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(CBS News)   One reason for the high cost of emergency hospitalization in the America? "Superusers" that are clogging the nation's emergency rooms by treating them like party rooms for any little thing that ails them   (cbsnews.com) divider line 259
    More: Interesting, Villareal, emergency rooms, San Francisco General Hospital, emergency physician, primary care physicians, MedStar Washington Hospital Center, rubber bands, American College of Emergency Physicians  
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9776 clicks; posted to Main » on 15 Oct 2013 at 10:22 PM (40 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2013-10-16 08:21:27 AM
Of course, I want people to have health care," Vinson said. "I just didn't realize I would be the one who was going to pay for it personally."

Link
 
2013-10-16 08:24:06 AM

ginandbacon: AlwaysRightBoy: If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.

Ah no! I have tutored kids in reading but it is a volunteer gig. It's insanely gratifying and something I would recommend to anyone. I have had insurance through the private sector and the public though. Both were wonderful. My private sector insurance was top notch. I think it was $10 to see my PCP, $40 for ambulance or ER visits, and $5 for meds. Admissions and diagnostic tests were free. I pay less with my gubmint one but it is a little more restrictive and I can't just do whatever my PCP wants whenever we want to. I have no real complaints though. Everything I have needed on it has been covered. The private insurance I had when all of this first started really needing insurance was through a very well known university and was one of the things that made up for the thin-as-air paycheck. That and the time off were hard to beat.


I stand corrected, sorry. You must have a very good plan. The last time I went to the ER, my bill was over $400 just for an x-ray and visit to see if my arm was broken... it was not.  And I thought I had a good plan.

/pays for the premium plan at work.
 
2013-10-16 08:24:56 AM

Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency


This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.
 
2013-10-16 08:31:10 AM

AlwaysRightBoy: ginandbacon: AlwaysRightBoy: If I remember right, you're a teacher. Of course you have no worries. Most people in the private sector have worries.

Ah no! I have tutored kids in reading but it is a volunteer gig. It's insanely gratifying and something I would recommend to anyone. I have had insurance through the private sector and the public though. Both were wonderful. My private sector insurance was top notch. I think it was $10 to see my PCP, $40 for ambulance or ER visits, and $5 for meds. Admissions and diagnostic tests were free. I pay less with my gubmint one but it is a little more restrictive and I can't just do whatever my PCP wants whenever we want to. I have no real complaints though. Everything I have needed on it has been covered. The private insurance I had when all of this first started really needing insurance was through a very well known university and was one of the things that made up for the thin-as-air paycheck. That and the time off were hard to beat.

I stand corrected, sorry. You must have a very good plan. The last time I went to the ER, my bill was over $400 just for an x-ray and visit to see if my arm was broken... it was not.  And I thought I had a good plan.

/pays for the premium plan at work.


OMG that's awful! My BF got an ER bill for $250 that I thought was just outrageous given what he's paid in contributions. Good lord.

I hope you're arm's okay at least.
 
2013-10-16 08:38:08 AM

hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.


When I was young, my mam used the story of how Bessie Smith died as a parable. (Although I guess it's been somewhat discredited, it's not like it wasn't believable for a very good reason.) This country has a lot of shame it has yet to acknowledge and make right.
 
2013-10-16 08:45:15 AM

AliceBToklasLives: Nice article - good job mentioned the key reason there are "superusers" - lack of health insurance.  For many people, the only way to see a doctor is to go to the ER.

And no, no one gets "free" treatment at the ER.  They send a bill and the patient is responsible for his care.  Of course hospitals have a hard time collecting since lack of health insurance is generally accompanied by a lack of monetary resources.  So who pays for a good chunk of ER visits?  Everyone else.

Also, you cannot get just any kind of treatment at the ER.  Sure, if you are having a heart attack they will stabilize you, and if you have a primary care physician you might (as TFA suggests) get some needed tests.  But it's not like you can walk in and say "I have a family history of colon cancer, I'm 50 and I'd like a colonoscopy."  Well, you can say that but you ain't getting no colonoscopy.  So you don't get the preventative treatment.  Who pays for your frequent visits during your bout with colon cancer?  You know who.


Hmm.

Maybe a bootstrappy political party that values personal responsibility will create a plan that makes people insure themselves. Then some years later a black man will agree that it is a good idea and then suddenly that party will hate that plan and go full retard to block it.

Lol, that would be a ridiculous plot for a crappy sitcom even.
 
2013-10-16 08:45:46 AM

vudukungfu: I wants mah oxybamacotton an skrimps!


jesus this is the second overtly racist post I've read from you in two days. Do you press your clan robes before you put them on?

you farking disgust me.
 
