Friday, March 25, 2011

EMTALA-Obama, Impacting Now....


Never know what you will run into on those two day drives to the beach... Here, we run into the future of American medicine. Cheers.

43 comments:

  1. THAT AINT NO HANK WILLIAMS SONG!!!!
    I mean "Drive to the Beach", unless you live in that Yankee/Commie/Sharira state of Tennessee...
    Oh, you said "2 day Drive" guess your goin to one of those Homo Beaches on the Left Coast...
    Seriously, I like North Georgia, not nearly as many minorities, I mean mosqutios as the rest of the Peach State...
    "Battlefield Auxillary Breast Center"??? thats as wrong as 2 dudes kissin...

    Frank

    ReplyDelete
  2. I don't get it... Nothing there sticks out as abnormal. Townnames and other names are what they are, however odd, and naming a building or treatment center after a major donor is as old as time.

    ReplyDelete
  3. Looking again at the 'no emergencies' sign (which I did miss the first time); it's simply reminding people these are medical offices, where you need to make an appointment, not walk-in clinics. That isn't something new or odd, in my view. You need immediate medical care? You look around for an urgent care clinic, or an established ER.

    ReplyDelete
  4. Dear Aleigh,
    Do me a favor Google "emergency department closures in United States." Then come back and tell me that there's nothing wrong with this picture.

    ReplyDelete
  5. If specialists want to shun emergency care/not take ED call, that's their decision..to each his own. Im always at a loss when people tell me of their longstanding passion for radiology or their hatred of EM and acute conditions in general (did you really go to medical school because you found cosmetic surgery to be your calling?) But it takes all types I guess.

    It hurts the quality of care patients are getting, but if it gives me, as an EP (eventually...)the opportunity to do procedures/medicine that would normally be reserved for the specialist on call, its a bit of a payoff, I guess.

    Or do the patients just end up not getting the care?...

    -MS1

    ReplyDelete
  6. Dear MS1,
    play out that scenario... tell me what you come up with. give a minute and I'll tell you why you and everyone shod run away from EM, and fast.

    ReplyDelete
  7. Unfunded mandates, etc...

    ReplyDelete
  8. I think I'm going to die horribly someday because of all the ED closures.

    ReplyDelete
  9. Thinking...

    Malpractice? Maybe 911 shouldn't be performing laparotomies behind curtain 4?

    I spent all of last night in the ED, im high on central lines and LP's.

    --MS1

    ReplyDelete
  10. I'll give the little guy a hint 911.

    MS1, name the door at the hospital, that if kept closed, would most effectively reduce money from flying out of the hospital?

    -SCRN

    ReplyDelete
  11. Here's a hint... 28 yo gsw chest... Dumped on your doorstep even though you are not a trauma center... You crack his chest and save his life for the next twenty minutes... You have no trauma surgeon... Your general surgeon is one of only two on staff and this is his night off... Life Flight is weather down... Trauma centre on diversion... What do you do?

    Or a precipitous delivery but you have no OB on call...

    Or a facial abscess, septic, but you have no ENT on staff or OMFS...

    Or food bolus impaction... But GI is not on staff...

    All have surrendered their hospital privileges to avoid ER call an it criminal requirements...

    What now?

    ReplyDelete
  12. They are working at Hutchinson on the Parkway...

    ReplyDelete
  13. Well 911, you dipshit, you didn't let the kid figure it out for himself!!

    ReplyDelete
  14. I dunno, I just wish I had the ability to

    a) sew up the 28 y/o's torn SVC
    b) deliver the breech baby
    c) drain and pack the abscess
    d) remove the food bolus myself
    e) get the easy new mother's number

    I know that's all unrealistic and I know that not having the proper coverage leads to worse outcomes--I'm just saying that if there's something good to come out of it, it's the opportunity to do more, see more, be part of more.


    -MS1

    SCRN--is the answer the women's bathroom?
    oh, wait, that was the last blog entry. ;-p

    ReplyDelete
  15. ah MS1,
    you and me we are twins... i too wanted to help... desperately... i wanted to be the one running to the fire when everyone was running away... and i did it... can't do it anymore... i had one third of a career in the ER and the sad thing is that all we would need to do to fix the ER is to allow ER docs to say 'no'. that's the other thing, MS1, you can't say no. ever. i mean, you can, but if you do you will be fired or sued or both. and after a while having all the consultants dread your calls does wear on you, and for those who don't get that it's not 'personal', that you are not 'killing them' on purpose, you just might find yourself, like i did, asking one of them to step out into the parking lot so you could finish your discussion, and then you realize, when you are about to fight your own teammate, that something is horribly wrong and that you need to leave.

    ReplyDelete
  16. I gotta do it though, gotta. I just can't see myself sitting behind a TV screen looking at plain films all day or shuttling around my family practice monitoring serial BGL's.

    ugh. you're killing my buzz, man.

