SOME COMMENTS FROM AN ER PHYSICIAN:

Right or Privilege:

If health care was a right of every person, every patient, US citizen or not, would have access to medical care - whether they could pay or not. Actually, this system is already in place at every state-funded university or teaching hospital in the nation. Due to EMTALA (Emergency Medical Treatment and Active Labor Act), emergency physicians and hospitals are FORCED to see and treat people who can't pay. EMTALA defined- any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives. So, we as ED physicians and the hospitals that house us, are forced by law to see and treat patients who can't pay for services, and then are still liable for litigation by those patients when there is a bad outcome. I'm sorry, but if I am to be forced by the government to see and treat you, than the government should be liable, not me. Better yet, don't sue, be thankful you're even getting care, and stop being a drain on society.

What is supposed to happen in this system is that people get their medical care and the government picks up the bill; however, in our current system, this doesn't happen. So, people get their free care and who pays? Nobody. The physicians and hospitals supply all their services (nursing time, equipment, supplies) free of charge. Basically, the hospital and physicians are giving charity care, which should not happen. The end result, hospitals have to overcharge patients who CAN pay for medications and supplies in order to partially offset the enormous costs of giving away care to the millions that can't afford it.

In the last decade, over 400 emergency departments have closed while the number of patients seeking emergency care has jumped over 10 million - leading to problems with waits for beds and boarding of patients in EDs. Now, in a monetary economy such as ours, you would think that with such a demand for emergency care, emergency departments would be springing up like weeds. Simply put, medical care, in selected areas throughout the country is socialized and free. It is the non-paying American public (citizen or not) who is driving American health care into the ground.

Health care is a privilege, not a right. Every person deserves care for actual medical problems, but with so many people actively abusing the system (getting free care for non-life-threatening problems and wasting our time) my sympathy on the matter is gone.

SMOKING

Patients who need to walk outside in a hospital gown trailing IV poles to smoke cigarettes are extremely frustrating. They waste everybody's time. The nurses sometimes have to wheel them outside, plus, I stop by in the 2-3 minutes I have to see them during the day, and they aren't even there. I understand that smoking is quite possibly the hardest addiction to kick, but it is just bizarre to see a patient outside with IV pole in hand, gown on, no shoes, sick as hell, and smoking. Kind of defeats the purpose of what we're trying to do at the hospital, don't you think?

On a different note, smoking should be absolutely banned from any public building, including the outdoors part of a restaurant. Sorry, just because you made the extremely bad decision to start smoking doesn't mean that I shouldn't be able to enjoy a meal outside. First of all, you smokers stink (how can you not tell?), and secondly, your smoke always seems to blow right in my face. But, when you come into the emergency room for your chest pain, shortness of breath, and massive heart attack, you won't be smoking then...there's no smoking in the hospital.

I think the whole concept of natural selection is completely wrong. People who become highly educated, acquire good careers, and actually have something to contribute to society usually have to wait to have children. By the time they do have children they have an increased risk of birth defects or problems with pregnancy. On the other hand, it seems like any teen with half a brain, but able to screw, is able to get pregnant on the first try and have a completely normal baby. Unfortunately, these teens will have their babies, never go far in school, will take the lowest jobs in the world and be total drains on society, while all the highly educated people who can't have kids end up paying high taxes to cover the medical care, food, etc. of these young societal black-holes. Natural selection is failing miserably.

BROKEN HEART

Informing a family that a loved one is very sick or died used to be the toughest part of the job. The absolute worst is informing of a child's death. Obviously those times are terrible and nothing can prepare one for dealing with the emotions, which is probably why doctors have a high rate of alcohol and drug abuse. Thankfully, I have neither. My saddest moment thus far...

An elderly woman was brought into the ER from home due to dehydration. She had a long-standing history of Alzheimer's dementia and received care from her elderly husband. They lived alone and it became quickly apparent that the woman was not dehydrated, but perfectly normal (in a demented way). The husband had a look on his face of fatigue. He had spent the last 5-7 years watching his wife deteriorate into an abusive shell of a woman. Apparently, the years had finally taken their toll and his call to 911 for dehydration was actually a cry for help. He had been trying to arrange for both of them to go to some assisted care facility in Penn. or South Carolina, where their daughters lived. Basically, he was trying to do this on his own, with no money, no family close by, and with a wife that needed constant care. I was amazed at how strong his love for her was. He was keeping his vow to take care of her in sickness and in health, and was being destroyed for it. Truly tragic.

SOCIALIZED MEDICINE

This is for those who dream of socialized medicine where all people have access to medical care. Wake up! It already exists in the U.S. Any poor, homeless, or uninsured person is able to walk into any university or teaching hospital and receive FREE care. They can't be turned away, it's the law. They will walk though those big expensive doors of a state-of-the-art facility, see world-class physicians, receive the same top-quality meds that any CEO would get, and are placed into hospitals where the most cutting-edge research is taking place. When these patients leave the hospital, they still have no money, and they will never pay their bill. So, what happens. The hospital and I eat the costs.

Now, if you are complaining about the system, you are probably a well-educated and working individual with enough income that you actually do pay your medical bills. Unfortunately, the real people being screwed in this whole ordeal are the working middle-class. American medical care is expensive (due to litigation, the price of malpractice insurance, expensive medications, research, etc.), and those working enough to pay their bills bear the brunt of the problem; however, you are still terribly naive to think socialized medicine is the answer. Before you cry any longer about the system do this. Travel down to Latin America or another country with socialized medicine and try it out. Acquiring health care and treatment is quite different with such a system. You may soon change you mind and come to appreciate what you already have a bit more. Stop thinking you're politically informed and start thinking more realistically.

