not to then in twenty years they may die from the heart attack that would have been prevented by proper long term blood pressure management.

    the emergency department for emergencies. management of ongoing health issues for internists and family practitioners. patients take responsibility for their own health. that's it.

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  10. I agree, 911, there is NO responsibility these days. There is such an ingrained culture of "who's gonna help me?" or "when am I gonna get mine?" that I think some groups of the chronically dependent really would have a difficult time finding their bootstraps without govt. help, much less pulling themselves up by them. And none of the stats on the uninsured report how many of the uninsured CHOOSE to spend their money on things other than health insurance.

    We need to open a hot dog stand when we get out: 911 DOG-Home of the 4 1/2 inch wiener. What do you think?

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  11. it may only be 4.5 inches but it is thick 'like pepsi can'.

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  12. Until someone important needs us (i.e. senators, congress, powerful, etc..) and we are not there for them, nothing will change. Someone (not in healthcare) recently asked me how the healthcare system was possibly going to survive the period it is in, especially with the increase in the aging population. I said, "like all public funded programs, they either hold to their mission and fail or survive by selectively dropping the poor and needy (those least able to pay) to maintain coverage for the people with more money". Maybe not consciously, but funding has to be cut somewhere and the places it is cut are never from the places that hurt the wealthy or powerful. It is our compromised populations that bear the brunt. Is this the way it should be? Do they use the largest portions of the healthcare budget? In ways, perhaps, but that is because our system is broken. Yes, the emergency room SHOULD be for emergency cases, but when people have no where else to go, they end up here. Thanks to EMTALA, a ruling born of good intention, applied in the real world it highlights the cracks in our foundations... I believe the last medical service in this country to disappear will be liposuction & botox clinics...

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  13. it only makes sense that the botox and liposuction clinic will be the last do disappear. we live, still, in a capitalist society. businesses that support themselves and grow thrive, and those that don't die. the shell-game that is funding of modern medicine will work just as well as all other shell games. it will fail.

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  14. Yikes! I feel for that staff and others that endure that load and more. It would be devastating to lose that ED and others as they are so desperately needed. It is also too bad that the burn out rate is so high and that they lose good people which only perpetuates the problem.

    I also would hate to be a patient waiting for 13 or more hours. However,I can think of patients in our little hospital that would get pissy if they had to wait an hour and would threaten to go to another local hospital that was 30 minutes away.

    Actually, I have heard that those hot dog vendors can rake in the bucks if they have a good location.

    I don't think the wiener size matters-they just have to be good. :)

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  15. Until EMTALA is revoked or substantially changed, the problem will only get worse.

    Illegal aliens getting free medical care and birthing their new Gringos only add to the chaos. And the American taxpayer foots the bill.



    until EMTALA is revoked the problem will only become worse? for who? i'm so confused! would it be for the wallets of doctors, or for the people who are gravely ill and can't see a doctor because they are also poor?

    explain that one to me, please.


    also, you know what would be interesting. having someone who is so against the universal right for everyone in this country to have access to healthcare explain a parallel theory where everybody in this country doesn't have the right to a basic education. i mean, you know, if you can't pay, say, $1,000 at the front door of kindergarten the first day, you're ass is back in your livingroom watching cartoons for the next 12 years during the day.

    how is it so different, is what i'd like to know.

    why give everybody the right to a free education? think of all the people who would never be able to afford it if it was privatized (which, if it was, it would be SO much better, right? i mean, privatized health care is SO much better... and privatized EDUCATION is SO much better for those who have parent's who can afford it).

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  16. We already pay dearly for the right for everyone to have "free" public education, in the form of school taxes indexed to property values. And the overall quality of our educational system is generally considered to be poor compared to other countries as well.

    Of course the quality is measured mostly by test performance, which by necessity must include many of those who would otherwise be among the cartoon-watchers mentioned above.

    It seems that the same people who are dragging down the educational system are also dragging down the healthcare system with their lack of personal responsibility. Hmmmm.

    We must not be redistributing wealth adequately enough.

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  17. Amen, scapel. It has been a while since I went to public school (which was actually a good school, unlike a lot of public schools, other than magnet schools, which are disrupted by thugs, dumb down courses, and spend time showing Brokeback Mountain to 6th graders), but I don't recall anywhere reading about the founding fathers and their belief in "inalienable rights, that among these are life, liberty, the pursuit of happiness, and universal health care,regardless of how you treat your body, spend your money on booze and cigs, and generally fail to take responsibility for your general welfare" I just don't remember that last part. Must have been asleep.

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  18. scalpel, you are so right. We do in fact "pay dearly" to the tune of billions and billions of dollars pumped into the public school system.
    And once again, the responsible people (the people who work hard, sacrifice and pay an exorbitant amount of taxes)who are contributing the most are the not the ones taking advantage of the "free" public education. They are in fact actually saving the public education system money by NOT sending their kids (and paying extra for a private school!) The system gets their tax dollars whether their kids use the system or not!

    Food for thought with respect to redistibuting wealth...I have imagined walking up to Hilary and saying, "Hilary, I want to turn over 100% of my paycheck to you. I think that you, Hilary, can spend my money better than I can, and I certainly think that you have a better handle of the greater good than do I--for I would only spend my money unwisely and selfishly." A couple of months later, I have a feeling she would call me saying, "You know, your paycheck is helping things out, but could you please get a part-time job in addition to this paycheck? It's just not enough..."

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  19. See this funny article on medical insurance.


    http://www.tcsdaily.com/Article.aspx?id=051507A

    I want prostitution insurrance!

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