Also see more news tidbits from around the web on the Satellite Edition over at ER Stories.
Rome, GA woman is arrested after police find her on top of another patient in a dark emergency department room … throwing punches. After being seen yelling profanities at the patient, the perpetrator told law enforcement that she passed out and didn’t know what she was doing. Good answer.
You can only go to the doctor whose next appointment is in six months and the hospital that has a reputation for maiming patients. Otherwise you pay full price. Insurance companies are testing out programs that limit what hospitals and doctors a patient may see. If patients go outside the network, they pay full price for the care. One insurance executive was quoted as saying “We think it’s going to grow to be quite a hit over the next few years.” Just like HMOs were a hit in the 90′s, huh?
The insurance mandate IS NOT a tax … OK, we lied. Last September, Obama was quoted as saying that “For us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase.” In recent court briefs defending the health care law against lawsuits from 20 states, the Obama administration now admits that “the requirement for people to carry insurance or pay the penalty is “a valid exercise” of Congress’s power to impose taxes.” Change you can believe in, baby.
Charity medical care in Utah hospitals drops by 40% in 2008. I’m sure that the numbers are worse in 2009 and 2010.
The Mike Royko approach. Don’t want to pay the overpaid sawbones? “Just have the kid the old-fashioned way. Squat and do it. And if it survives, you can go to the library and find a book on how to give it its shots.” Some people are actually doing that. Only they’re going to YouTube and not to the library to learn how to drain abscesses, remove warts, and … have home births. Only problem is that things don’t always turn out as planned. The article highlights this case in which a 14-year-old girl in Texas was charged in relation to the death of her newborn boy after she and her 11 year old sister learned how to deliver babies on YouTube.
Here’s a news release to slip under the hospital CEO’s door … After several injuries to hospital staff, OSHA fines Danbury Hospital for failing to provide adequate workplace violence safeguards. Does this mean that our 75 year old security guard with the bad back can finally get a TASER? Hat tip to the ageless GruntDoc.
Blacks, Hispanics, and Asians all tend to think that doctors of their same race or ethnicity provide better medical care. Unfortunately if they go to the emergency departments, they have a 4 in 5 chance of being disappointed. 80% of the emergency physicians in the US are white.
It’s a trust fund, not a piggy bank. Wisconsin Supreme Court rules that state has to pay back $200 million it “borrowed” from the trust fund physicians created to compensate medical malpractice victims. With only $45 million left in state budget reserves, the state budget just became a much deeper shade of red.
Here’s an idea. Why don’t Wisconsin residents force the state to sell off its assets to balance the budget? State parks and other state land. State office buildings. State vehicles. If you owe taxes, the state and federal government will force a sale of your assets to pay your debts.
Wisconsin has a projected budget shortfall of $2.5 billion for next fiscal year. I’m sure that the state has more than $2.5 billion in assets. Fork ‘em over.
Anyone want to go in halfsies on a Wisconsin State Police cruiser for those vacations in the Dells?
Dengue … Dengue very much. Dengue Fever getting a foothold in the Florida Keys. One of the first patients to be diagnosed with the disease (after multiple doctor visits) describes her symptoms. “My head hurt so bad that I wouldn’t wish it on my worst enemy.” “Your bones just hurt. That’s why it’s called breakbone disease. It’s indescribable. I can’t even articulate the crazy pain that you’re in. You feel like you’re heavy and out of your body.” Twenty eight cases of Dengue Fever have been confirmed in Key West and about 5 percent of the local population may have been exposed to the disease.
Tennessee emergency department closing after being projected to lose $1 million this year. Urgent care center taking its place. Now patients with emergency conditions will have to add 40 minutes to the trips they take to see a doctor. The local EMS director estimates that each emergency call will now take a total of 2 hours. A major accident in that town will have disastrous consequences.
Press Ganey survey data from them shows that the average time a patient spends in an emergency department visit across the United States was more than 4 hours. Utah patients spent an average of eight hours and 17 minutes per visit while only Iowa and South Dakota were able to break the three hour wait mark.
By the way, did you know that some hospitals/systems pay Press Ganey well more than $100,000 per year to perform these surveys and compile the data? Or that Press Ganey partners with more than 40% of the hospitals in the US?
Some people are starting to get the whole insurance/access disconnect. Arkansas Surgeon General is concerned that adding another 400,000 patients to the ranks of Arkansas’ Medicaid program will worsen the state’s doctor shortage. “We’re going to have to better organize our system so we have access and availability. Otherwise, we’ll have financial coverage but no accessibility.” Exactamundo. Unfortunately, organizing a system won’t do much if you don’t have enough medical personnel providing care.
I personally absolutely believe in the insurance purchase mandate. Call it a tax or whatever. Without it, people won’t buy any til they get sick.
Again, the young and healthy can buy cheap plans that restrict where you can go for routine care (since they won’t have to go often anyway) but provide good coverage when they perf their appy.
I believe that the insurance mandate will only increase the amount of money going to middlemen insurance companies.
