May 9th, 2011 by Edwin Leap, M.D. in Opinion, True Stories
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Years ago I had a conversation with a surgeon at our facility. He was unhappy that a seriously injured trauma patient came to our facility after a MVC. ‘These patients shouldn’t come here Ed, they should go to a trauma center!’
Fair enough; we aren’t a trauma center. Not a Level I, not a Level II or III; not even a level 0.5! But we are the only hospital in a large rural county, and the closest, largest facility for portions of a few other counties nearby. The nearest hospital with neurosurgery and thoracic surgery is at least 30 minutes further away.
The problem is, torn blood vessels, crushed spleens, collapsed lungs, swollen brains don’t look at the clock, and cars aren’t designed to wreck only near trauma centers, any more than assailants shoot and stab people only within proximity of appropriate care. (It rather defeats the purpose of attempted murder, you know. )
Recently, my partner had the same conversation with the same surgeon. The patient had been shot twice and was hypotensive. ‘These patients shouldn’t come here!’ We understand, the conditions may not be ideal and trauma is, to be quite honest, fraught with medical and legal peril. Read more »
*This blog post was originally published at edwinleap.com*
April 27th, 2011 by Edwin Leap, M.D. in Health Policy, True Stories
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Our emergency department was very busy recently. The hospital was full and we were holding patients. Three had been in the ER many hours; one waiting for a bed for six hours, another eight hours, and still one more for eleven hours. Of course, ambulance traffic hadn’t stopped and the waiting room was full, with patients waiting too long to be seen. (And we all know that the media loves to highlight bad outcomes from the ER waiting room!)
Administration set up a ‘command post’ to try to arrange beds, discharges and moves. At one point I asked one of our administrators to move those waiting the longest to hallway beds up on the patient floors. He told me that he couldn’t because each of the two floors in question already had one patient in the hall. And besides, it would violate the patients’ privacy and make it too difficult for the nurses to do their admissions assessments.
I pointed out, ‘our nurses do assessments in the hall, our patients don’t have privacy and sometimes we have to work with seven or eight patients in the hallway!’
He replied, ‘yes Dr. Leap, I know, but I won’t move anyone else to the hall upstairs. I just won’t.’ I asked why. With a slight sense of obvious discomfort he replied, ‘because there is a different standard. When patients leave the ER, they expect to go to a better place.’ Read more »
*This blog post was originally published at edwinleap.com*
April 9th, 2011 by Edwin Leap, M.D. in Opinion
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I sometimes see men and women who come to the emergency department and tell me about their PTSD, caused by service in Iraq or Afghanistan. I believe some of them; others I doubt, since their PTSD seems directly connected to a desire for Percocet, Lortab, MS-Contin or other prescriptions for back pain. Sadly, the VA system does not lend itself to inquiry by outside physicians, so in many instances I am treating them in an information vacuum.
However, as I contemplate their allegations of PTSD, I wonder how many physicians and nurses from emergency departments have the disorder. I’m no psychiatrist, but it just seems probable that the years of cummulative stress, the years of sleeplessness and snap decisions, the untold shifts filled with unpredictable chaos, pain, threats, death and anxiety would add up to significant emotional turmoil for providers who work in that environment.
It is appropriate that we are attentive to the needs of those who serve in combat zones. And yet, they may spend only spend one or two years there. Granted, that can be terrible enough. Read more »
*This blog post was originally published at edwinleap.com*
April 6th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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So I have a Droid. I purchased it in July, not long after taking my old flip-phone for an oceanic bath at Hilton Head, SC. I waffled for a long time. In fact, I almost purchased a Casio phone that was marketed as water and impact resistant. ‘Mil-spec,’ was the phrase used…a phrase which appeals to me as a one-time Air-Guard flight surgeon. What it meant to me was, ‘you can’t hurt it.’
Still, I was attracted by medical applications and the assorted other cool things a Droid can do. I mean, my old phone didn’t have a Magic 8 Ball, for crying out loud! More to the point, my old phone didn’t have Epocrates, or the Emergency Medicine Residents Association Guide to Antibiotic Therapy. It lacked a flashlight, an mp-3 player, a protractor and a scientific calculator. (It also weighed a fraction of my Droid, but that’s what belts are for). On my old phone, I couldn’t have taken a photo of an ECG, turned it into a pdf file, and e-mailed it to our fax-impaired cardiologist. Read more »
*This blog post was originally published at edwinleap.com*
March 27th, 2011 by Edwin Leap, M.D. in Health Policy, Opinion
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My column in Sunday’s Greenville News.
‘Medical education shouldn’t cost an arm and a leg.’
I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year. And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their medical educations. Another young woman I recently met is in residency and her loan payments are around $2000 per month.
Thinking back on my own medical education, it seems my tuition was around $5000 per year. But then, what with all the Saber Toothed Tigers, Neanderthals and stone surgical tools, things were simpler.. These days, I don’t know how students will do it.
The thing is, American healthcare is expensive. But so is medical education. As we embark on this century, what are the odds that physicians with $240,000 loans for medical school will be able to offer inexpensive care? What are the odds they will enter low-paying specialties? They might be interested in charity care at first, but when the first loan payments come due all the good intentions in the world won’t change the fact that lenders want their money back. Likewise, it won’t change the hard reality that it will be extremely hard for these young physicians to pay for their student loans, buy a house, have a practice (pay malpractice) and raise a family; at least without making a large amount of money in their practices. And then there’s this striking (but seldom mentioned) fact: student loans are non-bankruptable. Student loans are friends for life, or until payed off. Whichever comes first. Read more »
*This blog post was originally published at edwinleap.com*