    -MS1

    ReplyDelete
  17. Oh 911, let PollyAnna keep his dream alive a little longer. Stop telling him the truth. Let his bubble stay afloat awhile longer. Let him punch out the surgeon at 3AM and feel like he's the good guy. It was good for me! Just not my pocketbook..

    ReplyDelete
  18. MS1,
    and Oldfart... contrarian that i am.... back in the mid nineties the thing that was dying was anesthesia... now it's the place to be... the fact is that there is no one that can save lives like we can... eventually, others will realize it and listen to us and we will be allowed to say 'no' again... something will change for the better... hell, someone may invent a lab test that quantifies physical pain levels... that would solve it right there!

    and to you, doc, that i asked out into the parking lot, the offer still stands.... you pedantic, effete, mincing, prancing pussy. ANYTIME, but i know it's not your style. nice prius by the way.

    ReplyDelete
  19. 911, you are being obtuse.

    You see MS1, the specialists can be sneaky and exit stage left right when you need 'em. They don't really HAVE to take a patient from 911, well, they are supposed to (God says so), but there are ways to well, pretend you were "busy" at some hospitals if that patient doesn't have great insurance. You and 911 by law, have to treat everybody. Here comes the family all in tears looking to you to fix the mess the ambulance brought in, and you don't have a surgeon who will answer call.

    Everybody loses tons of money on trauma (or what ever) patients without insurance, coming in through the ER to surgery to ICU... EMTALA. So, you got places like Hucheson sprouting up, who can pick and choose patients with good insurance. What specialist wouldn't rather have that with everything all nice and little chance of losing money? They also will never hire an ER doc over there, because they will never offer ER services.

    -SCRN

    ReplyDelete
  20. ding ding ding!

    and i don't blame them and that's where i part company with ACEP and many of my colleagues.... specialists did not train to take care of all comers... i did.... if the ER is ruining their lives and losing them money (and it most surely is) then i am not angry at them for bolting. i am angry at the government for making it a federal law that we can't say no to anyone, anytime, for any reason.

    ReplyDelete
  21. I don't envy a specialist either (should have said) having to take contract-call and finding him/herself emergently cutting into someone's head, chest or abdomen without really anything other than a few labs (maybe), and a CT and no idea of past hx/comorbids, etc. Then, after all that and losing another of your 9 lives, you don't get reimbursed worth nothing, and you find that something little screws up because of some hx you didn't know about and you get sued -- you'll probably be OK, but there goes another of your 8 lives having dealt with all that crap. Soooo many are just waiting for a chance to sue. It blows my mind. Of course it's better to plan every surgery.

    -SCRN

    ReplyDelete
  22. Hey I know that hospital. It's down the street from my in-laws and it is desperately trying to merge with a large Chattanooga hospital. If it doesn't, it'll close. There are few docs there now. That's why the ER is closed. Its financial situation is horrible.

    ReplyDelete
  23. dear stork doc,
    you are correct about location... that's where it is... have no reason to doubt you about the rest of the story... doesn't change my point... ERs vanishing... specialists running away from ER call... i'm sure you will agree.

    ReplyDelete
  24. C-C-C-C-C-Caint W-W-W-We Just G-G-G-Get along??
    and I do the best Rodney King impression....especially the "tazed large black man on PCP" dance...
    Seriously, I haven't seen as much Sturm und Drang since I left that copy of "Mein Kamp" in my a-hole Pediatric Interns short white intern coat by mistake...too bad I forgot to take that "Property of Frank Drackman" sticker that I put on the inside cover of all my books, cause you know how many book burglars there are...
    Specialists not takin ER call?? What is this, RUSSIA!!!!!!!!!
    I mean Canada? where physicians work for the Government for PEANUTS!!!!!!!!!!!
    How would YOU feel, 9-11, if you were home jerkin off, and some Yahoo called YOU up wantin to dump some disaster of a patient on you? You'd be as upset as I would be if my College Football Team went 6-7 despite decades of top 10 recruiting classes, but you won't fire the coach cause he goes on Missionary Position trips to Africa...
    Old Fart, aren't catecholamines bad for your ICD???

    Frank

    ReplyDelete
  25. But Frank, your business card says you can do any procedure one-handed...

    -SCRN

    ReplyDelete
  26. dear 14-0*,
    it's 'mein kampf'...
    and i only have a beef with one specialist... the one that i asked into the parking lot, except for him, i agree with the specialists, i would be running away too.

    you know, you are really adding up a bunch of karma for when aubie does a nose dive next year and the dawgs with the SEC. but i'm not a vindictive guy.

