Friday, August 08, 2008

Hello Taxpayers! (volume 67432)

Me: Hello sir, how may I help you?
Pt: Uhm... I screwed up...
Me: What did you do?
Pt: I smoked some crack and then my chest started hurting and my arm and I got scared so I called the ambulance.


Wait thirty seconds for it to stop then go grab it and turn it off...

Me: How are you feeling now?
Pt: I feel better... I need to use my cell phone...
Me: Do you smoke cigarettes?
Pt: Yeah, only 6 a day.
Me: Do you drink?
Pt: Yeah, I had a bunch of beer today.
Me: Okay... Let's make sure you are okay...

Insurance? No. Diagnosis? You have it. Bill? I don't know, $4000 and $1000 for the ambulance ride? Who pays? EMTALA says you and me!!! Thanks again, American taxpayer.


  1. Hey 911
    It gets better and better...

    The rich rapper dude with a house in the richest part of town gives a false name and social to the Mayo!

    So he almost got free care courtesy of EMTALA (the branch of the Mayo there apparently has a regular hospital with a regular ER), Sadly, he will probably only serve time on the dog fighting charge, 'cause that's a real crime (which it is!). Stiff a hospital for big bucks... not so much.

    Can I come work for you at your other career? Please? Pretty Please?

  2. Yeah, those of us who don't abuse our health pay the cost for this guy can barely afford our own health-care. I wonder how many patients were waiting to see you while this guy was taking up your time? You must really want to slap patients like him...

  3. Those guys don't bother me as much as my relatives who complain about howmuch their Knee Replacement costs, like they were really paying for it themselves.

  4. The ones who suffer the most are the responsible non-insured, like my aged-out foster son, who broke his hand but managed to pay all his bills on his limited income.

  5. Ran a call once at a 29.99 no tell motel. Guy shot up a bunch of coke. About a gram over the past 3 hours. Complains of chest pain. Has 12-lead changes suggestive of ischemia. Gets ride to hospital via ambulance.

    I'm making small talk. So what do you do, where you from kind of shit. Guy says he installs metal detectors and security systems into public schools. Was out of town working on some area schools and decided to "treat himself" with a little IV coke.


  6. Then let the poor die
    and decrease the surplus population!

  7. dear happyian,

    not letting that one slide. not saying to let anyone die, simply saying that folks should be responsible for their medical bills if only for a portion... this would, i believe, immediately solve the bulk of our medical crisis. the ER is used all the time because it really is 'free' due to EMTALA. however, if you have a job or insurance you WILL pay and you will pay a lot more than you should to cover guys like this one.

  8. Yeah I know
    Im sorry...

    I just love that quote so hard...

    I'd die before letting anyone else.

  9. no worries! come back anytime.

  10. hey igloodoc,
    what do you do? if me and 'cat make it in our separate endeavors then we will hook you up!

  11. 911Doc
    Same as you -- ER (with golden handcuffs). Like everyone else around here, wanting out badly.

    Let me know... I'm always interested in an escape plan.

  12. Rough week in Neuroramaville. You've made me laugh though. Thanks.

  13. Old Fart, leave in your lines. We need you to get better. Hugs and prayers.

  14. A fine example of tax dollars at work.

  15. i agree with frankie up there..
    folks walk around with 30-50 extra pounds on their bones.. then get rewarded with hip/knee replacements.
    .. and complain about the "cost".

  16. Was that six cigarettes a day,
    or six PACKS a day?

  17. dear goldtrader,

    as a standard rule of thumb one is best served by taking the answer to "have you had anything to drink?" and multiplying by two or three to get the truth.

    for alcohol i can usually guess within 5% accuracy what someone's blood level will be, but this is based on hard-won knowledge and fudge factors for weight, age, and experience.

    i've seen professional drinkers appear sober at a BAL of 300 which would put me on or in the ground.

    for cigarettes i'm not sure that the multiple is 2 or three but this fine citizen was talking about six cigarettes a day.

    i consider it a fine day, and the patient involved goes way up in my estimation, when they answer thusly...

    me: "do you use drugs?"
    patient: "yes."
    me: "what drugs do you use?"
    patient: "anything i can get."

    saves me and them a bunch of time.

  18. Just had one last week, collapsed lung from and afternoon of smoking crystal meth.

    Can't pay their bills but always have a cell phone.