If we want to improve *access* for everyone, then take all the extra money and put it into a “health care system mandate”. Create sets of regional hospital systems and clinics run by the government (we can start with the VA system and expand it if necessary) where patients can walk in the door and know ahead of time that all of their care is absolutely paid for.
Why can’t the government do this? The infrastructure is already in place.
Uh, that’s called socialized medicine. You can’t really be for that, dude.
Arkansas can’t possibly have a physician shortage. It got tort reform several years back, and WC told us we had to choose between suing doctors and having doctors. Arkansas listened to physicians like WC and enacted “reform”, so it’s not possible that physicians didn’t flock to it in record numbers.
After all, why wouldn’t they want to come to a small, rural, poor state once it had that great equalizer of tort reform?
Unless WC was just making that up. And I KNOW that’s not true.
Matt-uENdo
Please show me where I “told us we had to choose between suing doctors and having doctors.”
You repeatedly and unethically change my statements to further your own agenda.
I have consistently stated that in some instances society has to choose between perfect care and available care. As the liability increases, availability of some care decreases. I have also posted journal articles substantiating that point and have linked to articles about how the availability of medical care in Texas increased once tort reform was enacted.
You know, I know, and the people who read this blog know that tort reform is only one facet of a growing problem in health care. Payments are another facet. Micromanagement is another. Government regulations are another. Practice environment is another. Medical school debt is another. Lifestyle is another. There are others. To single out one facet and imply that doctors should feel thankful for it at the expense of all the other factors is disingenuous. You knew it before and you know it now. Yet still you make the same misleading posts.
You want to make the lame argument and innuendos that any amount of tort reform – by itself – should be the sole determinant of whether or not physicians are willing to practice in a given environment, go ahead. People that read this blog realize your arguments are not genuine and people on KevinMD.com also realize that your arguments are not genuine.
I find it amusing how many people around the web mock your comments and your reasoning.
I wonder sometimes if you read your own statements. The innuendo is not mine – I’m repeating EXACTLY what you said. Did you forget you wrote it? I’ve never seen any of these qualifiers you mention when you’re posting these “tort reform=access” claims. Did you have a sudden onset of honesty in the above post?
It’s kind of like your tort reform=less defensive medicine or tort reform=cheaper healthcare claims. 40 years of it and there’s literally no evidence it’s true, but you keep believing.
“As the liability increases, availability of some care decreases. I have also posted journal articles substantiating that point”
No, you haven’t. You’ve posted some physician surveys and lobbyist statements. That’s it. In fact, 40 years of evidence show you to be wrong. Not to mention the availability of physicians per capita charts, which CLEARLY illustrate the driver of access is the wealth of the community. Here’s a useful link, and not from anyone with an agenda:
http://www.statemaster.com/graph/hea_tot_non_phy_percap-total-nonfederal-physicians-per-capita
Note who else is in the bottom with Texas – Arkansas and Mississippi, both with tort “reform”.
“how the availability of medical care in Texas increased once tort reform was enacted.”
How exactly does one reach this conclusion when Texas is in the same place for physicians per capita it was before “reform”? And that many of the physicians coming into Texas are coming from another state with tort reform – California?
Strangely, though, you never seem to comment on whether there’s less malpractice. Wonder why that’s not all that important for you?
“Yet still you make the same misleading posts.”
Doctor, you’re the one lying. 40 years of evidence shows that you’re lying. Physicians go to places where there is money to pay them. Period. Nothing wrong with that, but quit trying to sell everything else based on access.
I’m sorry you find my reasoning amusing, because it shows a serious ability to disregard facts in reaching conclusions on your part. I don’t know how one can be a doctor without that kind of error, but maybe your blind spot is limited solely to political issues favoring insurance companies. At least, for your patients’ sake, I hope it is.
With regard to the genuineness of a position, if you don’t find facts compelling in forming opinions, I have no doubt you don’t find my positions genuine. When one gets their sources from opinion surveys and lobbyists, they already know the outcome they’re going to get, which is why they go to those sources. Those of us looking for genuineness prefer more non-partisan data.
From a political standpoint, the really sad part of your misinformation campaign is that by focusing on screwing those without economic damages, you’re missing the real boat on health issues – payment reform. I wonder how amusing it will be to you when you are a federal employee? You’ll be chuckling all the way to the Department of Human Services I guess.
But by all means, get your chuckles while you can. The single payer train is coming in the station, and you’re leaving with it, my friend. Whether you want to or not. Enjoy the ride!
“Please show me where I “told us we had to choose between suing doctors and having doctors.””
Not a problem:
“If we keep trying to sue our way to better health care, soon we’ll see how much more the availability of health care diminishes.”
Or this one:
“We have to ask ourselves whether we value the ability to find a physician to care for us in an emergency more than we value the right to sue that physician if anything goes wrong. ”
And I didn’t even look through many of your comments. Surely your cognitive dissonance isn’t this bad. Remember man, this is the Internet, it’s preserved forever!
