WhiteCoat

Healthcare Update — 09-23-2010

Bitten, shot, spat on. A day in the life of a health care worker. Hospitals would be wise to start taking the safety of their employees more seriously. I guarantee that this issue will come to a head in the near future – probably literally and figuratively.

Speaking of health care workers being shot … doctor tells patient and son about patient’s medical condition. Son then becomes upset, pulls out gun, shoots doctor, mother, and himself. Additional stories here and here.

After news of the shooting was published, this eloquent letter to the editor of a Baltimore newspaper emphasized why violence against physicians is escalating. “Stressed patients don’t see doctors as allies; rather as people to fight, manipulate or blame.” “We now seem to be living in a country where death is no longer natural; instead it’s a doctor’s mistake.” If you want some clear insight about why medical care in this country is deteriorating, you have to read this letter.

Lawyer mess up screws injured client. An anomaly, I’m sure. Nevertheless, it’s about time to push for legal care reform.

Annals of Socialized Medicine. A look at care in countries that provide socialized care.

How much is a lack of foreskin worth? Parents sue when baby is inappropriately circumcised after consent form is misread.

Patient gets nothing at trial after allegedly informing doctors of an allergy to morphine and then going into a “psychosis” when given morphine during his hospitalization.

Family sues for “cruel and discriminatory” treatment of man who died in his wheelchair while waiting 34 hours in a Canadian emergency department.

When you need 80 primary care doctors for every 100,000 people and you only have 36 doctors for every 100,000 people, what happens? Hospital emergency department visits increase between 12% and 54%. One California urgent care clinic in the article had an increase in patient volumes of 250%. Oh, and if you don’t want to wait, you can pay 25 bucks to reserve an emergency department appointment at Loma Linda University Medical Center. If you don’t have the $25, you wait in line like everyone else.

If you can’t repeal Obamacare, defund it. So say the Tea Partiers.

Another article showing why it is always necessary to get an itemized copy of your medical bills and to question any charges that don’t seem legitimate. A CT scan of the head for $5,874, $457 for drops that cost about $2/day, and a baby aspirin for $4.07. Yowza.

25 Responses to “Healthcare Update — 09-23-2010”

  1. DefendUSA says:

    WC
    There are so many people who deny that UHC or Canada and Britain’s versions of socialized care is better that it is astounding. I posted that link to the man who waited 34 hours and people tell me it is the exception!! It is not!! It frankly pisses me off.

    I have been called a liar, an extremist for my views. Sadly, it won’t make sense to those who believe it is a panacea until they are not able to choose the doc or hospital of choice.

    If Canada has trouble with quality of care and access with the population that is 35 million people and cannot provide adequate and timely rationed care, what the heck makes people think that with our population of 310 million, it will be better? I scratch my head. We do one hell of a job here and people don’t get it. ARGH!!

  2. Matt says:

    “When you need 80 primary care doctors for every 100,000 people”

    Is 80 per 100K the optimum number? Or the minimum?

    • throckmorton says:

      Matt:

      That is a good question. 80 is the minimum that is felt to be needed to handle acute healthcare issues.( infections, fxs, Mis) If you add in health maintainence, chronic care, well care, etc it is much more.

  3. Steve says:

    “Annals of Socialized Medicine. A look at care in countries that provide socialized care.”

    and the First link on there “Much less equipment available in UK vs US.”

    and how many times has the good doctor whitecoat told us about the stupidity of US defensive medicine?

    Cause, meet effect.

    • KT says:

      Just what I was thinking. Less equipment means it only gets used when it’s indicated, not just in case.

      • throckmorton says:

        KT:

        We have a Shumacher sternal cutter in the ED, it hardly every gets used. If you need one but dont have one, the patient dies.

        When you have a ruptured thorasic aorta, I hope your ED has one, just in case.

  4. GrumpyRN says:

    DefendUSA – yet strangely UK has a higher life expectency than USA.

    No one waits for 34 hours to be seen in a British Emergency Department, we have a national 4 hour waiting time limit from door to disposal.

    • Storkdoc says:

      Of course, your 4 hr wait period does not count the time spent in the ambulance outside of the ER. That way the wait is no more than 4 hours in the ER, but waits outside the ER can go on and on. So unless you actually make it into the ER, your wait time isn’t counted….

    • DefendUSA says:

      Grumpy…
      They may not wait for it in the ER in the UK, but how about my two friends, Americans, living there?
      He herniated a disc in his back and was forced to wait for 10 months for a CT scan. Then 8 months later told about his ruptured disc!
      10 more months later, he gets steroid injections,7 months later, injections round 2. 8 months after that he finally had surgery. By then there was no disc to “repair, some of the vertebrae had broken during surgery. He was left for 9 hours w/out pain meds because no one there could restart an IV!! He signed himself out after two days and is now about 2 inches shorter. nearly three years of bullshi* for much pain and nothing is resolved as he deals with it daily.
      The other friend was dxed with Prostate cancer. They told him he would have to wait for treatment. Needless to say, being a bit more well-off than my other friend, he took a leave pf absence, got on plane and was treated in the US.

