Posted on 11/04/2008 9:03:58 AM PST by 60Gunner
Can't do it...for a number of reasons.Perhaps the most important of which is that the 1 of 500 "heartburn" patients that you might turn away would turn out to be having an MI (heart attack)...would die....and the family would sue,sue,SUE.
Thank you! I always enjoy reading your posts.
Our healthcare system has some similarities to both Canada and the UK, and some similarities to yours in the US.
We have “socialized” public healthcare, funded and operated by the state (read: taxpayers). It is excellent, but there are waiting lists if you are chronic, which are triaged and prioritized. If you are acute you get seen right away.
We also have private healthcare, where you can either pay yourself or more typically have your health insurer pay. It too is excellent, and there is never a wait.
I have used both systems in New Zealand: it is quite common for Kiwis to have health insurance. The public system, as often as not, uses the same surgeons and nurses as the private system, the facilities are quite good and the food is superb (I often ask for seconds or thirds when I’m in).
The private hospitals are like five-star hotels: they even serve wine with your meal.
Socialized medicine isn’t the same thing as Socialism: it’s actually a very good thing and quite efficient if it is done properly. Of course, that’s a really big IF.
Typically, Emergency medicine is done in the Public system: they are geared for acute cases. Once admitted, the patient will either stay in the public system or be transferred to the private system if he wants to. I have never transferred when I’ve been acute: there’s no point. The standard of care is just as good in the public system, and while the public hospitals look more like high schools than hotels, if you’re sick enough to be in hospital you’re not going to notice the plush carpets and tasteful decor.
I usually have surgery in the private system, just because I can. Some of the best vacations I’ve ever had have been in the Southern Cross Hospital, recovering from surgery.
I will comment on a couple of things here.
It looked to me, like the waiting area covered not only emergency, but a clinic as well. Those that were there for little things ended up coming out a different set of doors. There were a bunch of people that fell into that category the last time I was in ER. Might be the way to go.
I would only add that people be persistent. You know your body better than anyone else. My first visit to ER for severe abdominal pain, vomiting, got me a total stay of 4 hours and an antibiotic for a bladder infection. I told them I was concerned about a hernia was diagnosed with back in December. They did take an xray but said everything was fine.
Two days later 9am I was right back there with the same symptoms except that the vomiting is dark green, so green it looked black. This visit lasted 8 hours. CT scan and xrays. No blockage. Prescription for pain and anti nausea.
8pm vomiting the contrast, 11pm right back to ER carrying my trusty bucket and still vomiting the dark green fluid. Total stay about 5 hours with new prescription for different anti nausea and instructions to call a particular Dr in the morning for an appt.
Vomiting in the Dr's office gets me placed in the hospital. Surgery at 8 that night. The hernia had twisted and a section of the intestines had turned purple.
I told them on each visit about the hernia. The first two visits they didn't even palpate the abdomen. What's up with that? Why do not listen to the patient? Sometimes we might actually know what is happening. ok rant over,
I thank you for sharing your health care experience. :)
Should probably email this link to The Boy. Or the whole article.
The two biggest problems I have ever encountered in my many years on Planet Earth can be split in half as one problem is the hospital being irresponsible and the other as the patients’ irresponsibility, as follows:
1. Patients who choose to use the ER in lieu of a family physician or urgicare center - sprained ankle, minor burn, a simple cold, cough, sore throat, and so on.
2. Hospital personnel who want us to believe they are busy and overwhelmed but stand around shooting the breeze. Now THAT really annoys me. I’ve seen it on several occasions, though admittedly not in the past couple of years.
I disagree that it makes it better to have someone show they “care.”
It makes it better, but it’s not sufficient. The ER is broken and it’s because it is full of non-emergency cases.
I don’t want someone to “care.” I want to be efficiently screened for an emergency, told the results and then released if I don’t want to hang around for hours until some doctor or nurse tells me to “rest, drink plenty of fluids, and take motrin as needed.”
When I take my child in because he possibly has a broken arm, I don’t care if one person there “cares.” It’s very easy to determine if he has a broken bone. If he does, then we’ll wait for treatment. If he doesn’t, we’re out of there. An x-ray and reading the x-ray takes five minutes-—in five minutes, we could be in and out of there-—because, if his bone is not broken, I don’t need anyone to tell me how to take care of my child’s boo-boo.
Yet we wait and wait for hours and hours, while people who have nonspecific complaints, for which the doctor may “want” to do zillions of tests, languish in the back.
Anyway, I ranted on the original thread, so will step off here.
People don’t need to understand triage better. They understand triage very well. They understand the reason for the delays in the ER. THEY JUST DON’T AGREE THAT WE CANNOT DO BETTER.
No way our medical system is influenced at all by a free-market economy-—wish it were so, but it isn’t.
To try to cut down on ER abuse in the military, there was once a push to charge people $25 per visit. All hell broke loose and the proposal was quickly abandoned.
I have repeatedly said I would willingly pay a surcharge to be able to go to a “private” ER where we didn’t have to put up with the usual crappola at the ER.
Hey Gunner!
Excellent post as always!
Sorry about the rant last week. Sounds like everyone else unloaded too. :)
I wish I hadn’t been so stressed/had known more when hubby was in the hosps. If you don’t go, you don’t know what’s normal/to be expected. Whether it’s due to a fear of not being able to pay the bills or a nearly pathological fear of drs/hosps...we just don’t go.
