A Budding Emergencist
Friday, August 11, 2006
  The Road to Hell...

Cross posted from a comment about this shining example of misguided intentions, from Dr. Parker at A Chance to Cut...

Do ppl think of that guy in Grey's Anatomy when they think of neurosurgeon? D'ya remember he drove a Jeep and lived in a trailer? An it's not just the doctor. More often than not in cases of necessity and dire financial straits, a doctor will negotiate or waive fees altogether, like my father, who is one of the only oncologists in his area, and treats everybody. Of course, without renumeration, nurses, techs, janitors, billers, and security guards will not show up to work. Electricity will not cauterize bleeding vessels, equipment will not be sterile, and x-rays will not magically appear out of thin air. It is an enormous commitment of manpower and materiel to maintain a L1 trauma center. I overheard that simply activating the trauma team costs $5,000, whether it is a drunk-fall-down-go-boom or a young mother-hit-by-a-stray-bullet.

I think tha problem has to do with the fact that nobody has any idea of what things cost in medicine. I get bits and pieces here and there, like suture costs around $10 a pack, an implantable pacemaker/cardiodefibrillator costs $30,000 (just the device!), and a venous access graft for dialysis costs upwards of $5,000.

Doctors, as a rule, rarely discuss costs with a patient. We may pat ourselves on the back for giving a $12 antibiotic versus a $50 one, but it's really peanuts compared to labor and maintenance in an intensely labor-intensive environment such as an ICU, or a course of chemo. The reason why we don't discuss payment, why we as physicians avoid even finding out how much things cost until WE'RE paying for it, is that many patients would refuse treatment. Most medical treatments are painful and scary enough without them costing a fortune--the only difference between a poison and a drug is the dose.

Now, in China, people gotta pay up front. I think that's the way of things here with specialty stuff, like child psychiatry or a scheduled c-section, or other planned procedures. China beats us at our own game of merciless mercantilism, and coupled with a populatio of 1 Billion kind of makes life, and suffering, cheap. Here we crucify our greedy, arrogant doctors who let gomertose, vent-dependent patients die during a F#!%@#$ HURRICANE--as the water creeps up over your knees, nowhere to go, no help in sight, people with guns...believe me, you. would. do. the. same. precious principles be damned But it's still "DAMN THE TORPEDOES!" when it comes to costs in the ER.
The reason why we don't discuss payment...is that many patients would refuse treatment.

Hell, demanding so much as a $0.50 copay for an ambulance transport or ER visit would cut the census by half or more. When it's "free" people will take advantage of it.
yeah, man. what our frequent flyers don't realize is that an ACLS ambulance ride can cost cabout $800, when all the systemic factors come into play, i.e. most of these paramedics are actually firefighters, ambulances and para's ain't cheap, equipment, maintenance, dispatch, maintaining 911 service, etc.

a side note: i read about an ambulance being called in bogusly, and while the paras ran up the stairs with the stretcher, some dealers broke into their ambulance and stole...Narcan. Left the Morphine. Apparently when you sell junk, it's bad for business if someone OD's in your crack house. Cuz, see, authorities come in and crate the person away, yes, but, they also ask questions, like, "so, who did you get the dope from?" And so if someone OD's, pushers like to have narcan around so they can stop an OD in progress, and avoid the amublance ride in the first place! Trip out!
Thinking of the EMS crew that was held up here at gunpoint. The assailant demanded morphine and they dutifully handed over...syrup of ipecac.
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Emergency medicine, from the beginning of a new doctor's career.

Location: Big City, Metropolis, United States

Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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