If you really want to make a change in the system, here is my advice. Advocate for caps on malpractice claims and consequences for inappropriate lawsuits. The price of physicians' malpractice insurance will decrease, the price of physician costs will decrease, and hospitals and doctors wouldn't have to charge so much for care. As for the extremely high cost for medications, we're all screwed. Lastly, if you still want socialized health care that bad, leave.

ACCESS TO EMERGENCY SERVICES ACT

Here's the problem: Physicians that work at free clinics or urgent care centers, where patients can come in for emergent free care, are at no risk of being sued. They are protected under the law from litigation. Emergency physicians anywhere else are under legal force to see any patient that walks through the door, insured or not. Hence, uninsured patients who come into the ER, 1) end up receiving free care (usually the hospital eats the cost) and 2) can still sue the doctors forced to take care of them. Basically, we are forced to treat patients for free and then have no protection from litigation. If you think about it, some patients get free care and then get a large settlement because insurance companies would rather settle out of court than defend the doctor, even when that doctor didn't screw up in the first place. And you wonder why your medical bills suck.

LAWYERS AND MEDICAL COSTS

In regards to personal injury and/or malpractice lawyers, I think that anyone who makes a living in such a way must find it difficult to look at themselves in the mirror. I'm sure at some point during thier path to "greatness", they felt a flicker of humanity; however, it seems that such a flicker is momentary. Yes, I make a living off sick people...some may say that I am exploiting the sick just like those lawyers I speak of. If this is what helps you sleep at night, so be it. But I take comfort in the concept that, while mistakes will be made, I am trying to actually help the patient. These blood-suckers swoop in after mistakes are made and exploit not only the patient, but the physicians, hospitals, and insurance companies - all the while filling their pockets with no risk of being sued themselves.

For all you patients out there complaining about the rise in health care costs, look no further. I have your answer right here. As long as there are naive patients, with imperfect doctors and heartless lawyers, the amount I have to spend on malpractice insurance will increase, the amount of your insurance will increase, the cost of health care and medical bills will increase, and you will find yourself screwed. You, the patients, will ultimately be left behind in the end because lawyers will earn more, doctors will still earn a decent living, insurance companies will do just fine, and drug companies will run rampant over us all.

ANNOYANCE

Last night I was working another shift in the ED (emergency dept) and was once again annoyed by the absolute abuses taking place. It was the night shift lasting from 9 PM till 7 AM, and I was having a relatively good shift. I was working though patients quickly, solving problems, diagnosing, and getting them out the door or to the floor efficiently. Unfortunately, around 3-4 AM the usual folks walked through the door. This is the "It's 3 AM and I have a cold" crew of which I speak. OK, for those of you out there who can relate to these people, you're idiots. These people, who come in all ages and ethnicities, come into the ED in the middle of the night with nothing more than a cold or flu. What's even worse is that these same knobs, if I don't get to them right away because I'm off trying to help someone who actually is sick or dying, get upset and give me attitude because they have to wait for so long. Screw you. First of all, it's an ER, not a restaurant. It is not first come, first serve. If you think so, don't come in the first place because you'll just end up disappointed. And for those of you who do come to see me in the middle of the night with some benign and pathetic complaint, I will still treat you with the same care and professionalism you don't deserve.

Even though many of the concepts presented here may seem politically one-sided, I am strongly against party politics and will support whatever I deem fit to support. I have a very jaded view of society given the profession I work in; therefore, if you don't agree with me, it is simply because you have not seen what I have seen

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FEDS "LOOKING INTO" MEDICARE TRANSPORT ABUSE

Federal auditors are examining the skyrocketing costs of providing transportation to Medicaid patients across the country, a problem that D.C. officials are struggling to control. The Office of Inspector General for the U.S. Department of Health and Human Services said it "will determine whether state Medicaid agencies make erroneous payments for transportation services," according to its recently released 2007 work plan.

Medicaid transportation costs across the nation rose by 48 percent from 1999 to 2003, reaching $1.5 billion, according to the work plan. The District has seen its Medicaid transportation costs rise to more than $20 million overall last year. More than $16 million was spent on van rides alone, according to a report last month by the D.C. Office of the Inspector General. But the city's Medicaid transportation program, which also pays for public transit and taxis, cost taxpayers $14.3 million in fiscal 2004, according to the D.C. inspector general's 2006 work plan.

The program was also the subject of recent reports by the city's inspector general and the D.C. Council Committee on Health. The Washington Times on Monday reported that the District last year spent $22.3 million for nonemergency transportation of Medicaid patients -- slightly more than what the city paid for patients to see individual doctors, according to city records.

In the federal work plan, the inspector general does not single out the District or any state in outlining a review of Medicaid transportation services. Medicaid, which provides health insurance for the poor, is funded by the federal government and the states, which also manage their programs. Reimbursement rates and rules for Medicaid transportation vary by state.

"Since so much money is involved here, the federal government certainly has a very keen interest in how it is spent," Donald White, spokesman for the HHS inspector general, said yesterday of the nationwide look at Medicaid transportation costs. Health care consultant Robin Mathias said that it's not uncommon for Medicaid programs to lose 30 percent to 50 percent of nonemergency transportation spending to fraud and abuse.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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