I would not have treated either, but that is based on knowing my area, knowing (googling) squirrel rabies rates (low to zero), knowing rabies is rarely transmitted except by bite, I think it is safe for not treating. Lots of illnesses could be highly lethal, but we still don’t automatically treat them all. The patient made the decision to wait until the next day and not call his PCP. THe health department will almost always refer to a doc/ED for evaluation. THey are not giving medical advice, they are referring to someone who can.

To Marilynn,

As an ER doc, I am sorry for what happened to your daughter, but that sometimes happens. C-diff can be self limiting in some situations, and probably NOT the underlying cause of the overall illness. We are now doing some testing in our ER, but only because we have quicker turn around times for the test. It is the ER job to rule out the serious stuff as best as we can. We cannot always figure it out. I tell people quite often that I don’t know what is wrong with your family member, but I am confident that it is not x,y z for these reasons. It is important to follow up with your primary doc and RETURN if WORSENS. 2 or three visits for a worsening problem equals admission to the hospital for a second set of eyes to re-evaluate.

If you have to use discharge instructions to CYA then perhaps the lawyers are involved for a very good reason.

There seems to be a double standard involved with patients. They are expected to know and be involved in their care but if they are too involved or question their care that is bad. Where that line is drawn varies widely. Ultimately, I have concluded that if you get really sick you will be subject to massive costs, anything but a basic office visit is going to hurt the wallet and no medical professional can be soley relied on for medical advice.

Patient has been sick since early April (nearly three months), and getting sicker, has lost more than 10% of her body weight, going from 112 to 98 pounds in two months.

Bloody diarrhea getting bloodier, patient unable to walk without assistance because she cannot move without starting to lose consciousness.

Is it an emergency yet? Or can it wait until Monday morning?

The doc who told her it was an ovarian cyst and would get better in a couple of weeks, the same doc who gave her the antibiotics (and SHOULD have been attentive to the fact that C.Diff is frequently an after-effect of antibiotic therapy) blew her off.

I’m not opposed to paying for emergency visits, and paying the high price. It’s worth it for the skill offered there.

But someone (and, now corrected, not the ED doc) cost this girl unnecessary money and unnecessary suffering. I am not a believer in trying to profit off of suffering, but the doc who caused the delay ought to absorb the EXTRA cost that could have been avoided. This could have been nailed down for under $1,000. Now the bill is ten times that.

And for your viewing pleasure:

Bat Bite Visit 1, Summer 2009:
Level 3 Exam Emergency Dept $145
Inj Ther (injecting immune glob & vaccine) $40
Rabies Vaccine (Imovax) $334

Visits 2-5:
Treatment/Infusion Room $135
IM injection $25
Imovax $334

It appears that I and my insurance (thank God for my insurance!) were not charged for the immune globulin. Maybe it comes out of a federal public health fund? (Like the Tamiflu stockpile?) At the vaccine-only visits, the fee for a nurse to administer a vaccine was $25. The fee for use of an outpatient surgery room for 20 minutes (during non-surgery hours) was $135. Those 4 visits could perhaps have taken place at a physician’s office. Cost for a specialist to evict the bats from our house: $3000 out-of-pocket, with a 1-yr guarantee.

(Oh and squirrels are rodents, and rodents somehow don’t generally carry rabies. I think.)

If someone was willing to see you within 2 hours of your decision to seek medical care and provide that care to you for $100, and you trusted the advice of that person, then there’s not a problem.

However, if no one was willing to provide those services to you for that price, then you would need to decide whether it was worth more to you to pay nothing and incur the risks of developing rabies (whatever those risks might be), or pay the asking price to get an answer from someone with experience in the issues.

$600 is a lot of money, and I agree that it seems excessive for the perceived services, but it isn’t just about the doctors getting paid. It’s malpractice insurance. Hospital building costs. Fixed costs such as rent/heat/water/waste disposal, etc. Costs to hire nurses, techs, and secretaries that are there 24/7. You’re not just paying the doctor’s salary, you’re paying to keep the whole hospital afloat. And think about how much it costs to keep a hospital running – especially when subsidizing the care of patients who do not pay their bills.