      The point is that my friends or those patients are NOT the exception in what kind of access and quality of care they received. And as I said, what will happen to access and quality in the US when you add patients and docs treating decreases because the government will not pay them what they are worth?

      • GrumpyRN says:

        Storkdoc,
        Pish, this is old news and has been rectified a few years ago and was caused by bad management insisting on meeting targets without changing the systems. Do not listen to scaremongers like the Daily Mail(UK).

        DefendUSA,
        Back problem – I don’t believe you.
        Prostate cancer is not necessarily best served by operation. In US surgeons are only paid when they operate therefore there is greater emphasis on surgical treatment. Urologist in charge will make decision in consultation with oncologist.

      • DefendUSA says:

        Grumpy…
        Really? So, I am lying about my friends? I guess you are in denial then. Holy cow. What is with people not believing the truth?
        The truth will hurts, it can make you miserable, but it will set you free. Open your eyes.

  5. HospitalRPh says:

    Re “Annals of Socialized Medicine” – The links I checked took me to other blogs, which took me to newspaper articles, which for all I know could be the Swedish version of the National Enquirer. In any case, I prefer to make my decisions on objective research, not case history.

    • One example of the newspapers used for stories is the London Times. One look and you know it isn’t the Enquirer.

      These are stories about medical neglect, not visits from spaceships.

      For example The Times Online UK

      What is the objective research you are referring to?

      • Steve says:

        One swallow does not make a summer. You want me to find similar cases in the USA?(It wouldn’t be hard, you keep armies of lawyers doing just that!)

        The point is that a list of silly links can be made to prove anything you want.

        I’m sure the best care for the wealthy in the USA is better than the NHS, but the average is worse. The difference between us is that I think everyone deserves a good standard of care, whatever their wealth, you may call that socialism, I call it being a human being.

      • To Steve,

        You might like the story titled Britons demand decentralization of NHS
        The National Health System plans to decentralize control in response to publick revulsion at rising costs and lousy health care.

        Everyone makes his own decisions about what looks like an unusual event or part of a disastrous pattern.

        The average delivered care in the US is better than in the UK, as measured by outcomes for chronic disease. Everyone may deserve quality healthcare, but in the UK they are not getting it. I would of course be interested in your link to different statistics.

        Will the average care delivered by a socialized “system” be great care, or merely the same miserable care for everyone? Our legislators have expressed their opinion about the coming quality of care. Their insurance (and the insurance for federal workers and union memebers) is not part of the coming “system”. I suppose it is OK to have superior healthcare for the rich (and voting blocks) as long as you are part of the ruling class.

    • Sorry for the error, the link should have been

      For example The Times Online UK

  6. Elizabeth says:

    That article about the lawyer mess-up reads to me like it was the doctor who delayed so long they missed the statute of limitations – although it was still the lawyer’s responsibility to ask what was going on.

  7. To GrumpyRN,

    What data are you using for UK life expectency vs the US, and why do you think that is significant?

    The usual claim that US healthcare costs more and delivers less comes from statistics by the UN World Health Organization. The WHO health statistics are biased. The WHO itself ranks the US #1 in health care delivery that is important to patients. It issues another ranking of 37th because this quality of care costs more and is not delivered by government in a “fair” way! Critics of US health care always refer to the ranking at 37th. That is a political judgement by the WHO.

    The arguments offered against the quality of US health care are based on flawed infant mortality and life expectancy comparisons.

    Just two points, with more at the link:

    (1) The US follows the WHO definitions exactly for counting a live birth, “even one breath”. Other countries do not count premature births or babies with severe birth defects. The increased deaths of these children raise US numbers for infant mortality and decrease US life expenctancy accordingly.

    (2) The US has far more death from auto accidents and violent crime, but higher survival for cancer and other chronic diseases. Overall mortality is not a good statistic for judging health care effectiveness or population health.

    USA Healthcare is First – Infant Mortality is Low

    • DefendUSA says:

      Andrew,
      Exactly. The WHO does not take into account that it is comparing two completely different health care delivery systems. I wrote this last year:

      “Let’s see. The World Health Organization puts the U.S. 37th when it comes to health care. Does anyone question that? Yes, the U.S. does spend more money on health care than any other nation. But the WHO is not comparing like systems, number one. It compares free market or privatized systems to socialistic ones. While it is not a deal breaker, consider that we are ranked 37th because of health care distribution and cost, not quality of care!! They are judging what they deem too be fair “distribution” of health care! At the very least, it’s subjective. Population deviants are not considered. We have 308 million people to serve in the United States. The population of Canada is 33.2 million, Germany, 82.3 million, UK is 60 million and let’s not forget Sweden, Norway respectively at 9 and 4.7 million. All of those populations are considerably smaller and all apparently have trouble with quality of care and access.

      Those that believe the Canadian system or even the UK’s National health care are a boon, have not been paying attention. In both places, access is pitiful, as is quality of care. Ask yourself why people come here for surgeries or treatments if where they live has such a wunderbar system?