2013-10-16 08:48:17 AM

ginandbacon: When I was young, my mam used the story of how Bessie Smith died as a parable. (Although I guess it's been somewhat discredited, it's not like it wasn't believable for a very good reason.) This country has a lot of shame it has yet to acknowledge and make right.


I had to look this up to see what you were talking about. The actual story is far worse than people might think.
 
2013-10-16 08:50:58 AM
houseofgeekery.files.wordpress.com

When I get overcrowded, I just start sending people to the auto-autopsy machine. It thins the herd, and advances the cause of medical science.

/Although it gets kinda funny when I send a whole bunch at one time, and they have to wait in line. Not one of them seems to care that people go into the machine, but don't come back out.
 
2013-10-16 09:19:58 AM

thegreatmurgatroid: The average lay person is so ill informed regarding healthcare.

Most 'superusers' usually have some form of insurance...the most common offender is medicaid patients. They often pay nothing for their ER visits and thus have not a single disincentive to wait to see their primary doctor. If you ask them why they are in the ER for a minor ailment, they are usually very up front that their doctor cant see them for a few day and they didnt feel like waiting. Its a matter of convenience and there is no cost to them.

Other forms of 'Superusers' come in the form of privately insured or medicare patients with some variety of personality disorder which drives their need for repeated er visits. Typical examples are the chronic pain patient who is never given enough pain medication or the borderline personality patients that fabricate a variety or nonsepific symptos in order to get attention and create a disturbance.

The fear of legal consequences permits the continuation of this behavior at the detriment of care to others. Even without all of these people abusing the system, emergency services are already struggling to meet demand.

And if I can give one piece of advice, it is for lay people to please stay out of healthcare decision-making. The reality is that most people are ignorant of the actual problems and their good intentions often only make things worse.


This, plus in Kentucky, you have to pay a $2 copay for your doctor, nothing for the ER. That caused more problems than it solved.

/former ER worker
//some of the patients were there more than I was and I was getting paid for it
///slashies in threes
 
2013-10-16 09:21:22 AM

hardinparamedic: ginandbacon: When I was young, my mam used the story of how Bessie Smith died as a parable. (Although I guess it's been somewhat discredited, it's not like it wasn't believable for a very good reason.) This country has a lot of shame it has yet to acknowledge and make right.

I had to look this up to see what you were talking about. The actual story is far worse than people might think.


Oh sorry! I grew up in a bubble and that story was common knowledge like the Kennedy assassination. We all knew it and took away lessons from it about the imbalances in this country when it comes to healthcare.

My mam used it often to get me to pull my arm in whenever I stuck it out the window of her car. "You don't want to end up like Bessie Smith!" I still think of Smith if I roll down the window and have a smoke with my elbow out. The things that stay with you, right?
 
2013-10-16 09:27:41 AM

QueenMamaBee: This, plus in Kentucky, you have to pay a $2 copay for your doctor, nothing for the ER. That caused more problems than it solved.


One thing I've learned over my short career is that the people abusing the 911 and ER system in the US are overwhelmingly medicare patients with either COPD, Diabetes, or CHF. People who claim it's typically illegal immigrants can safely be ignored as political hacks OR people who have no idea what they're talking about.

In our area, the illegal population will overwhelmingly use the church-affiliated free clinics in the area, because there is less of a chance of running into law enforcement.

Which is why when MedStar EMS in Fort Worth, TX targeted these populations for their community care paramedic program, they saved millions of dollars in unnecessary admissions in the first year of the program alone, and cut the system abuse in their area by around 90%.

/so, why are we not funding that.
 
2013-10-16 09:34:27 AM

hardinparamedic: Urgent care centers still cost more than a family doctor will typically charge up front per visit for the uninsured, and unless they are within 100 yards of an ER, or meet certain requirements outlined under EMTALA, they are under no obligation to see you or treat you if you cannot meet the up-front fee. (Typically 75 to 200 dollars)


If they are within 100 yards of an ER they have to take you, but if the nearest ER is miles away they can just let you bleed?  That sounds completely backwards.
 
2013-10-16 09:35:25 AM

Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency. Let them go to the local welfare clinic the next day.


What welfare clinic?
 
2013-10-16 09:38:38 AM

flondrix: but if the nearest ER is miles away they can just let you bleed?


As I understand it, it actually depends on if they are in a healthcare system which offers ER care. For example, a clinic which is owned and operated by a hospital system which has an ER which they can transfer to can activate the EMTALA obligation for that system, while an independent provider has no EMTALA obligation. When you presented to that clinic, it's the same as you presented to the ER.

It's the same with ambulances. A hospital-owned ambulance activates the EMTALA obligation for that facility the moment you initiate care, but a private or government-based ambulance does not.
 
