Comments on: Unpleasable

By: CJ

CJ — Sun, 07 Nov 2010 17:18:04 +0000

Many patients that come through the ED don’t have a PCP and expect the hospital and doctors of the ED to work miracles. Some patients are aware of the limitations of the ED, while others see the ED as a “clinic”, seeking treatment (drug) for minor things such tooth pain. There is a big difference between life threatening and an minor ache and pain. Somehow people need to be educated on the meaning of “emergency”. It can be serious if an elderly person falls and It’s wonderful if the elderly has an advocate to speak for them, to question things, however, it’s not acceptable for them to be verablly abusive and threatening to staff and doctors. Often times, I see the patient shaking their head in disbelieve, not at the staff and doctors, but at their advocates. Where did respect go?

By: Mike

Mike — Thu, 04 Nov 2010 07:40:20 +0000

Thank you all – i have to meet with my boss tomorrow to discuss why the lawyer wasn’t happy with the discomfort of nasal packing (even though I warned him that nasal packing was the worst thing we do to people). I guess he thought I was exaggerating.

By: paul

paul — Sat, 30 Oct 2010 13:34:18 +0000

yeah great. so you and i get to split the risk, while the insurance execs who get to pocket the money instead of spending it on an admission assumes no risk for bad outcomes. that sounds super.

this line of thinking is already here. the biggest offender is probably chest pain, which routinely doesn’t get paid for once they figure out retrospectively that the patient “didn’t need to be admitted.”

By: Rogue Medic

Rogue Medic — Wed, 27 Oct 2010 08:05:17 +0000

Minimedic makes some great points.

My solution is an atomized Ativan atmosphere, and not just for the alliteration.

In California, if Prop 19 passes, hand out free marijuana. Satisfaction scores will soar, leading to increasing reimbursement. The main problem would be choosing a designated driver. It isn’t as if the decision-making capabilities of this family could be any more impaired than it already is.

By: ERP

ERP — Tue, 26 Oct 2010 02:14:40 +0000

Satisfaction scores in my book: “I’m satisfied, you should be be too”.
BTW, I would have gone back in and confronted that douchebag who threatened you. Sat scores or naught. I would have told them that is potential felonious and I will document that I was threatened with violence.
Then afterwards I would have gotten an ER tech to run out and slash his tires….

By: matthew

matthew — Sun, 24 Oct 2010 17:54:46 +0000

This country just does not understand that people just get “OLD” and shake and ache and wither. A trillion dollars of care won’t stop it.

By: Stalwart Hospitalist

Stalwart Hospitalist — Sun, 24 Oct 2010 15:33:53 +0000

I suspect the day will soon come, given the impending lack of reimbursement for marginal admissions or readmissions, that “general medicine” (me) will refuse to accept an admission for “the dwindles”, and recommend disposition from the Emergency Department. I’ll even be happy to do a formal internal medicine consult confirming the absence of criteria for admission to an acute care hospital.

By: Former EDPhysicianwannabe

Former EDPhysicianwannabe — Sat, 23 Oct 2010 19:01:25 +0000

Why is it that patient satisfaction is trumping decision making based on evidence based medicine or the standard of care? Do the administrators who create these satisfaction scores even know what EBM is? If I worked in a pediatric ED would I be penalized if a five-year-old is “unsatisfied” because I won’t give him what he wants but I make decisions based on recent EBM that are in the best interests of the child? Perhaps hospitals should think about the health of their workforce and how well they treat (or have been failing to treat) their workforce as educated medical professionals who deserve respect.

By: NurseBeth

NurseBeth — Fri, 22 Oct 2010 21:57:20 +0000

Some of our newer (younger) docs respond to these situations by saying we are only here to rule out “emergent, life threatening” ailments (and they really do decline to order more tests mostly), and the rest is best dealt with with your PMD. But yeah, their PG’s are in the toilet, too.

By: paul

paul — Fri, 22 Oct 2010 19:46:32 +0000

the irony is hilarious. they are desperate to find ways to save money without having to acknowledge the need for (already ongoing) rationing. but to do so like this… “make your patients happy or we will reimburse less!” okay… in this country where “more is always better” i guarantee you the strategy will lead to more health care spending, not less.