WhiteCoat

Open Mic Weekend

Back for another open-mic weekend.

All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section.

Only rules are that there are no personal attacks and that the comments are medically-related.

Have a safe and enjoyable weekend.

9 Responses to “Open Mic Weekend”

  1. Rocketman says:

    Just throwing this out- saw it while running last week. A car had a sticker- “Take my daughter to [...] Children’s Hospital”

    Just trying to think of what hospital marketing dept thought it up. At first glance it seemed like a good way to put your hospital’s reputation out there. But that hospital is almost 2 hours away.

    Does the child really have a disorder that needs specialized care? No way an ambulance would drive there bypassing numerous (non-childrens) EDs, right? If the medic does take the child to the local ED are they opened to a lawsuit? Is the child in the car the one the sticker applies to?
    The more I thought about it the more stupendously bad an idea it seemed like.

    • WhiteCoat says:

      I don’t think that the sticker was a legal directive to do something, but rather an advertising gimmick.

      When “911″ is called, EMTs generally have to take patients to the closest hospital, so no liability for failing to transport to hospital on sticker. People in car may have been visiting from out of town.
      If specialty care at children’s hospital was required, then child could always be transferred to specialty hospital once stabilized in local hospital.

      But think about it. What were your first thoughts after reading the sticker? Why does the child need to go to ____ Children’s Hospital and what makes ____ Children’s Hospital worthy of a 2 hour car ride to get care?
      If you think about taking your sick child to ____ Children’s Hospital in the future because you’re subconsciously thinking about the implications of this sticker, then the advertising gimmick wasn’t such a bad idea after all.

    • Steve says:

      I was an EMT for 10 years so I can speak to this situation, however policies on EMS transport vary VERY widely from system to system. One town or county may have a completely different policy from the town or county next door.

      In my system- it was a tricky balancing act. While we had a community hospital across the street from my ambulance company, every once in a while you would get a request to be taken to a “Mecca” in Philadelphia- which was about 45 minutes to 1 hour away. Our system had a policy of honoring transport requests to distant hospitals within reason.

      A 2 hour (one-way) trip wouldn’t be considered reasonable but I was on more than a few hour long transports to a children’s hospital because the patient’s parents flat out refused to be taken to the closest hospital. In all of these cases the child was stable and could handle transport but I heard of a few borderline cases that should not have been taken an hour away to a children’s hospital. Most of these cases revolved around parents swearing “Hospital XYZ nearly killed my child” and demanding transport for a stomach bug to the city an hour away.

      I remember one case clearly of a child with a dislocated knee whose mother insisted on taking him to a children’s hospital 45+ minutes away. It was one of those “Hospital XYZ nearly killed him when he was a baby” cases. The child was in a lot of pain and we were just a BLS crew with no capability to give pain meds. I explained this to the mother and she steadfastly refused so we transported the child to the children’s hospital. As luck would have it, he self reduced about 20 minutes into the transport so that was good but he went a lot longer than he should have without pain control.

      In an extreme situation with irrational parents and a crashing child we could override the parents and take them to the closest facility but I never heard of any cases of this actually happening. My system seems to have been somewhat of an outlier. I have heard of a lot of other systems that would never honor a long distance transport request and would only take you to the closest hospital or the next closest- assuming it was an additional 5 or 10 minutes away.

  2. E says:

    If you were President, what would you change and what would you keep in healthcare reform? How and why would this be the best plan?

    • WhiteCoat says:

      Trick question.

      If I was President, I wouldn’t have the ability to singlehandedly pick apart healthcare reform. That’s within the purview of Congress.
      However, if I was going to make recommendations to Congress, here is the first thing that I would recommend:

      Ditch the health care “insurance” farce.

