Articles by Mark Plaster, MD
After sitting for hours reading the transcript of the Supreme Court oral
arguments on the constitutionality of the Affordable Care Act, I had
worked up quite an appetite. “It’s about time you came to eat,” my wife
said as I came into the dining room. “What have you been doing?” she
said without hiding her annoyance. “You know we have the grandkids for
“Of course, health care is a right,” my young friend said with a
disdainful twist of her face and a shudder that seemed to shake off the
unthinkable. “You are a doctor,” she added, reminding me of what I had
done for thirty years. “ Surely you agree that health care is a basic
Have you ever gotten a chance to see how one of your ‘one in a million’
cases turned out? You know, the gunshot to the chest that got opened in
the ED and actually lived? In emergency medicine, unless you work in an
academic center doing research, most of our cases are lost to any long
term follow up. But that doesn’t keep us from wondering just how things
Senator John Barrasso was “Doctor” Barrasso, an orthopedic surgeon from
Casper, Wyoming, long before he came to Washington. So, after the
passage of broadsweeping healthcare reform, it came very naturally for
him to offer a physician’s perspective on the floor of the Senate. Since
then, he’s given these “second opinions” about the unintended
consequences of healthcare reform nearly every week.
I don’t often get calls from thoracic surgeons asking for my help. But
this was a unique circumstance. His son, a first year student at the
U.S. Naval Academy (a plebe as we call them) was going through his first
baptism by fire. He was concerned that his son was hitting a breaking
point, so he reached out for my help.
It’s a simple question. Given a specific set of facts concerning the
presentation of a patient in the ED, what would the reasonably prudent
physician do? Or stated more specifically, was an emergency physician’s
actions in response to a given set of facts reasonable? This is the
“standard of care” against which the physician’s actions will be judged
in a case of alleged negligence.
A response to the backlash following last month’s op/ed “Life Cycle of a Parasitic Specialist” Normally, we would allow an opinion piece to stand as just what it is,
an opinion. After all this is America and we still have free speech.
However, in this case, the vitriol and vulgarity of the responses to an
opinion piece demanded an explanation from the editors who published it.
As I arrived to work I saw that the parking lot and the waiting room were packed. This is not supposed to happen at this place. “I’m getting too old for this,” I mumbled to myself as I dropped
my 2am lunch in the frig and grabbed a handful of charts. I’d raced
through an hour of charts before it dawned on me that they were filling
the rack as fast as I could empty it.
The CDC reports that 123.8 million patients visited an emergency
department last year. That’s 41.4 visits per 100 population. That number
has risen every year despite numerous, concerted efforts by the
government and the insurance industry to stem the rising tide. Could it
be that patients see what the politicians and planners seem to be
missing, that the model of emergency care by qualified specialists, when
and only when you need it, is a good model for health care delivery?
With less access to primary care and multiple gatekeepers adding to the expense of health care, perhaps EPs should be the final stop for many ED patients.
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