Grinding to a Halt

I’ve been in a foul mood of late at work, and it’s because I see the beginning of the end of the health care system I know and respect.

I am not involved in health care policy, or planning, just the trench-line delivery of modern, ‘high-tech / low touch’ American medicine. I realize it’s terrifically inefficient and at the same time realize I am individually powerless to change it. However, I’ve been thinking more and more about our future, and it’s not at all good.

I’ve recently had several interactions just like this one from Australia:

Sometime during the night they were moved out into a corridor to make room for the incoming. I saw them again the next morning. There was no longer any room to sit beside her, so he stood at the foot of her bed. He was angry. “This is disgraceful” he shouted. “I’ve had top private health cover for as long as I can remember….and now I need it, I can’t even get a bloody bed for my wife!”

He sat, red faced and embarrassed at his outburst. It was all beyond him.

Since November, with few exceptions, we’ve been ‘holding’ admitted patients in the ED. Yesterday we had about 1/3 of our physical rooms occupied with patients ‘admitted to the hospital’ who were going to be cared for in the ED. No windows, no TV, no phone, just a real hospital bed, real hospital food and their medications. It’s the biggest shock to people who haven’t been to an acute care hospital for a while, and just assumed there would be space in the hospital for their loved one. This is, by the way, after we’ve been putting admitted patients in the hallways of the upstairs wards to try to relieve the ED overcrowding.

So, 1/3 of our space is now dedicated to inpatients, therefore the hallways were lined with gurneys of the actual ED patients. Four years ago this was an occasional, ‘surge’ thing and now it’s everyday and around the clock there are patients being cared for in the halls. (Mental exercise: describe how much fun it is to give a history in a busy hallway with people and other patients / families constantly walking by, and I’ll leave the thrill of the physical examination to your imagination).

There’s no incentive for hospitals to add beds, unless you happen to have one of those really-well-billing cardiac diagnoses, and there’s money for that, so hospitals are building cardiac units that are closed, meaning if you don’t have a cardiac diagnosis and a cardiologist on the case you lie in the hall. We have, simultaneously, the best and worst healthcare has to offer.

I’m of the opinion many of the problems of modern healthcare do stem from a complete absence of a market in medicine. I wouldn’t take my car to the shop and just say “fix it” without at least discussing the costs (unless I had the insurance / medicare system for my car, then I’d drive it like a nut and sue if it wasn’t perfect when it came out of the shop). I’m 100% for posting signs in the waiting room, patient rooms (and, regrettably hallways) outlining what these tests they’re getting charge. It’d be eye-opening, and it might just cause a few people to think about need vs. want, and would make my job a little harder. I’m okay with that. I’d like to discuss the pros and cons of ‘do you really need me to CT you from stem-to-stern’ with an alert patient who’s able to make informed decisions.

People ask me what I think the future of medicine is when we’re staring at the overcrowding, and ask what I think will happen. I don’t think it’s going to be anything cataclysmic, we’re just going to grind to a halt at this rate. Money continues to be poured down expensive therapies of marginal benefit, there’s no barrier to asking for more healthcare, “now!”, and have a quick peek at nursing demographics if you’re in doubt about the short and long term problems we face.

The Wall Street Journal (may require subscription, sorry) has an editorial about healthcare today, and here’s the money:

[Shifting to a market system] won’t be easy, especially given the ideological stake that so many politicians have in a government-run system. They like the leverage of determining payment rates to hospitals and doctors, not to mention being able to take credit with voters for providing more benefits. But there is no free lunch in health care, any more than there is in any other part of the U.S. economy.

Health care is either going to be allocated by prices or by government, which in the latter case means price controls and waiting lines. Though it represents one-sixth of the U.S. economy, health care is the one industry in which the purchasers actually have no idea what anything costs. An individual market for health insurance would allow more freedom of choice while making consumers more cost conscious.

If we don’t do something, soon, there not only won’t be a medicare system, there won’t be anyone in the hospitals left to take care of us. If we can get out of the hallway, that is.


Comments

  1. “Name one where millions were awarded for “emotional distress” without physical injury”

    C’mon Matt, even with your last added disclaimer just use google for lots of fun and interesting reading.

    “She can’t get an answer NOW, and she hasn’t hired a lawyer.”

    A good way NOT to get an answer is to get a lawyer involved, because then any discussion or apology will be construed as an admission of guilt and used against you in the courtroom. Gruntdoc and the previous posters are correct, TRY writing a letter or talking to administration first. You think yourself way too important. Nothing will misconstrue the truth from both sides once lawyers are involved.

    In 3 frivolous suits filed against me the first thing I ever heard from the plaintiff was a letter from an attorney. I would be happy to talk with a patient or family but you have to come to me about it. I see 25-30 patients a shift, I don’t follow everyone home or know what happened. Now the decedant in these lawsuits will suffer through years of lawyer agony only to learn that death happens while keeping lawyers employed on both sides wasting money.

    “You guys are almost Bushian in your willingness to blame literally everything wrong on others, and claim that you haven’t made a single mistake.”

    Huh? I’m no bush fan and disdain politics in general, but what does Bush have to do with it? unless you want to blame him for everything like the liberal left. “Its not my fault” has always been the liberal battlecry.

    DS is right, you really have lost all credibility. Find a new pseudonym and start over.

  2. “C’mon Matt, even with your last added disclaimer just use google for lots of fun and interesting reading.”

    So I take it you couldn’t cite such a case. I’ll try again. Please list a med mal case where a victim got millions in damage for purely “emotional distress” unaccompanied by physical injury.