      Providing “insurance” is only going to make the healthcare situation worse. Government won’t pay reasonable rates to providers. More and more providers are refusing to take patients with government insurance. The only way that the government will get sufficient providers to care for government “insured” patients in the future is to create regulations mandating that doctors provide care to government “insured” patients as a requirement for licensure. That, combined with all of the current red tape, low reimbursement, and liabilities for making a mistake (RAC audits) will just drive more doctors from practice. Maybe that’s what the government wants, but it isn’t the right thing to do.
      Instead, the government should create its own “safety net” healthcare system where anyone receives free *care* by walking into a VA hospital or a county hospital. Lines may be long. Care may not be “cutting edge,” but everyone gets medical *care*, not medical *insurance*.
      Pay for it with a national sales tax. Everyone pays 10%. That way, even undocumented aliens and visitors from abroad pay into the system when they purchase groceries, gas, or hotel rooms. “Rich” people pay even more into the system when they buy their luxury cars and houseboats. Decrease the income tax if you want. I liked Herman Cain’s idea of a flat tax without all of the deductions and loopholes. Whether you earn $10 or $10 million, you pay 10% national sales tax on everything you purchase and you pay 10% income tax on all income, including investment income. Play with the percentages to suit your needs, but everyone pays into the system. End of story.

      Think about the benefits:
      1. People wouldn’t have to worry about insurance “exclusions” for pre-existing conditions. They walk into a government facility, they get care.
      2. Easier to track patients’ medical history. Centralized history and testing makes redundant care and testing less likely. Every provider has access to the centralized database. Presumably better care and cost savings to boot. Plus, it would be easier to bust those who “doctor shop” for medications.
      3. Less defensive medicine. Government facilities covered under federal tort claims act, so liability to providers is limited. No longer have to order that CT scan to rule out the 1 in a million possibility of a tumor or bleed.
      4. Less discrimination against patients who aren’t poverty stricken but who can’t afford medical insurance. I think that the de facto health care discrimination against the “working poor” in this country is despicable. Why should someone who sits around and earns no money be guaranteed government health care while someone who contributes to the system and works at a minimum wage job is refused government health care because they “make too much money”?
      5. Less animosity toward those patients on government insurance who are “abusing the system.” Everyone has the same care. Doesn’t matter if you’re Donald Trump or a homeless person on the street. You have the same access to health care as everyone else sitting in the waiting room with you.
      6. It creates a free market! Remember the whole “fast care, quality care, free care” conundrum? If patients don’t like the speed or the quality of the health care they receive from the government, then they have the *option* of purchasing insurance so that they can go to a private hospital for “better” and “faster” care. Now private hospitals would have to compete with free government hospitals, so they would have to show patients value for the money that the patients are spending. And insurers would have to keep premiums in line, otherwise patients would just tell them to go pound sand and would go to the free government hospitals.

      If any patient had any type of medical insurance, I’d also recommend that the patients had to pay at least 10% of all of the costs for their medical care. That way everyone sees that health care has a cost. Do you really need that $1500 MRI? If it’s free, you don’t care. If you’re paying $150 for it, you sure as heck do care. Patients make their own decisions on what is “medically necessary” and doctors can help them decide whether to spend their money on testing or procedures.

      Finally, I’d suggest that, just like most other businesses, medical providers must post the costs of their services so that patients are aware in advance of what they could be required to pay. Set a limit on how much the final charge can vary from the initial estimate. And if the provider doesn’t notify the patient of the charges for a service in advance, the provider cannot charge the patient for that service. Only fair, right?

      I could go on, but implementing these suggestions would be a huge step in the right direction.

      • defendUSA says:

        I think you have some great points in here, WC. As soon as people realize through actual expense what is required, they put more skin in the game. In college I took a class centered on this debate. And the thing that still sticks in my craw is the lack of fee-for-service schedules posted anywhere.
        When I thought my son might have a hernia, I was so petrified of the costs without insurance and lack of savings. I called 5 general surgeons around town before someone finally told me what it would cost if I were paying up front. Didn’t include the anaesthetists, OR and all that, just his fee.
        The good news is that when I questioned my son about his symptoms again, I figured out it was merely inguinal swelling of his lymphs…he didn’t want to tell me he’d had a huge mosquito bite near his privates. I had the biggest laugh and the last one! :)

      • Matt says:

        All great suggestions. So when will we see some legislative proposals from your lobbyists along these lines?

      • Vladimir von Winkelstien says:

        Your suggestions are excellent ones, but I think you’d get a lot farther if you ditched the “flat tax” idea. I can’t get behind a system that tells a single mom making $20K that her fair share is $2000.

        “Fair” is the system you would design if you weren’t sure which role you got to play.

      • E says:

        I am listening. Thank you for a thoughtful answer that gave some ideas.

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