Lessons from an Emergency Room Nightmare

via AlterNet:



Lessons from an Emergency Room Nightmare

By Harold Pollack, The American Prospect. Posted December 18, 2008.

Several people made mistakes in my wife's care. The worst and most deadly mistake was ours.



I held my wife Veronica's hand as the technician applied cool gel to her chest. At first, the ultrasound images were the fuzzy black-and-whites I remembered from before our daughters Rebecca and Hannah were born. After a few touches to the LCD screen, a breathtaking three-dimensional movie began to run. It featured Veronica's heart, its thick walls beating yellow against a black background.

The technician maneuvered a trackball to reveal the various parts undulating in unison. Colored regions displayed blood velocity and turbulence through the different chambers. Suspended in virtual space, Veronica's heart looked every millimeter the impregnable pump I had always assumed it was.

Veronica is 46, does four hard workouts every week on the stepping machine, eats sensibly, and has a resting pulse of 60. So when she woke me at 2 A.M. and calmly reported funny chest pains radiating to her shoulder blades and down her arms, the obvious came to mind, but it was hard to really believe. Veronica and Rebecca had been coughing and feverish for a week. The three of us had embarrassing cold sores. Acid reflux, a sore diaphragm -- anything seemed more likely than a heart attack.

You need a hard head and a soft heart to manage a loved one's medical emergency. It's surprisingly easy for smart people to be nudged by circumstance and human frailty into doing careless or foolish things. We had two sleeping daughters across the hall. The thought of them waking up to flashing ambulance lights was daunting. We worried about leaving them or dragging them to an emergency room. Still, Veronica had never felt anything like this. We had to do something. So we threw on some clothes, and drove to the 24-hour urgent-care center a half-mile from our house.

***
Several people made mistakes in Veronica's care. The worst and most deadly mistake was ours: going to this urgent-care center. Veronica's symptoms demanded a 911 call. I knew better -- or I certainly should have. I am a certified expert, director of the University of Chicago Center for Health Administration Studies. I've served on expert panels of the Institute of Medicine, no less. ..............(more)

The complete piece is at: http://www.alternet.org/healthwellness/113091/lessons_from_an_emergency_room_nightmare/

is that the writer, who works in healthcare public policy couldn't when the time came negotiate the healthcare system to get the most efficient and useful care for his wife in what they really thought was a life-threatening emergency. He was a clueless and scared as we all are when our loved ones are deathly sick, or seem to be. We don't know. We're not qualified to make that distinction.

But in the caveat emptor world of lassiez-faire capitalism as applied to healthcare that we have in the US, it is incumbent upon the customer/patient to shop and compare services and outcomes, and get the best care for the best price. Right. You try that when you are scared out of your mind with worry, or too burdened by treatment to explore further options. Using healthcare is not interchangeable with searching for a better grocery store, as some immoral economists seem to think.

Is it any wonder that less bureaucratically savvy people have problems getting the proper care? Lots of people wind up in the ER who shouldn't be there just because it's the easiest, most visible intake point for the patient for the whole system.

I'm lucky. I live about five miles from a major research and teaching medical center. It is also my closest urgent care facility. I have been to urgent care places, but for nothing more than a cut.

In the writer's case, it eventually worked out. But not everyone is so lucky.

Our healthcare system is such a mess. This writer's voice as an important one because he can see both sides of the system, from the professional and the patient side. I would hope that his colleagues would listen to him about the dysfunctionality of our healthcare system.

I have been saying for years that now, one has to view and speak to most doctors like Used Car Salesman.

I have had to stand my ground on getting even the simplest, most obvious treatment, such as an x-ray to establish a baseline.

The fucking guy is trying to bullshit and gladhand me out the door without even establishing a baseline for future comparison should the problem worsen!

I did stand my ground and get my x-ray, but fuck if I didn't leave his office shaking my head that such was now the NORM not the exception.

The difference with our clinic is that we do not bill insurance companies and thus are not beholding to the insurance bean counters.

