Sunday, September 21, 2008

Slate Debunked

I didn't spend too much time picking apart the Slate article two posts prior. I must admit that because it was Slate that I suspected a lefty spin but didn't see it initially. No matter, Igloodoc and Nurse were all over it and I quote...

NURSE K: There is one really obvious error in this article---they say the uninsured don't use the ER more than the insured. Medicaiders have something like 89 visits per 100 people on Medicaid, uninsured is about 45 visits and privately insured is 23 visits per 100 people.One cool concept going on around here is some of the bigger medical clinics are buying their own CT scanners and/or having ultrasound techs on call (in addition to Xrayeurs) and staying open until 10pm or so. When my mom fell and bruised her hip, she asked to go to the ER by her house because she was having trouble walking on her leg, and when I went there, there was an "urgent care"/walk-in clinic-type-thing down the hall and the regular ER. The ER waiting room was crowded and the urgent care had a 15 minute wait and was billed as an office visit. Sadly, the staff are not legally able to tell the patients to try the urgent care because that would be illegal, you just have to kind of figure it out on your own despite it being way down the hall and having no flashing signage.

: The slate article does miss the point with the stats provided. Nurse K has the correct stats. The multi-million dollar abuser is most likely insured, but by the government. And the same government, along with the lawyers, prevent us from stopping it. Even a strong primary care network would only help a little, because, by federal law, we still have to see the patients/abusers before triage to primary care.We have, thanks to the reinforcement of the lawyers, a culture of "it might be". An example: take the old fashioned baseball collision between the second base and the runner at a little league game. In the old days, the coaches would come out, dry the tears, dust the kids off, and tell them to be more careful. Any bone deformities would be put in the coach's car and taken to the ER. Now, right after the collision, coaches immobilize the kids, call the ambulance, and viola! Two C-Spined patients arriving by ambo in 10 min for curative radiation. Why? "It might be" a head injury. "It might be" internal bleeding. "It might be" a broken bone. No one along the way will stop that train from leaving the station, because no one wants to apply common sense to the "it might be" culture. The lawyers make it too costly, in terms of money and grief, for anybody but us to apply common sense in the 1 in a million event it was a head bleed. And the government stops us from turning it away at triage. (Your comments about nurses and triage notwithstanding).So, we ER Docs become the professional responsibility-takers, or the sin-eaters. We have done this to ourselves. You may disagree, but unless we apply some common sense and some form of legal immunity to the triage process, it is only going to get worse.
Thanks Nurse K and Igloodoc. One more thing. Since the ER is, in fact, a 'one stop shop', and since, it is true, that people now realize that they can get definitive care more reliably than in most office practices, then supply and demand dictates that we would see an explosion of ERs. But no, since payment and service have been separated by government intervention the exact opposite is happening. ERs are closing.


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