2013-10-16 09:46:29 AM

flondrix: hardinparamedic: Urgent care centers still cost more than a family doctor will typically charge up front per visit for the uninsured, and unless they are within 100 yards of an ER, or meet certain requirements outlined under EMTALA, they are under no obligation to see you or treat you if you cannot meet the up-front fee. (Typically 75 to 200 dollars)

If they are within 100 yards of an ER they have to take you, but if the nearest ER is miles away they can just let you bleed?  That sounds completely backwards.


To elaborate:  My home town has an urgent care clinic, but no ER.  If the urgent care clinic can turn you away for not having the bucks...I guess you're dead.
 
2013-10-16 09:46:42 AM

hardinparamedic: flondrix: but if the nearest ER is miles away they can just let you bleed?

As I understand it, it actually depends on if they are in a healthcare system which offers ER care. For example, a clinic which is owned and operated by a hospital system which has an ER which they can transfer to can activate the EMTALA obligation for that system, while an independent provider has no EMTALA obligation. When you presented to that clinic, it's the same as you presented to the ER.

It's the same with ambulances. A hospital-owned ambulance activates the EMTALA obligation for that facility the moment you initiate care, but a private or government-based ambulance does not.


Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?
 
2013-10-16 09:47:33 AM

Flashlight: pete1729: What my girlfriend who is an ER doc has to deal with on a regular basis.

http://www.youtube.com/watch?v=Q6sRyrB_UMA

I see stuff like this all the time. Most frequent fliers are on Medicaid. And unfortunately in this state there is a (small) copay for the primary care doctor but not for the ER and everything is paid for. So they have no incentive to go see their primary care doctor. They come in for any reason at all and mostly they are desperate for attention. There is a collective groan among every employee in the ED when frequent flier's name appears on the tracker and the person is there for insomnia at 3PM. Yes it has happened. This is why we need to stigmatize people like this


I worked at a hospital and got to know the frequent fliers. One was a man who had mental problems--and a crush on an ER admitting employee. He rode the ambulance 4-5 times a week to the ER for vague symptoms. He lived close enough to walk to the ER, but where's the fun of that? He mainly wanted attention and human interaction. Due to his psych problems, he had no friends. The hospital staff served as (very costly) surrogates for a social network for him.

This hospital did not have a psych ward or any psychiatrists on staff. Occasionally, we would transfer him to the VA for mental health care, but more often than not, he'd ride the amberlamps back home after having enough testing and examination to determine he was in no physical crisis.

We had other FF's who would come in with a raft of meds. One patient brought hers in a kitchen trash bag; a regular grocery bag would not hold them all. I always wondered if her "problem" was simply that she took so many meds, because her complaints were all very vague.
 
2013-10-16 09:50:05 AM

flondrix: To elaborate:  My home town has an urgent care clinic, but no ER.  If the urgent care clinic can turn you away for not having the bucks...I guess you're dead.


It depends. Under EMTALA, they can, because unless the clinic is affiliated with a local hospital system providing ER care, it doesn't fall under their jurisdiction. Under various state laws, there is a duty to act that exists for healthcare professionals who are advertising their services as a clinic when an emergency medical condition is reasonably believed to exist. And that clinic is still, then, only required to treat them to the level they can reasonably be expected to provide.

Fulfilling that duty can extend to simply offering to call 911 for someone if they cannot afford to pay - especially if they need resources that clinic cannot offer, and that duty is subject to weird state law stipulations. And there is no duty to act if an emergency medical condition doesn't exist.
 
2013-10-16 09:53:13 AM

ginandbacon: Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?


If you called 911 and got that, my recommendation would be to contact your State's EMS Board and report that. Especially if you feel they are not treating you to the standard another provider would.

If that's not the case, can you explain the situation? Were you being transferred to another hospital? If that was the case, there may not be anything to do except for monitor you during the transport and be prepared to intervene.

Destination determination is not subject to the dispatcher's whims, but is your decision within certain limiting factors. (I.e. Paramedic feels that diverting to closest is the best for your continued survival, that's the only unit in the county and they can't leave, 911 system won't transport out of county because there are various high level hospitals in county - which is what Memphis has)
 
2013-10-16 10:01:33 AM

TelJanin: Welfare/low income people are coached the following: "Go only to the ER, walk up to the desk person and say 'I cannot pay, I require Pro-Bono health care' ". This is the source for tons of spurious ER visit. From a few years in the ER, I would say probably 1/2 the traffic is pro-bono/welfare/medicare/medicaid related work.


Please don't lump Medicare recipients in there disparagingly, those people are either retired or disabled (supposedly) and the vast majority have paid their dues to society. Many have been forced out of their employer sponsored health plans intentionally.
 
2013-10-16 10:05:29 AM

ginandbacon: hardinparamedic: flondrix: but if the nearest ER is miles away they can just let you bleed?