  19. Okay, but how about the people, families, self employed, who trully can't afford insurance and need a Emergency Attention? This is getting truer by the day...Adequate health care is hard to come by and there are a lot of folks out there who can't afford to see a Dr. So they have to live with the condition until they end up in the E.D.
    And also, why do so many, and I mean many, people turn to drugs? What is wrong with our society, our culture, that drugs are so attractive, so frikkin' available?
    Meth, for example, makes no sense at all to a rational person, it has all the attraction of drinking pure Drano, yet it is everywhere.
    Why is that?
    There exists some research too, that says people are attracted to the illegal drugs that relieve symptoms of underlying problems, a person needing anti-anxiety (or even antipsychotic) medication will be attracted to downers, where as someone with fatigue or ADHD will be attracted to things like Meth or other amphetamines. We see that alot at the State Hospital where I work.

    I guess I just exist to annoy you guys.

  20. I don't understand the complaint anyway, I do understand the humor, however...
    But when stoked up or crazy people show up on our door, we just shrug our shoulders and call it JOB
    If everybody was exercising, meditating, eating right, being law-abiding, having adequate healthcare, etc...where would some of us be?

    I don't care how poor you are, everybody pays into the system...pays taxes...just try getting gas or a buying a pop without paying tax.

  21. dear kr,

    you are wrong on a few points.

    first and foremost, no, not everyone 'pays into the system'. this is true only for sales tax and i am not sure if folks with food stamps even pay sales tax.

    second, per the IRS own statistics available on their website the truth is this... the top 50% of wage-earners, and this includes folks making about 50,000 a year (conservatively) pay NINETY-SIX PERCENT of all federal income tax.

    also, i do not see it as 'job-security' because the number of functioning ERs has dropped precipitously in the last ten years. it is, in fact, the opposite of job security. the result is that the burden of taking care of the uninsured and 'poor' is falling more and more on physicians and nurses alone. it is no wonder that many are quitting.

    ultimately the cruch of the ER under EMTALA forces specialists out of their hospitals and now the 'poor' DO NOT HAVE ACCESS to life saving care that they had when they had to pay something for their care.

    as to you question about drugs, you kind of answer it yourself. there is no one to blame but the people themselves. for every suicidal patient i see that is 'poor', roughly 75% of them tell me they 'can't afford' their anti-depressant medicines because 'they' (the government) won't pay for them, but these same patients do figure out how to pay for their car, their cell phones, and their tattoos. they also figure out how to pay for their booze, meth, and cocaine. it's ugly, but it is true.


  22. I am a sonographer, and I see this all the time. One hospital I worked at had an abundance of pregnant women coming in in the middle of the night with "spotting", but once I had them in the room, they would tell me they had no insurance and wanted to know the sex of their baby. I don't give out the sex if a patient comes through the ER, so after my first month (this was a small town) I stopped getting paged so much in the middle of the night. Go figure. I love this blog by the way

  23. We all ... every single one of us ... abuse the health care system, whether it's in the U.S. (and you guys suck at it) or in Canada (and we suck at it even worse).

    I haven't met one person who doesn't eat badly, exercise rarely, use recreational drugs from time to time, drink a little too much at a dinner party.

    Come on, this could be your kid!!!! It sucks that people get as messed up as they do, but ... wait, did anyone make you go into the medical profession? Did you think it would all be guts and glory?

    Sorry, I know you deal with it on the front lines every day, and I have no experience, no true knowledge of this at all, and would probably rant a lot more than anyone else ... but one single life. Remember the Dalai Lama.

    Does that come off as preachy? Sorry, but one life ... you save one life and you save the world :)

    Thank you for all that you do.

  24. dear kate,
    No worries, it is I who will come off as preachy. No, everyone does not abuse the health care system. I've had patients leave the ER against my advice because they couldn't pay even when their lives were at stake. They are almost all in their 60s or more. They know they will be hounded for $ and they are, in fact, paying for thousands of idiots like the one above, almost none of whom will pay a dime because they have no tangible assets.

    You may say all the more reason to make it "all the same" or "have the government pay".

    Dirty little secret, when it is "all the same" the quality and availability of care decreases for all and the wealthy simply pay out of pocket to get their care somewhere else... Canadians coming south because they want their cardiac bypass before they die for instance... My grandmother moving here from England where she was told to "go home and pass quietly" and getting life saving surgery which gave her ten more years with us.

    When it comes down to it on a spiritual level none of us "deserve" anything, but here on earth the best deal for ALL is a system where responsible behavior and hard work are rewarded and their opposittes discouraged.

    As PJ O' Rourke famously said, "If you think health care is expensive now, wait untill it's free."

  25. One of the BESY blog ever! I enjoy reading you guys!!