If you like these, check out the satellite edition of the Healthcare Update over at ERStories.

“The only thing that changes is the names.” Canadian patients dying waiting for emergency department care. One patient’s family was told that the emergency department was short two doctors and four nurses and that “there was a 16-hour wait and that I just had to be patient” – as the patient died while sitting next to the nursing station. Nurses are forced to do overtime and then “the health system is not able to retain them.”
When you make the practice of medicine unattractive, not as many providers want to practice and this scenario will repeat itself.

It’s called job security. Survey shows that 61% of adults in the US drink “liquid stupidity,” only 31% of adults exercise regularly, and 20% smoke cigarettes. While 64% get 7-8 hours of sleep per day, 28% get 6 hours of sleep or less. The comments to the study were … interesting, including a post of the text of a now-dead Mississippi House Bill that purported to improve obesity in Mississippi by prohibiting food establishments from “serving food to any person who is obese”.

Think about this before your next one night stand. According to Bloomberg.com, one in six Americans has genital herpes. About half of all black women and 40% of black men have genital herpes. To treat the problem, GlaxoSmithKline sold $1.29 BILLION worth of Valtrex last year. Dang!

Georgia Supreme Court upholds liability protections for emergency medical services. The Georgia legislature passed tort reform in 2005, finding that health care providers in Georgia were having increasing difficulty in locating liability insurance and that when the insurance was able to be found, it was extremely costly, resulting in the potential for diminution in access to health care and an “adverse impact on the health and well-being of the citizens of this state.” Potential litigants must still prove “clear and convincing evidence that the physician or health care provider’s actions showed gross negligence.”
The dissent in the opinion (.pdf file) called the law “arbitrary” because it protected emergency health care providers, but did not afford the same protections to physicians who treat the same conditions in their offices or in the patient’s homes. The dissent forgot one thing – physicians can refuse to provide care to patients in their offices or at their homes. Emergency physicians provide care to all patients all the time. Protect the safety net.

More evidence that “insurance for all” isn’t the answer. This New York Times article describes the difficulty that Michigan Medicaid patients are having when trying to find medical care.
“With states squeezing payments to providers even as the economy fuels explosive growth in enrollment [now 47 million patients nationally], patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage.” One parent called 4 or 5 pediatricians to see her 2 year old son. None of them accepted Medicaid. She ended up having to go to a public clinic with a four month waiting list.
One obstetrician who stopped providing services “feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies because of underlying health problems.” Only 2 of the 72 surgery residents who trained at one Michigan hospital decided to remain in Michigan.
Not only are states cutting reimbursements for care, but they are also cutting benefits — including dental, vision, podiatry, hearing and chiropractic services for adults.
Realize that, on a “dollars and cents” basis, lack of providers is beneficial to the bottom line. Less access means less provision of services, which means less payments for provision of services. Is this the kind of “insurance” that we’re seeking on a national level?

Kevin MD published a good Op-Ed piece in USA Today about patient satisfaction surveys – showing how the surveys have little correlation to quality of patient care. A couple of the editors at EP Monthly are working on publishing the results of the survey on patient satisfaction surveys taken on this blog a few months ago.

Same law firm obtains $9.7 million dollar judgment on behalf of patient whose cancer diagnosis was delayed and $38.7 million dollar judgment when obstetricians allegedly fail to perform a timely Caesarian section on child who was born with cerebral palsy.
Another firm obtains $23 million judgment against a physician after patient ends up paralyzed from waist down when treated for leg fracture.

Is substance abuse a problem with our troops in Afghanistan? The number of narcotic prescriptions written by military physicians has quadrupled since 2001.

Answer: $400,000. Question: What was the median amount in damages awarded to successful medical malpractice plaintiffs in 2005? By the way, plaintiffs won less than 25% of the cases that went to trial. Using those numbers, if I were a radiology researcher, I’d be able to call all medical malpractice cases “inappropriate.”

You hospitals want to save money? Stop treating low income patients in your emergency department. After implementing its Urban Health Initiative, the University of Chicago doubles it operating profits for the year. During that same time period, ED visits dropped 22% and admits dropped 8.5%.
One problem, though. If more hospitals take this approach, where are the poor patients going to get the more “mundane” medical care?

Minnesota Governor Tim Pawlenty suggests that one way to cut health care costs is to change federal EMTALA laws so that “not every ER is required to treat everybody who comes in the door, even if they have a minor condition.”
He’s now getting flamed all over the internet. See here, here, and here for examples.
The thing is, EMTALA laws don’t require every “ER” to treat every patient. Hospital emergency departments are only required to provide a screening exam to everyone and to treat emergency medical conditions. Pawlenty already has his wish, and it’s not so radical, folks. To wit: (I saw that phrase in a lawsuit brief and am getting a kick out of using it, so leave me alone)

More hospital emergency departments are jumping on the “pay before you see the doctor” bandwagon. Burke Medical Center in Georgia stated that it was “following the trend of other facilities” when it implemented a policy of paying your insurance co-pay or $100 before receiving treatment. If you don’t pay and don’t have an emergency condition, you’ll be given a list of outpatient clinics where you can go for care.

In the same vein, do doctors in America turn away the uninsured? Absolutely. Read this HuffPo article to get a good idea of how and why. Good insights.

Nebraska physician advocates personal responsibility as one way to improve this country’s health care problems. I agree.

“Do you know where your son spent the night?” College students go to emergency departments for intoxication and college calls parents to narc on them. “Sent to the hospital.” “Alcohol poisoning.” “Not the first violation.” The schools also call home every time a student is caught with alcohol. Some schools allege that “telling mommy” decreases the amount of binge drinking on campus, but isn’t there some type of privacy issue going on there, though? What’s next, a voice mail message at mom’s work if you don’t finish your carrots in the cafeteria?
If an administrator did this to me when I was in college, I would have followed him all over campus and followed him home, calling his mommy and his wife every time he rolled through a stop sign or looked at me crosseyed. Then I would have written an article to the school newspaper chronicling all of his transgressions. Then I would just randomly go to his office with a notebook, wait in the waiting area, sit there writing for 30 minutes at a time, then get up and leave. Can’t be too careful about those college administrators, you know.

Reserved parking for the four pronged canes to the left, leave your brown paper bags of medicine on the counter. A geriatric emergency department – the wave of the future or a flash in the pan? Will they remain viable with Medicare cuts to physician payments or will hospitals use them as a loss leader to draw in patients for more profitable procedures?