As I understand it, it actually depends on if they are in a healthcare system which offers ER care. For example, a clinic which is owned and operated by a hospital system which has an ER which they can transfer to can activate the EMTALA obligation for that system, while an independent provider has no EMTALA obligation. When you presented to that clinic, it's the same as you presented to the ER.

It's the same with ambulances. A hospital-owned ambulance activates the EMTALA obligation for that facility the moment you initiate care, but a private or government-based ambulance does not.

Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?


If it's a life threatening emergency, they have to take you to the closest appropriate facility. If not, it's supposed to be your choice unless for whatever reason, that facility may be on diversion (mass trauma coming in, etc).
 
2013-10-16 10:15:36 AM

whatshisname: TyrantII: Those uninsured drive up your health insurance costs

More than the healthcare lobby and their shareholders in government? America's health care industry even drives up costs in neighboring countries. The provision of health care should be a regulated, compassionate and efficient venture, not the loot-and-pillage for profits situation in the US.


Kinda surprised there haven't been any MSM stories about how the insurance companies are driving up rates 3-400% above what the ACA alone would require this year, because starting next year rate increases will be regulated. I was discussing the ACA/shutdown with my aunt who is a billing officer for a national HMO, according to her the rate gouging is an 'open secret' in the corporation. (yes it's anecdotal evidence/etc...)

/something something job creation
 
2013-10-16 10:16:30 AM

hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.


Did you miss the bolded part?  I'm not talking about dead babies, I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)
 
2013-10-16 10:19:20 AM

hardinparamedic: ginandbacon: Okay wait, I have a question about this. When I get picked up by the fire department ambulance, they initiate care immediately: I get a bag put in, AND they take me where I want to go. When I get picked up by a private company, they won't do anything and the take me wherever the dispatcher tells them which is usually the last place I want to go.

What the actual fark? What gives?

If you called 911 and got that, my recommendation would be to contact your State's EMS Board and report that. Especially if you feel they are not treating you to the standard another provider would.

If that's not the case, can you explain the situation? Were you being transferred to another hospital? If that was the case, there may not be anything to do except for monitor you during the transport and be prepared to intervene.

Destination determination is not subject to the dispatcher's whims, but is your decision within certain limiting factors. (I.e. Paramedic feels that diverting to closest is the best for your continued survival, that's the only unit in the county and they can't leave, 911 system won't transport out of county because there are various high level hospitals in county - which is what Memphis has)


Huh. Yeah this was just a normal pick up from my house and I wasn't in any acute distress other than being seriously dehydrated and having my normal issues. I asked them to start a bag which they refused to do and then asked to be transported to Mercy which has all of my records and has always been great with me which they also refused to do. I ended up at Johns Hopkins Bayview which SUUUUUUUUCKS!!!! It took six hours to even get saline. I was ready to call an ambulance to pick me up from there to get transferred. And then the asshats admitted me even though I told them exactly what I needed because the attending wanted to write me up. So then I had to deal with armies of residents during rounds until I finally got out of there. 

And they put me on a farking low sodium diet WHICH ALWAYS HAPPENS even though my cardiologist has me on a high sodium diet for my hypotension. Good lordee that food is inedible. I mean hospital food is bad enough but saltless hospital food is just torture, especially if you have gotten used to 4-6,000 mgs of salt per day.

And you can't smoke. *sniff* And the attending wouldn't give me any anti-anxiety meds for the withdrawal. 

Sorry...ending rant now. That was a bad experience.
 
2013-10-16 10:24:14 AM

Cold_Sassy: hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.

Did you miss the bolded part?  I'm not talking about dead babies, I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)


Ummm Medicaid is very hard to get. Children get it fairly easily but adults have few options whether or not they possess papers. That would be why we have those nearly 50 million uninsured Americans.
 
2013-10-16 10:24:59 AM
Well, I can tell the majority of you couldn't be bothered to RTFA. A superuser is defined as someone who visits the ER ten or more times in a year. This is not what the uninsured are doing. The uninsured still have to PAY for their hospital visit. If they do not pay, then the bill goes to COLLECTORS. Those scum of the earth go after their money. If they can't get it, they sue. No one goes to the ER ten times in a year if they are going to get a bunch of lawsuits for their trouble. The superusers are people with real chronic problems as well as a few hypochondriac attention whores.
 
2013-10-16 10:25:00 AM

Cold_Sassy: I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)


HAHAHAHAHAHAHAHAHAHAHAHA.

You have no idea what you're talking about if you think everyone can qualify for state medicaid. Illegals DO NOT get Medicaid legally, and instead will often lie about their demographic information on hospital admission and triage forms, including giving fake phone numbers, so that billing departments cannot track them down to collect later.

ginandbacon: I asked them to start a bag which they refused to do and then asked to be transported to Mercy which has all of my records and has always been great with me which they also refused to do.