It also means that many patients will decide not to see us until their case is critical.

We shake our head daily at what some of what our patients put up with, the crazy decisions, etc. at other clinics, however I must tell you that the doctors and nurses in what we call captive insurance clinics is predicated by the fact that they can't get insurance companies to pay for many procedures without spending at least 1/2 an hour on the phone for pre-authorization, and then hoping that you might get paid eventually.

The insurance companies have got to go. Any solution that allows these blood-thirsty vampires to continue to exist will mean that health care in America will continue to be the worst in the developed nations.

We can and must do better.

"It also means that many patients will decide not to see us until their case is critical."

How much do you charge for a patient to just walk into the room? Do you give your patients a break on your charges - because YOUR costs are lower, not working with the insurance companies. Do you pass those savings ON to your patients? Or do you pocket those savings and charge the going rate of every other doctor in your area?

Pardon my skepticism, but in my area the doctors who claim to not use insurance will let people pass out in their waiting rooms, if they don't have CASH IN HAND.

No CASHEE, NO HELPEE. :sarcasm:

Of course they don't come to you until it's critical. They are (rightly) afraid that they will be signing away their life savings in order to get treatment. The whole system is FLAWED. Including the horrendous charges patients get hit with.

is the hip term in medical circles.

Well, it's one anyway. The idea is you stop taking insurance, dealing with the insurance companies, and get customers patients to sign up with your office for a flat yearly fee. The going rate has been about 3-4K and up. It's very nice for those that can afford it. But it does nothing to add to the total care available in a neighborhood.
It's rather like a private club.

But i do wonder, if that's so, is the practice then free to discriminate on what "members" they will accept? Are you as a patient still covered by all the typical laws governing medical care and malfeasence/negligence? I don't know. But it does make me wonder.

Hey, I used to work in a medical office. I'm all for docs not having to deal with the insurance companies. They are as much of a pain for the staff as they are for the patients. And they definitely hold care hostage, which is evil.

i have to say, as someone who has been to the er many times, it takes good advocacy to get good care, and it always has.
and people do hesitate to get care. my grandfather in law had an obvious heart attack back in the day. he didn't want to go. he shaved and put on a clean shirt first. that is how people are. that was way, way before the day of the wallet-ectomy.

no question. People scurrying about, barking orders, nurses and docs both (AT EACH OTHER! :rofl: ) Machine alarms constantly going off. You get to wait in a cold room while the staff go off and decide things about your care.

This is doubly bad if you have a patient with mental problems and can't really articulate his/her needs well.

I have a medical condition that requires that I know quite a lot about that area of medicine. I can't tell you enough about how well it has served me.

There definitely needs to be more effort put in to equalizing the doc/patient relationship, making it more of a partnership and the medical person taking on more of the elements of a coach. That would require a sea change in how we see medicine though. We would need to start placing more emphasis on wellness practices, rather than just dealing with people when they are sick.

i wouldn't even know what was wrong with me if it weren't for the internet. much as it bugs some docs, it has changed everything.

My primary care who is a wonderful Dr. sent me to a specialist for a "Redundant Colon", in short the colon is too long and can flip and cut off circulation to the rest of the organ my symptoms were major discomfort but it was progressing and if not treated the worst case is a choked off organ dying and catastrophic results.

The Dr. that I went to listened to my explanation looked at old films and had me go get more tests. When I met him in the 3rd week of Sept he said, "MM..hmm I want to do surgery next week", that is the point where I thought this is really bad. So I ended up getting surgery on Wed Oct 1st, the staff at the hospital was fantastic. I was home on the Friday the 3rd day.

T he surgery was successful. When he came to visit me he said that it was much worse than he thought and the colon was at the point of being completed choked off....

Needless to say I have been going to various specialist for two years and I got lucky and got to the right one. I have insurance, the bills if I would have had to pay out of pocket would have banktrupted me.

Healthcare in this country has to be examined and it has to change....