May 1st, 2011 by Jessie Gruman, Ph.D. in Health Tips, True Stories
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Nora misjudged the height of the stair outside the restaurant, stepped down too hard, jammed her knee and tore her meniscus. Not that we knew this at the time. All we knew then was that she was howling from the pain.
There we were on a dark, empty, wet street in lower Manhattan, not a cab in sight, with a wailing, immobile woman. What to do? Call 911? Find a cab to take her home and contact her primary care doctor for advice? Take her home, put ice on her knee, feed her Advil and call her doctor in the morning?
Sometimes it is clear that the only response to a health crisis is to call 911 and head for the emergency department (ED). But in this case – and in so many others we encounter with our kids, our parents, our co-workers and on the street – the course of action is less obvious, while the demand for some action is urgent.
The question “which action?” has become more complicated of late because:
- In some communities, there are alternatives to an ambulance or a drive to the nearest ED, such as Urgent Care centers.
- Disincentives exist for going the route of the ED: in many cash-strapped municipalities we are charged for the cost of ambulance ride; we risk not having our ED visit covered by insurance if we make the wrong decision or fail to notify our health plan in a timely manner. Or we don’t have insurance and the ED care is expensive.
- Some of us have a number of clinicians who could guide us about ED versus self care on any urgent health matter, plus our health plan may have a nurse advice line that could do the same. Which among them to call? How long will it take to get an answer in the middle of a busy workday or a late night?
- Many of us have no primary care clinician to call. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
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 26th, 2011 by GruntDoc in Humor, True Stories
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If you’re alleging assault, don’t get loud with the Officer there to take a report. Especially if you have Felony warrants.
*This blog post was originally published at GruntDoc*
April 22nd, 2011 by Shadowfax in Health Policy, Opinion
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I wrote at some length yesterday about the prerequisites for a medical group to self-insure. What I didn’t go into in detail was the why — the benefits and the risks. I’m going to tackle that a bit today.
Potential Benefits to self-insurance
Those who have been around a few years can testify that the medical malpractice insurance market is highly cyclic. It seems that about once a decade a crisis hits. Whether this is a rational market is another question entirely. Some have attributed these crises to macroeconomic factors, like the market crash of 2002, after which insurers had to recoup investment losses, or hurricanes and natural disasters in which insurers cost shifted onto other product lines. Other obervers cite skyrocketing medical malpractice losses as the driver of these intermittent price spikes. I don’t pretend to know the reason, but it’s a reality that prices go up, and sometimes rapidly so, for no apparent reason. Additionally, during these times of market disruption, it’s common for carriers to drop clients, leave states they perceive as too risky, or leave the med mal market altogether.
One big advantage of self-insurance is that you can control your own destiny and insulate yourself from these market forces. You set your own premium and it only has to go up if you deem it necessary and prudent. You have a carrier that is guaranteed to issue a policy, and that will never leave the market. These are not small considerations.
I know a group that liquidated because their insurer dropped them and they could not find insurance; a contract management chain picked up the contract. I know several groups whose insurer stopped writing med mal and they were left high and dry. They had to purchase a group tail at an exorbitant mark-up and scramble on very short notice to find a new carrier, whcih was excruciatingly stressful. So to have carrier permanence, guaranteed issue, and premium stability is a huge benefit of self-insurance. Read more »
*This blog post was originally published at Movin' Meat*
April 19th, 2011 by Nicholas Genes, M.D., Ph.D. in Opinion
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Reading the ER Stories blog is often a guilty pleasure for me. Today’s post, however, struck a nerve:
Very often I ask patients about their recent visits to other doctors. While I am taking a history, it’s important for me to know if you’ve recently been seen by another provider for the same or similar complaints and what they did, what they diagnosed you with, what they prescribed, etc.
I often get a kind of irritated response such as “Oh, he didn’t do anything” or “he said it was nothing” or “he didn’t say anything to me”. Although I know my share of layzee doctors, I bet the vast majority of times, the doctor DID do something and DID say something.
Just not what the patient either wanted to hear or that their perception or comprehension was wrong. …
… Now, maybe he is not a good communicator. Maybe he doesn’t have the time to sit there and explain the pathophysiology of viruses or something like benign peripheral vertigo – and thus you feel short changed. After all he “just asked me a few questions, listened to my lungs and told me to go home and rest”.
Early on in my training I was fortunate to be taught that proper communication is the responsibility of both doctor and patient. So when a patient shows up in my ED and says their last doctor “did nothing” — when I can see with a few clicks that they got labs, a CT, and two prescriptions — well, there’s a failure to communicate. And the other doctor carries at least some of the blame for this. Read more »
*This blog post was originally published at Blogborygmi*