Are you sure they weren't a basic unit? Basic EMTs in Maryland cannot start IVs.
 
2013-10-16 10:26:10 AM
So much fail, there's plenty to go around.
I've spent 22 years in emergency medicine (No, no medical school.  I'd rather not have the insane amount of debt that goes along with it).  I've practiced in many different environments, taught every level of provider, and at the end helped run the admin sides of things.  A couple of points.

When we talk about the "Healthcare System", we're talking about the whole shebang.  Doctors, medics, nurses, techs, administrators, and yes, patients.  Patients are a massive part of that system, and the whole system needs reform, of one form or another.

As a "Master of my Trade" (Got that on two evaluations, it made me chuckle) I took home less money than the local "living wage".  I taught in my spare time, and 90% of the time I had some kind of student attached to my hip while I was working the floor in a busy level 1 trauma center.  At least one day a week was spent coming back in to work for meetings on how we could make things better.  When a budget crunch hit, the good bosses told me they didn't have the budget for the overtime.  The obnoxious bosses forbid me from doing any kind of work in the facility (no meetings, technically no teaching).  Despite the hours and performance, why can't I get a good wage?  Despite my people working their asses off, why can't they get more than a twenty cent raise each year (cost of living far far FAR exceeded that).  My student loans have barely been touched, and I get no service credit because my hospital was for-profit.

Frequent Flyers...  A couple folks talked about being in the ER several times per month.  I'm not staring at you, yet.  I'm really eyeballing the guys that come in every day, or sometimes multiple times each day.  We have a guy that's been in the newspaper he's been in the ER so many times that the EMS crews greet him by name.  I lump these folks in with the people that manipulate the system to get what they want.  Drug seekers, food needers, bed wanters.  If your expertise with your condition is so incredibly high that you can demand something when you come through the doors of the ER, then you should consider talking to your primary care physician about having what you need at home.  Why do we put you through the wringer in the emergency room, and make you go through all the tests and exams?  Because it is our ass on the line if you have a severe complication or reaction.  Because we don't know who the fark you are.  And because even if we do know exactly who you are, we're trained in emergency medicine.  That means we HAVE to rule out the worst case scenario before we settle down on your presumed diagnosis.

Despite all of this, sometimes these frequently flyers die.  In fact, it's a guarantee that all of them will eventually die.  If it happens due to your negligence, it's not going to matter that they presented the exact same way that they did for the last five years.  When they die, the family is going to turn up, they're going to demand answers, and if they don't like them they're going to summon lawyers.

What happens then?  Then an entire team of dedicated workers is facing some nasty stuff.  The black mark on the record, the horrible interviews and depositions, and the possibility of a loss of a job or even loss of license.  All those years of schooling, the time and experience to get where you are, undone.  You've got nothing.  You're done.
Most of us know someone that this has happened to, so we work hard to make sure it isn't us.
Yeah, you mentioned you were stuck in an ER for six hours for something minor?  Do you know how often we've been ready to discharge a minor headache, some slight chest pain, even a sore throat, when we have to suddenly drop everything and panic because the patient is actually having a true medical emergency?  Do you know how often I've had to talk patients down, and convince them to stay because the discovered condition isn't matching up with their sunny diagnosis?  You freakin' bonehead!?
If you just want drugs, go hit up the guy on the street corner.  If he sells you some bad stuff, you can still come in, and we'll still be open and ready to take care of you.  His stuff is probably cheaper than our stuff.
If you want some specific medical procedure, you can actually schedule them with your primary care and a specialist.  You don't have to sit in the ER and wait for a bed to become available.

People are very happy to compare the US system with every other system out there.  It's a pretty apples and oranges comparison.  They may kinda look the same, but underneath they're completely different animals.
In the US, if you come to the ER (barring an unusual event within the hospital infrastructure), you can be assured that you will be able to get an x-ray and have it read almost immediately (same day).  You can have lab work drawn, analyzed, and reported immediately (for many tests).  There will be a doctor there.  The equipment is new, clean, current, and free from defects. The water is clean.  There is oxygen coming from those ports on the wall. They can provide certain immediately life saving treatments.  You will receive an exam and stabilization of your emergent condition no matter what your ability to pay is.
All of this, and more is true.  When it doesn't happen, the liability fairy comes visiting and liberally sprinkles the hospital with fines and malpractice lawyers.
The same is not true in many countries around the world (I've been fortunate enough to visit many of them.  Sometimes it's good enough to write a book about it).  In many countries with socialized medicine, they've had to cut some of those services, or at least curtail them.

I love medicine.  I really do.  If I win the lottery, I'll go back into it.  I might even take up the medical school on their offer of a spot.
But it's a sick, sick system (yeah, pun intended).  It's broke, folks, and people have been letting it break down for the 22 years that I've been intimately involved in it.

