A stream-of-consciousness reply…

This started as a comment on Shadowfax’s blog, where he went into significant detail about the study I (incorrectly) referenced yesterday. It just turned into some raving-sleep deprived mumbles that I felt guilty about leaving on his comment box, so I figured I’d just post it here…make of it what you will.

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I’m sure you’re right regarding the comments you left on my blog. I didn’t read the original study, just the press release (shame on me!), but the whole general idea of uninsured=ed visits really gets to me sometimes.

Today I had a young gentleman who wanted some bloodwork to check for “everything” just to make sure his drinking wasn’t a problem. I tried to nail him down about what specifically he was concerned about. (needle sharing, HIV, hepatitis, etc). He didn’t really know. But he wanted “everything” done. He had no insurance, no PCP, and no concept of the cost of the visit, bloodwork, nor it’s inappropriatness at specific point in time and place.

In fairness, I may have been the only doctor he’ll ever see, and the abnormal LFTs we discovered may be enough for him to follow thorugh with the AA/rehab/detox info I gave him. But if that’s the case, it’s a shame that healthcare is so inaccessable to a young man like this!

I wouldn’t mind it so much if my day was not already full of “for real” sick patients who are waiting in the hallways for my time and attention. Even if I would have kicked this joker out, which I was tempted to do, he would have still consumed 10 minutes of my time trying to sort out what he wants, plus 5 minutes of paperwork to document the encounter. Would he have been adequately screened for an ’emergency medical condition’ per EMTALA? In the same amount of time, I could assess and begin treatment on an acute MI and gotten him on the way to the cath lab. Which one is a better use of ER resources and nursing/staff/physician time?

The joker needed basic preventative health screening and counsiling, which I, in the emergency department, do not do. Even if I do, it costs 3 times as much as it would for a PCP do to the same visit with the increased costs due to “stat” labs, xrays and ED basic visit charges.

THe emergency department is not a free clinic, but sadly gets misused that way all the time, and is in many ways mandated to be that way by the federal government in spite of no compensation for doing so aside from what would otherwise be reimbursed from the patient/medicaid/medicare/etc… This reduces the time and attention we have remaining for the truly ill patients or patients who are percieved ill by themselves, their parents or their children, even if they do not have an “emergency medical condition”. This increases potential for patient risks and reduces patient safety as we try to do twice as much work in the same allotted time/space/resources.

I’ll stop here. Feel free to post any comments below. Nothing will be considered a flame, as this is just random rambling about what I see from my side of the stethescope, and you really can’t debate the stuff that goes on inside someone else’s head. What is there, is there.

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