And please, don’t engage in Clintonian parsing in an attempt to run from your position. I have a significant amount of respect for you, and I’d hate to see you play those kind of games.
Matt,
He doesn’t have to parse. You do it for him. As he said, those who read this blog regularly know he has talked about all those issues mentioned at various times. Does he mention all of them when having a post about one of them? No, of course not. One does not need a detailed discussion of every issue in every post. Otherwise , it would just be a book-and a lengthy one at that.
Of course then you’d argue that Chapter 12 on Tort reform was weak because it didn’t rehash chapters 1-11.
Matt:
There are many reasons for doctor shortages. Here is a question for you. In our area, there are independent nurse practitioners. They are held to a different standard in regard to medical malpractice than are MD and DOs. Why?
They have professional liability, not strict liability. The damage must have come from a deviation from their professional standards. If everyone had to have the same outcome, that would be strict liability. The liability would come from the bad outcome, no matter if the defendant did anothing wrong.
There is good evidence and naturalistic experimentation showing that tort litigation deters, not just the defendant, but the entire industry. Immunity grows the industry.
Here is a list of historical experiments. One, the KKK, has a repeated on-off, on-off sequence.
http://supremacyclaus.blogspot.com/2007/09/immunity-and-liability-are-stealthy.html
Thank the lawyer for the end of manufacturing in the US. Now the lawyer is going after drug companies. Those will be gone. Medicine happens to be relatively immune, and is growing. Lawyering is nearly totally immune, and growing.
Inevitably, they’ll return for “Fast Food.”
regarding the home birth blip, the problem is not watching a video, and having a baby at home. the problem is where the F was this girls family? do a mother or father exist? a caring guardian? You-tube is a crappy resource, like you say. i mean you can even get info on killing animals on there. its sad that this stupid young girl lost her baby. it doesn’t make home birth in and of itself unsafe.
Home birth without a trained provider is, in fact, unsafe. People these days tend to forget exactly how many things can go wrong that can cause serious problems to either mom or baby.
i am in exact agreement with you.
Interesting about Press Ganey. Nothing like statistical analysis (that does not meet statistical significance) to confirm the fact that in the great KFC meal of life, we are the moist towelettes.
To think, a patient like in your last post may ultimately determine the fate of an emergency group. The fate of hundreds of man-years of schooling and experience rests in the hands of a patient that won’t buy her kid a bottle of Motrin because it’s free by prescription. But she will buy all her kids ice cream. And she is all too happy to give you a crap ration in the process.
Rather than help teach this woman a little self sufficiency, the new emergency group will just write the script, and thank the patient for coming to their emergency.
Yes, some ERs are forced to recite a little “thank you in all your splendor” blurb as part of AIDET (public relations) nonsense, then make followup phone calls. (I’m lucky if I can get to the bathroom in a shift).
And this stuff is even harder for the nurses, who are required to buy into it and are disciplined for any perception of failure.
Emergency Medicine is changing. There must be something out there that is better…
“Blacks, Hispanics, and Asians all tend to think that doctors of their same race or ethnicity provide better medical care.”
Well I can speak from college about asian students in general. As students they’re great at memorizing and regurgitating textbooks, but when it comes to actually thinking they come up 0′s. Translation: give them a multiple choice test they’ll score 100%. Given them a problem and a blank sheet of paper for doing it out, they die. And when I’ve had asian doctors it’s the exact same thing…
Black doctors…I’d rather have a doctor that got into a college because they were smart, not because they were a minority. Until affirmative action gets killed I’m not changing my opinion on that. But I’ve also met some that are very good at what they do.
Hispanics…worst cheaters on assignments I’ve ever seen. Funny part is though you’ll see a group of 10 of them trying to figure something out and none of them are good enough to get it even when combined.
Whites…pretty much average in every category. Good ones, bad ones, cheaters, noncheaters, thinkers, non thinkers.
Okay, so I am now dying to know where you are from.
The Dells?!? I love it. Can’t sell the cruisers – that’s a big revenue source – hitting up speeding Illinois tourists heading north.
Sad that I am a physician from Wisconsin and found out about the Supreme Court decision through your blog – also sad this has been dragged out for so long.
I knew a woman who gave birth to her first child alone. At the birth of her second child only her daughter was in attendance. At the birth of her son only her two daughters were in attendance.
Insane and very very very lucky.
“Blacks, Hispanics, and Asians all tend to think that doctors of their same race or ethnicity provide better medical care. Unfortunately if they go to the emergency departments, they have a 4 in 5 chance of being disappointed. 80% of the emergency physicians in the US are white.”
In a study of cancer patients, same race patients initiated a lot more questions and conversations.
The implication is that if that with patients of a different race than the doctor, the doctor must initiate more clinically important conversation. You can imagine, in a cancer follow up visit, a lot of ground has to be covered. If the patient has a race different from the doctor’s, the doctor must bring up a lot more subjects.