You biatch about the Affordable Care Act?  It's not perfect, I grant you that. We probably should have started smaller and just worked to insure kids universally.
But you know what?  It's progress.  It's drawing attention to a system that is crumbling (ask anyone in healthcare how functional the whole system is.  They're going to point out problems, chronic ones).  It may not fix the system, but for once the general population is starting to pay attention to some of the issues.  We've been calling for help for decades.

We've been calling for help, you know, us, the guys that come running when you call for help?

//sorry for the rant, but someone needs to say it
 
2013-10-16 10:30:57 AM

Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement. Now, do you know why that is? Can you possibly contemplate the *fact* that the capitalist system produces so much incentive for progress it manages to almost single-handedly advance medicine for the globe? You god damned myopic collectivist?


That basic research that you are so proud of is funded by the NIH which, in turn, is funded by YOUR TAX DOLLARS!   There is some private funding of research, but the lion's share is funded by evil socialism.
 
2013-10-16 10:35:04 AM

Shryke: Second, the for-profit U.S. system you decry so vociferously is, in fact, responsible for over half of the WORLD's medical research and advancement.


Uh, yeah. Not so much.

Most of that research is subsidized by the NIH. Hell, even Viagra was subsidized because of it's promise in treating pulmonary hypertension.
 
2013-10-16 10:43:20 AM

hardinparamedic: Cold_Sassy: I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)

HAHAHAHAHAHAHAHAHAHAHAHA.

You have no idea what you're talking about if you think everyone can qualify for state medicaid. Illegals DO NOT get Medicaid legally, and instead will often lie about their demographic information on hospital admission and triage forms, including giving fake phone numbers, so that billing departments cannot track them down to collect later.

ginandbacon: I asked them to start a bag which they refused to do and then asked to be transported to Mercy which has all of my records and has always been great with me which they also refused to do.

Are you sure they weren't a basic unit? Basic EMTs in Maryland cannot start IVs.


Ahhhhhhh!!!! That must be it! I've never experienced that in Mass or DC until I got here and it was only the one time. They have all without exception started a drip which is the most important first step in my treatment plan. It helps raise my BP and cuts the dehydration. After that it;s mostly just a massive dose of anti-emetics and some Ativan to stop the vomiting. 

Do all states have basic units? I really have never encountered that before.

QueenMamaBee:

If it's a life threatening emergency, they have to take you to the closest appropriate facility. If not, it's supposed to be your choice unless for whatever reason, that facility may be on diversion (mass trauma coming in, etc).

Not life-threatening (it rarely is with me thank goodness) but they never even checked to see if my hospital of choice could take me. And I am stupid picky about when I go in. I mean literally stupid. I will wait so that I am not going in on a weekend night or during shift change even if it means I get sicker. It's just worth it to me to avoid the chaos. I actually had to go in once on the first day of rotation one time and I wanted to discharge myself as soon as I realized what day it was.
 
2013-10-16 10:56:35 AM

Cold_Sassy: hardinparamedic: Cold_Sassy: Honestly, the ER should just turn away "patients" who do not have a life-threatening emergency

This idea is the reason we have EMTALA in the first place. They used to do that in the 1960s and 70s. It resulted in people giving birth to dead babies in the hospital parking lot, and people setting on an ambulance for five hours because every hospital in the area was full when they found out they didn't have insurance during radio report.

Americans today aren't familiar with the idea that they could be turned away from emergency medical care if they were the wrong race, or didn't have the ability to pay up front.

Did you miss the bolded part?  I'm not talking about dead babies, I'm talking about some knob with a splinter who could wait until the next day.  Everybody has insurance, it's called Medicaid.  Even illegals get it, free of charge (except to American taxpayers, of course.)


I don't have Medicaid. I don't qualify. You probably don't either. But even for people who do qualify, they don't have it unless they apply for it. But there are a lot of people who don't apply for one reason or another. Either they don't know about it, don't think it's worth the hassle, don't have their shiat together enough to apply, or--as is frequently the case for illegal aliens--are trying to stay of the government's radar. And typically they have to reapply every month. Of course the hospital can try to get them to apply, but they can't force them to. And there's always the possibility that they won't actually qualify, which the hospital won't find out about until long after the patient has been treated and released. Or the patient will qualify, but the hospital didn't get the procedure precertified correctly, or they used drug A.124 instead of A.121, and Medicaid doesn't cover A.124. Granted, Medicaid is a lot better about paying for things in the inpatient or emergency settings, but even when they do pay it's frequently below the hospital's cost. Any time a hospital trays an uninsured patient, even one they think will qualify for Medicaid, they're taking a flier on it. They'll never see a dime on a lot of those. Many of the rest they treat for pennies on the dollar.
 
2013-10-16 10:56:47 AM

ginandbacon: Do all states have basic units? I really have never encountered that before.