      Canada made it impossible for private practice outside of the social system. It drove docs to other countries, but of late it has changed. Now, the best doctors practice privately making them accessible to those who can afford the cost, the rich. The government care is left with the remainder and by it’s own admission on the brink of failure. Daniel Castonguay, the original architect of Canada’s system has himself said, ” “We thought we could resolve the system’s problems by RATIONING SERVICES or INJECTING MASSIVE AMOUNTS OF MONEY into it. We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.”

      What drives developments in technology, medicine, or research? It’s true that Europe is on the forefront of many new surgical techniques and drug innovation, and vaccines. But so is the U.S., right?

      What drives it?

      Capitalism? YES!! Primarily, U.S. capitalism. Without our capitalistic market, the risk for investing in these items would be too high (i.e. not enough potential profit to incur the risk associated with the investment of the needed capital). In essence, the world’s investors make choices with their capital. If the potential profit is not in medicine they will shift their investment capital elsewhere, say food, energy, construction, transportation, etc.

      If the profit motive is taken out of the medical sector, due to its socialization by the government, the ability to make a profit in the medical sector will be determined by the government. Even if the government decided to leave in a profit margin equal to that currently in place, future profit margins would respond to government forces as opposed to free market forces.

      This factor alone would increase the risk of capital investment in the medical sector. In fact, investors would demand higher initial profit margins to make the same investment that they make today because of this added government risk.

      What happens? Prices would essentially go up in the sector and not down. If government reduced the profit in the medical sector through caps and payment regulation, the risk to investors would also go up.

      Again, what happens? In this case, the investors would leave the sector and move their capital to another more profitable one. The result would be reduced innovation in medical technology, vaccines and drugs.

      Furthermore, the intellectual capital held by physicians, scientists, etc. would choose sectors more profitable than that offered in the medical field. It is even more possible that this intellectual capital would move to another more favorable country. Costa Rica, anyone?

      And what would happen in an even bigger picture? Try to insure all 308 million people and compromise that intellectual capital and voila, get reduced access. With the flight of physicians and no potential replacements- who would study that long, and work that hard for less than what they are worth? The quality of care would also decline. How much more simple does it get?”

    • GrumpyRN says:

      Google it, pick your data base.

  8. midwest woman says:

    After reading all these comments, I question how you reconcile the economic needs of the providers and associated healthcare businesses with the needs of the individuals who require their services but are financially shut out? Or are impoverished by their medical bills?
    I understand that financial burdens carried by the physicians between education costs and just the cost of daily business obligations are staggering. But then again many people are are behind the genetic or just bad luck eight ball and are under astronomical burdens just to maintain their lives.
    Who gets left out? The physican made a choice to become one…the hemophiliac or diabetic or innocent victims of accidents or crime didn’t.
    I really don’t have a dog in this fight but would like to see a physician proposed delivery of health care that would be as equitable as possible for everybody.

    • Matt says:

      Well, that’s the balance we’re all trying to strike with regard to this issue, isn’t it? What’s the baseline of care we as taxpayers are willing to provide and at what cost will the providers care for those people?

    • WhiteCoat says:

      I agree with Matt (did I just say that?)

      You’ll note that the question Matt poses engages the free market. The less that we pay physicians, the fewer students that will want to take out huge loans to become physicians. Fewer physicians put those physicians still in practice in higher demand. When demand is high enough, some physicians may decide that they are no longer willing to accept the monetary losses created by low paying insurance plans such as Medicaid and, if the cuts go through, Medicare. I think that things are precariously close to that tipping point now – at least with primary care physicians. If you look at Merritt Hawkins recruiting incentives, family practice is consistently the medical specialty for which hospitals search the most.

      I don’t see any way other than a two-tiered system to bring more health care to everyone. The government will have to fund regional government-run hospitals where the care is free, but the waits are long and the quality maybe isn’t as good.
      Since the government won’t be able to provide timely care to everyone, rationing will occur. Then private hospitals will step in to fill the void. Patients will have to make a decision whether they want to pay for immediate care or endure long waits for free care.

      We just have to get rid of this farce about “insuring” everyone. Take all the money and invest in infrastructure for regional government-run hospitals that are free – much like the VA system. You walk in, you get care.

      • SeaSpray says:

        My family doc is is moving toward a concierge practice. (Because of ins companies) For anyone willing to pay 150.00 a month they will get his cell phone number and a minimum appt time of a half hr and more if needed. there are more perks, but don’t recall.

        He will still reg patients. I was afraid I’d lose him because I can’t do the concierge thing, but he told me I would not and so was relieved about that.

        I called the concierge company to see what it was about and the woman told me that there was one doc in our county that told his patients ..if you don’t become a concierge patient then your not my patient anymore. WOW!

        Oh and she said something about if someone is in out of the country, they still have access to him and his input. Not clear on that though.

        I don’t know how it will all work, but maybe it will be more difficult to get appts? Not sure.

        I wonder if this will be a trend?

  9. Gen says:

    I would most definitely sue the hospital for circumcising my child without my consent. It’s not worth millions, but someone will be held accountable for that mistake.

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