    ReplyDelete
  27. 9-11,
    sorry about the "Mein Kamp" typo, my keyboards got a sticky "F" key...Nome Sayin'???
    and if current trends hold, Auburn won't win another BCS until 2064, when I'll be 102.
    UGA should be due in...lets see, 1942, 1980, carry the 2, 2018...
    When Old Fart will be 102...

    Frank

    ReplyDelete
  28. That facility is in my hometown and is about a 5 iron away from the office where I practice primary care. It is NOT an inpatient facility. That is 7 miles or so down the road. The NO EMERGENCIES sign has been up since they first opened the building. It has no ED, no acute care clinic, and never has. The ED at it's parent facility is wide open and running as usual. No ED was closed in the making of this building, erection of this sign, or in the making of this picture.

    The parent 200bed hospital itself is averaging a census of 12 and will be bankrupt in a matter of days if it does not merge with the large teaching hospital in Chattanooga that is my employer.

    ReplyDelete
  29. dear Dr dawg,
     
    I hate NPR, that's why I'm using them here (http://www.NPR.org/templates/story/story.php?storyId=5485842). my point in this post was never to say that this particular facility, that I happened to drive by on the way to the beach, was not seeing emergencies because they had closed their emergency department, rather, that it serves as a symbol of a trend to take specialty care out of the tradtitional hospital, many times, precisely to avoid being tied to the ER and all that entails. reading the comment section (above where you commented) at 3/26 11:58, 3/26 12:19, 3/26 19:14, and 3/26 at 19:15... well, this has been hashed out. but thanks.

    ReplyDelete
  30. Dumb A** Loser UGA fans...
    can't even keep an inbred English Bulldog alive...

    ReplyDelete
  31. OK, Let me clarify...
    The sign is for a MEDICAL OFFICE BUILDING.
    It's a big shiny building that might be confused with a HOSPITAL by some meth-addled North Georgian.
    The NO EMERGENCIES sign is an attempt to prevent stroked out gramma from being pushed out of the back of the pickup truck at the front door at 2AM.
    911: if you were on the way to the beach, you shouldn't have exited I75 at Resca (the Yankees already burned it, and all we have left is this meth lab!

    ReplyDelete
  32. Oh by the way...
    The "Battlefield" part is because the building is about 5 miles from Chickamauga.
    A very unpleasant place to be in 1863.
    Not So bad now.

    ReplyDelete
  33. Auxilliary breast center? I guess I know where I can get that third tit I've always wanted ...

    ReplyDelete
  34. dear peggyU,
    i'm slipping.... i missed that... let this be the start of the auxiliary breast campaign... auxiliary breasts for everyone! and then we can start a pink ribbon campaign to prevent auxiliary breast cancer, but the ribbon will have to be redesigned.

    ReplyDelete
  35. Battlefield a "bad" place to be? Well sure if you were one of the boys in blue it sure was. One of, if not THE last great victory of the guys in gray of the whole conflict was Chickamauga.

    Never one to be considered forward thinking Gen. Bragg did not pursue his advantage and got his ass handed to him a few weeks later in the Battle of Chattanooga. Terrible, terrible military tactician was Bragg.

    911, after reading all the comments I now get your point. I was just very excited to see something I see every day and am very familiar with featured on such a "famous" blog.

    Now why the hell did you come down our little road off of I-75 on the way to the beach? Much better places for a respite iyam. Now, if you could have timed a visit to the aforementioned Resaca during the world famous Resaca Beach Poster Girl contest you might have been on to something!

    ReplyDelete
  36. 911,
    Do I have to be nice to Panda? OK, maybe I'll stop in and say "Hi" later ...maybe, but I'm going to watch ALL of American Idol ...cause it's really important and all.

    -SCRN

    ReplyDelete
  37. dear scrn,
    panda is a big boy and can take care of himself. have fun watching american idol... never did get the whole thing, but then again, since i was forced to play the flute in marching band in 7th grade by my parents i have had a gut-level revulsion against bad music and bad performances. guitar... why not the guitar mom and dad? come on man!

    ReplyDelete
  38. This is my first time watching it and I'm hooked. I find that if something bad happens to one of the contestants that I like, I'll cry ;( which means work is way stressing me out and I need to cry.

    -SCRN

    ReplyDelete
  39. The finalist Alaina on AI is goes to high school about 3 miles down the road from the sign noted at the top of the post. Local NW GA girl.

    ReplyDelete
  40. Dawg,
    I really enjoy listening to her. Would buy her music if she isn't ruined by any of those awful producers they have on that show, and that is big because I am definitely not a country music girl.

    -SCRN

    ReplyDelete
  41. frank,
    nearly forgot... we may not have been able to keep Uga alive but didn't you guys just gave some fucking TREES die on you? wonder if that dipshit waste-of-carbon poisoned Uga too?

    ReplyDelete

ALL SPAM AND GRATUITOUS LINK POSTINGS WILL BE IMMEDIATELY DELETED.