Yeah, but in some states EMT-Basics can do more than in others. Tennessee and Colorado allow theirs to do basic IV therapy and use isotonic solutions to treat patients, while in others they can do nothing more than give oxygen if it's indicated, do basic first aid and trauma care, and monitor during transport.

To contrast what I know, Alabama's EMT-Basic course in 2005 was 120 hours. Tennessee's was nearly 400 hours. (8 hours a day, two days a week for three semesters.)

Do you happen to live in a rural area, by any chance? It's more common up in Yankee territory that the volunteer ambulance squads and services in the rural areas employ more EMT-EMT units than EMT-Paramedic or Paramedic-Paramedic units because of the cost of training and employing Paramedics.

ginandbacon: They have all without exception started a drip which is the most important first step in my treatment plan. It helps raise my BP and cuts the dehydration. After that it;s mostly just a massive dose of anti-emetics and some Ativan to stop the vomiting.


What do you have, if you don't mind me asking?
 
2013-10-16 11:19:00 AM

hardinparamedic: ginandbacon: Do all states have basic units? I really have never encountered that before.

Yeah, but in some states EMT-Basics can do more than in others. Tennessee and Colorado allow theirs to do basic IV therapy and use isotonic solutions to treat patients, while in others they can do nothing more than give oxygen if it's indicated, do basic first aid and trauma care, and monitor during transport.

To contrast what I know, Alabama's EMT-Basic course in 2005 was 120 hours. Tennessee's was nearly 400 hours. (8 hours a day, two days a week for three semesters.)

Do you happen to live in a rural area, by any chance? It's more common up in Yankee territory that the volunteer ambulance squads and services in the rural areas employ more EMT-EMT units than EMT-Paramedic or Paramedic-Paramedic units because of the cost of training and employing Paramedics.

ginandbacon: They have all without exception started a drip which is the most important first step in my treatment plan. It helps raise my BP and cuts the dehydration. After that it;s mostly just a massive dose of anti-emetics and some Ativan to stop the vomiting.

What do you have, if you don't mind me asking?


I don't think Baltimore counts as rural even if it does seem a little country to me sometimes ;)

I have neurally mediated hypotension, cyclical vomiting syndrome (don't ask, you don't want to know,) fibromyalgia, and neuropathy in both of my feet and into my right calf. 

The NMH has been the most crippling. As well as the CVS. The other two are really about pain management and I am doing really well with neurontin. The NMH has completely flattened me. I was so bedridden from it at one point that I got multiple pulmonary embolisms which could have killed me and rickets which just hurt like hell.

NMH is not very common and I was lucky that one of my PCP's students has it (she is much more functional than I am) so I finally had someone other than my cardiologist who got what my life is like without me having to explain it. Most of my doctors have to go Google it so I really loved being able to laugh and talk with her about it. 

My PCP is amazing though. I am really fortunate to have access to him and I bless him every day. He's a saint. I often end up spending 5 hours in his office when I go in because he wants to see me in between other patients instead of just spending ten minutes with me. He's a really good doctor and a really good teacher.
 
2013-10-16 11:32:28 AM

ginandbacon: I don't think Baltimore counts as rural even if it does seem a little country to me sometimes


Ah ha. Baltimore is a tiered EMS response system. Only certain calls will get a paramedic sent to it.
 
2013-10-16 11:36:22 AM

ginandbacon: Not life-threatening (it rarely is with me thank goodness) but they never even checked to see if my hospital of choice could take me. And I am stupid picky about when I go in. I mean literally stupid. I will wait so that I am not going in on a weekend night or during shift change even if it means I get sicker. It's just worth it to me to avoid the chaos. I actually had to go in once on the first day of rotation one time and I wanted to discharge myself as soon as I realized what day it was.


That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.
 
2013-10-16 11:36:35 AM

hardinparamedic: ginandbacon: I don't think Baltimore counts as rural even if it does seem a little country to me sometimes

Ah ha. Baltimore is a tiered EMS response system. Only certain calls will get a paramedic sent to it.


LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.
 
2013-10-16 11:44:57 AM

QueenMamaBee: ginandbacon: Not life-threatening (it rarely is with me thank goodness) but they never even checked to see if my hospital of choice could take me. And I am stupid picky about when I go in. I mean literally stupid. I will wait so that I am not going in on a weekend night or during shift change even if it means I get sicker. It's just worth it to me to avoid the chaos. I actually had to go in once on the first day of rotation one time and I wanted to discharge myself as soon as I realized what day it was.

That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.