    “You think yourself way too important. Nothing will misconstrue the truth from both sides once lawyers are involved.”

    Actually, I don’t think I’m all that necessary at all. What’s sad is that you think it’s perfectly fine that her own physician won’t even speak to her, and now she should have to write a letter to the administrator. Why would you testifying under oath make the truth misconstrued? Would you lie?

    I’m sorry you didn’t get the Bush reference. It’s an analogy, but if you don’t have the context for it, it’s understandable. What’s funny is that if you read your posts, “it’s not my fault” seems to be your company line.

    I’m not too worried about the assessment of you and ds on my credibility. You two may be OK physicians, but beyond that your understanding of most other things appears to be painfully lacking.

    Watch out for that train!

  3. “So I take it you couldn’t cite such a case. I’ll try again. Please list a med mal case where a victim got millions in damage for purely “emotional distress” unaccompanied by physical injury.”

    I won’t waste time looking, but to parce things like a lawyer for you. I never said “got”, I said “claimed”. I never said “without physical injury”, you added that disclaimer as well.

    “What’s sad is that you think it’s perfectly fine that her own physician won’t even speak to her.”

    This is why you have no credibility as a troller. READ FOR COMPREHENSION (your favorite line). I NEVER said that was ok. Don’t put words in my mouth. That is why I say find a new pseudonym and start over.

    Sheesh, this is so childish, but CONGRATULATIONS Gruntdoc, you got 100 comments from your original rant.

  4. “I won’t waste time looking, but to parce things like a lawyer for you. I never said “got”, I said “claimed”. I never said “without physical injury”, you added that disclaimer as well.”

    Oh, so what’s important is not the actual result, but the claim. I see. And actually, what you originally asked for was to be compensated for the “emotional stress” of going through trial and implied that people got millions for similar claims. Presumably, that does not include a physical injury. In essence, you were just spouting off nonsense.

    ” READ FOR COMPREHENSION (your favorite line). I NEVER said that was ok. Don’t put words in my mouth. That is why I say find a new pseudonym and start over.”

    I hope you take your own advice because it’s pretty clear you aren’t reading what you write. You’re a nice kid, Jerry, but stay away from the hysterical rantings of the alleged ills of medical malpractice. You’re smarter than that, I’m sure.

    What’s amazing about these 100 posts is that, like most of the lobbying efforts and money spent by doctors, it’s about something that will ultimately effect them very little. Meanwhile, the bigger issues cruise right on by.

  5. That Girl, Jerry is absolutely 100% correct about the fact that once attorneys are involved nobody is going to talk to you. The best advice I have is get all your ducks in a row. Get a copy of the medical records, sooner rather than later. Read them closely. Then, go and talk to somebody high up in the administration. We didn’t make an appointment. We showed up at the administrator’s office. He was in a meeting for 2 hours. And we waited for 2 hours. Then we presented the records to him and asked what the hell was going on. We asked, How do you have a physician employed in your hospital who tells a ninety year old man he is going to have to “find a way home,” after he has fractured his hip in 3 places (the radiologist read it the next morning), and then give him no pain medication. My grandfather actually had to call his own ambulance to take him back home, because he couldn’t walk. If you think that administrator wasn’t squirming. He stammered and stuttered. We were pissed. THe hospital will do an investigation, and at least at the hospital my loved one was at we were told we would be notified of the results of that investigation. There’s always the option of suing, but that is a very long arduous process I wouldn’t wish on my worst enemy. If there’s any other route, I would say take that one. If you don’t get the answers from the hospital, then there’s also the option of filing a complaint with the dept of health or the Board, they will do an investigation, also.

  6. I just read DS’s comment about suing the nurse – that’s exactly what I was thinking. I thought IV’s were under the nurse’s domain. Aren’t nurses supposed to be monitoring and watching for infiltration?

  7. I’m a patient, but I couldn’t agree with you more. There are many areas in which patients could use more information . . .cost is only one of them.

  8. Wow, I thought it was over until I checked back. It probably is the nurse’s fault (if any fault) but I really dont know how it works. That was kind of my point.
    Who is responsible?
    I dont know, and frankly, Im more interested in fixing the problem rather than blaming someone.
    My son was diagnosed with a heart defect that would (in his case) leave very little margin for survival after birth. I read up on everything and came back to the doctor to tell him I had decided to go through with the pregnancy. I had read about many successful treatments and read about many thriving children. He said to me “Of course, you’re not going to hear the unsuccesful stories.”
    I took his point, and I was just trying to make the point that doctors never hear about people like me – who dont know (until you guys provided me with several answers) what to do to get an answer out of the hospital staff and are unwilling to sue as a reflex. We exist. Some of us get bad care.

    I was only trying to posit to a weary ER doc that there are plenty of us who are unlike the bad people he sees – just as I dont automatically assume that the ER doc Im going to see is stupid/negligent just because one was in the past.

    I would LOVE to have a medical review board but practically, for every person like me who may just want “Im sorry I screwed up. Ill be a lot more observant/change my habits so I get more sleep” there is someone who thinks that a reasonable accident should probide them with enough money for life. Or even the understandable if illogical view that someone must be to blame for everything and no margin for error exists anywhere.

    Once again, thanks to all the ER docs!

    And thanks for the explanation of the test-after-I-leave thing, Good to know. And fyi, i do understand why viruses and antibiotics dont mix I just didnt understand the connection since no one has ever called me to follow up from an ER.