One way universal coverage can save costs | DB’s Medical Rants
An ER physician justifies an admission for expediency. This patient needed an outpatient evaluation, but our dysfunctional health care “system” make him consider inpatient evaluation the best option.
So this patient spent 3 days in the hospital, at an outrageous cost, to obtain the evaluation. Of course the ER physician justifies the admission.
I know nothing of this particular case, but I’ve been in the same situation: a patient who needs an eval by a good internist, or a specialist, but it’s the patient has no insurance/it’s a long holiday and the patient cannot wait/the patient is unlikely to follow up as an outpatient/ it takes little imagination to understand why this is occasionally done. So, we get the patient admitted, usually to an overworked hospitalist who nonetheless understands the patients’ plight and admits them.
That’s right: it’s not the ER doc who admits patients. It takes two to tango, and to admit. The admission Dr. Centor is raving about here was done NOT by an EM physician, but an internist. All any ER doc can do is plead their patients’ case, but it’s the internist who makes the decision. Sounds like some displacement…
“Expediency”. One persons’ expedience is anothers’ outstanding, expedited care. Just because it’s inconvenient for Internal Medicne doesn’t make an admission wrong. That the system is screwed up and costs several fortunes isn’t the fault of ER docs.
As there is a shortage of primary care docs in this country, his last paragraph (go read the rest) fails to impress. We could go Single Payor/Universal care tomorrow and there would still be a primary care shortage for a decade, and that’s assuming primary care gets paid like they should.
DB is a very good blogger, and a terrible Emergency Medicine bigot. Too bad, he’s missing out on the most interesting group of docs, personal and professional, ever.