Oooof. So much work! but you're probably right. I'd hate for someone else to go through this. The other thing that really got me is that the nurses wouldn't give me a bag until a doctor ordered it which took SIX HOURS. I've never been in a hospital ER where that wasn't step 1 and fine for RNs to initiate on their own. I have no idea what kind of incentives the private company might have had. I was just used to one thing: getting a bag immediately and being asked where I wanted to go, and these guys flat out told me they wouldn't put a line in or take me to my choice. 

I wasn't a very happy camper.
 
2013-10-16 11:51:44 AM

QueenMamaBee: That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.


Baltimore has a tiered response system, which is where he lives. The Basic EMT unit that responded to him wouldn't have been able to do anything but transport him, as they cannot start IVs.

ginandbacon: LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.


The Medical Priority Dispatch System. Omega, Alpha and Charlie level calls get a BLS response, while Bravo, Delta, and Echo get an ALS (Paramedic) level response.
 
2013-10-16 11:57:44 AM

hardinparamedic: QueenMamaBee: That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.

Baltimore has a tiered response system, which is where he lives. The Basic EMT unit that responded to him wouldn't have been able to do anything but transport him, as they cannot start IVs.

ginandbacon: LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.

The Medical Priority Dispatch System. Omega, Alpha and Charlie level calls get a BLS response, while Bravo, Delta, and Echo get an ALS (Paramedic) level response.


I'm a she ;)

And that's really interesting. I wonder if that one time was because my BF was the one calling 911? Usually I call in but I was too sick too that time. That's the only variable I can come up with.
 
2013-10-16 12:01:45 PM
*too? Really I meant to. 

I wish I could still drink coffee. I obviously need it.
 
2013-10-16 12:03:00 PM

ginandbacon: And that's really interesting. I wonder if that one time was because my BF was the one calling 911? Usually I call in but I was too sick too that time. That's the only variable I can come up with.


Possibly. If they rule out priority symptoms, the MPDS assigns a code of either 26 Alpha 1-11, or if you have a fainting spell without cardiac problems a 31 Alpha 1-3
 
2013-10-16 12:05:45 PM

hardinparamedic: QueenMamaBee: That's wrong, and you should file a complaint with the state EMS board. 

Are the private companies receiving some kind of fee from the hospital for bringing people in? Sounds fishy to me. We have some really crappy local private companies (and a few good ones, and a great county system) and I've never heard of that going on here.

Baltimore has a tiered response system, which is where he lives. The Basic EMT unit that responded to him wouldn't have been able to do anything but transport him, as they cannot start IVs.

ginandbacon: LOL I always knew there was something strange afoot here! So how do they tier these calls? Out of five? calls for the same thing, I've only had that bad experience the one time.

The Medical Priority Dispatch System. Omega, Alpha and Charlie level calls get a BLS response, while Bravo, Delta, and Echo get an ALS (Paramedic) level response.


But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.
 
2013-10-16 12:14:07 PM

hardinparamedic: ginandbacon: And that's really interesting. I wonder if that one time was because my BF was the one calling 911? Usually I call in but I was too sick too that time. That's the only variable I can come up with.

Possibly. If they rule out priority symptoms, the MPDS assigns a code of either 26 Alpha 1-11, or if you have a fainting spell without cardiac problems a 31 Alpha 1-3


I usually refuse an ambulance for the syncope episodes. I know how to manage those on my own. There's not much any medical team can do for me except the saline drip which actually does help but I find that just lying down with my feet up accomplishes the same outcome. I mostly only call for the CVS and that's because I ended up in acute renal failure from it once so that kind of put the fear of God in me. I don't screw around with that now. I learned it can kill me and I didn't enjoy the whole dying thing while I was going through it.

If I could start my own line of saline and glucose, add some anti-emetics, and throw in some Ativan, I would never call 911 ever. I'd just handle it on my own.
 
2013-10-16 12:15:40 PM

QueenMamaBee: But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.


LOL ya'd think, right?
 
2013-10-16 12:21:19 PM

QueenMamaBee: But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.


True. And on the second part...well....
 
2013-10-16 12:23:58 PM

hardinparamedic: Most of that research is subsidized by the NIH. Hell, even Viagra was subsidized because of it's promise in treating pulmonary hypertension.


And Minoxidil started out as a high blood pressure medication that turned out to have a side effect of causing hair to grow on bald heads.
 
2013-10-16 12:26:12 PM

hardinparamedic: QueenMamaBee: But they can still take her where she wants to go. As far as I know, Basic EMTs can read maps.

True. And on the second part...well....


Okay you're probably right. But geez, Mapquest will even read the directions to you out loud.
 
2013-10-16 12:38:16 PM

flondrix: hardinparamedic: Most of that research is subsidized by the NIH. Hell, even Viagra was subsidized because of it's promise in treating pulmonary hypertension.

And Minoxidil started out as a high blood pressure medication that turned out to have a side effect of causing hair to grow on bald heads.


Also had a side effect of making a great Simpsons episode
 
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