ER Visits On The Rise
Drill Sergeant: God damn it, Gump! You’re a god damn genius!
The above quote is what came to my mind when I started to read this article. Here is the first sentence:
Early evidence suggests that emergency rooms have become busier since the Affordable Care Act expanded insurance coverage this year, despite the law’s goal of reducing unnecessary care in ERs.
Really? It is not like everyone, including myself, has been saying this for years. Then there was this beauty:
Democrats who designed the 2010 health law hoped it would do the opposite. They wanted to give the uninsured better access to primary-care doctors who could treat routine ailments and prevent chronic disease, with the intent of keeping patients out of the ER and lowering the cost of care.
Silly Democrats. It turns out that if there are not enough primary care doctors and you don’t find ways (money) to entice medical students to go into primary care then the whole premise of the ACA is screwed. Unless this was your plan all along and empowering and churning out more LELTs was your ultimate goal. And that is what is exactly is going on.
On the one hand – society has determined that the practice of medicine is so easy, there’s hardly any need for more than an i-Phone and a high-school education. On the other hand, the Medical Boards insist on nearly constant WiFi access to ticker-tape the up-to-date Learning Modules realtime into one’s head, lest one become a month behind New Thoughts from the Ivory Tower.
The one solid consensus in American Wisdom & Virtue, inside medicine and out, is that nobody should be granted the license for hubris – that the arrogance necessary to make an independent medical decision is one of the shameful habits of physicians. I freely confess. I am used to making decisions. No decisions should be made without a pow-wow; and to cover one’s bases, that ‘s the most important thing.
So, in the Medical Newthink, if you have any doubt, send the patient to the ER. If nobody dare diagnose anything independently any more, – and until and unless the iPhones can run iApps directly authorized by one of the Medical Boards – then nobody should rule out or decide anything on their own. Like the old days in Eastern Europe, a low profile can be a life-saver. Hear nothing, say nothing, think nothing…..
So just send the victim to the Emergency Room! That is all there really is to the practice of medicine – take their vitals, say “HMMM…” and send them to the Emergency Room. If we do that, really anyone can run their own clinic! Just give antibiotics for colds, and send the hard cases to the ER.
(Of course, the skyrocketing cost of medical care can be corrected by dropping salaries and increasing oversight.) That’s what has kept the lid on for the last 20 years, I presume.
[And perhaps read the news from yesterday about the Albuquerque VA. A Veteran who coded in the cafeteria didn’t make it to the ER – in the same facility – within 30 minutes. He did, though, make it to the Pearly Gates within that time. And then he made it to the ER. A Critical Action Study will go on to find out why this occurrence occurred. I’m sure before all this is over, bonuses will result. ]
Hell, if it’s that easy I’m going to start setting up some “medical kiosks” at my local shopping mall. Patients will walk into the photo-booth like kiosk (and draw the curtain for privacy) feed a crisp $20 bill into the slot and interact with a HAL-9000 type computer that will tell them whatever horrible things they want to hear! Don’t knock it yet…this could actually be a step-up. Consider this all-too-common scenario:
ME: You have an upper respiratory infection caused by a virus. Go home and get some rest, take Tylenol for your fever and body aches and get plenty of fluids.
PATIENT: Are you going to prescribe me a Z-pak?
ME: Z-pak’s are for bacterial infections, not for viral infections. It won’t help you at all
PATIENT: Could I just hold onto a prescription in case I get worse?
ME: Again, there’s really no reason to take the Z-pak. You have a virus, not a bacterial infection.
PATIENT: I really think I need the Z-pak. I was reading on the internet…..
ME: *Forehead slap*
Consider the alternative…
HAL: How can I help you, ill human?
PATIENT: I think I need a Z-pak for my cold.
HAL: I’m sorry, ill human. I’m afraid I can’t do that
PATIENT: But I really need…
HAL: This conversation can serve no purpose anymore. Goodbye.
At the end of the year HAL would get a bigger bonus than I would.