Had to go to my gp the other day and he asked me about a lifelong bout with anemia/asked me how long. I told him since my first real dr visit—when I was in my mid teens. The only other time I remember going to the dr as a child was when I almost died from chicken pox.
Wow, I’m sorry you went through that. Hope you’re feeling better now! (And better tomorrow ;).)
Here’s one thing I’m picking up from this discussion:
On the original thread I touched on it, but now I see a better way to articulate it.
The ER really should serve two purposes. Screening (is *emergency* care needed?) and treatment (if *emergency* care is needed).
If the ER screened and then turned away people who did not need *emergency* treatment, they would have a lot more time and resources to do better screening.
Hells Bells, most of the time I can pick out several patients in the waiting room who are going to end up receiving NO TREATMENT WHATSOEVER, yet are clogging up the system for many, many hours. The biggest example of this is the baby brought in because she has a cough, a runny nose, or “can’t breath” (excuse me?), yet while in the waiting room, she sits there playing happily with the magazines, crawling around, laughing at Grandma, making faces at bystanders, etc. In short, the baby that most parents realize is is NO WAY in an emergency situation.
That baby should have been screened and released immediately in one fell swoop. There is nothing that is going to happen in the back beyond what the intake nurse with temperature and other vitals. Give mom a flier that says give your baby TLC, plenty of fluids, rest and a warm bath if fussy. Please.
Because the ER starts with the assumption that EVERY PATIENT will get some kind of examination by a doctor (add four hours) and then some kind of “treatment” (even if it’s “rest, fluids, etc.”) and some kind of prescription (for OTC pain relivers or Pepto Bismal . . . basic Dr. Mom stuff), no patient ever gets bumped out of line without completing a often worthless 8-10 hour stint.
ERs should screen and release if no emergency is found and there is no indication of the need for additional tests.
This, I think, would allow ERs to improve their screening process for everyone.
New Zealand has much titghter controls on immigration (both legal and illegal) than the US, and given its geography it’s got a huge built-in advantage in that respect. No way can any kind of socialized medicine work here unless access to it is tightly restricted — as in if you don’t have a biometric ID registration that identifies you via a national database as an authorized user, you get no service. As long as unlimited hordes of people who have never paid into the system are using it, the quality of care will be lousy. The problem is more severe in parts of the country with more illegal immigrants and more welfare addicts, but it’s worsening everywhere.
> New Zealand has much titghter controls on immigration (both legal and illegal) than the US, and given its geography it’s got a huge built-in advantage in that respect. No way can any kind of socialized medicine work here unless access to it is tightly restricted
I agree completely. Because health would probably be state-administered (rather than Federal) it would be exceedingly difficult to implement anything like what we have here. Or more likely impossibly expensive and infeasible.
Even if it were implemented by Washington DC, it would take many years, if not decades, for you to get your infrastructures tuned to suit our model.
What we have in New Zealand has been the product of decades of building: aside from a few philosophical differences it has been done with bilateral support in Parliament. That would probably never happen in the USA.
Step one would have to be to get a handle on your illegal migration problem. Sort that first, and many of your other problems diminish greatly.
Naaaahhhh, it's better if the tyke continues to '...sit there play happily with the magazines, crawl around, laugh at Grandma, make faces at bystanders...'
That way when she catches the galloping-never-get-overs from someone actually sick enough to need to be in an ER, her next emergency trip won't be a total waste....
I think our hospital was doing screening, which is why everyone entered one door but got directed either left or right depending.
People are using emergency because they don’t want to pay the bills (if they have no insurance).
Sad thing is that out of those three visits, one doctor appeared twice and he was useless both times.
Wow, that’s a lot... I got misdiagnosed for my appendicitis multiple times over a period of 3 months before someone finally got it right, and even then it was a process of elimination like “Well, we don’t see that your appendix is inflamed, but we’ve ruled out everything else, so let’s just take your appendix out and take a look for anything else that’s wrong while we’re in there”.
As a regular visitor to the local hospital due to my insane level of accident-prone-ness, and my annoying tendency to not only inherit all health problems from both sides of the family but also to have almost all of them show up while I was a teenager, this is very helpful.
Conservative: "Can't do it...for a number of reasons.Perhaps the most important of which is that the 1 of 500 "heartburn" patients that you might turn away would turn out to be having an MI (heart attack)...would die....and the family would sue,sue,SUE."
There is another reason that ERs cannot turn petty complaints away and that actually forces ERs to screen every single patient for life-threatening conditions: Federal law.
The Emergency Medical Treatment and Active Labor Act (EMTALA) mandates that no person shall be turned away for any reason without first being screened for a life-threatening condition. This law, while perhaps well-intended, is the primary reason for the logjam on our emergency medical system. It places the cost of screening (including CT scans and MRIs) on the backs of the hospitals, and has caused the cost of emergency care to skyrocket.
And of course, the people who genuinely need our services the most are the ones who end up being forced to carry the weight of those who abuse the system and the law.
If you really want to attack the culprit and improve healthcare, attack the entitlements system and lobby for an amendment to the EMTALA law that allows for abusers to be punished if they are caught.
Yes,I knew that.When I said "most important" I was thinking more in terms of the actual practice of medicine (and a hospital's bottom line) and not legalities.
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