Monday, January 21, 2008

Glenn Beck's ER Experience: Much Ado About A Total Lack of Perspective

So we've all been subjected to CNN's poorly informed pundit's "harrowing" ER experience. From what I can gather, he had a thrombosed hemorrhoid, waited for 40 minutes to be brought back to a room and around 2 hours for pain medications. He sobbed when recounting the event and how unfair it was that he, Glenn Beck, had to wait for medical care. Somehow, this has become a national news sensation and is being touted as an example of how horrible our medical system is. To top it all off, Beck's hemorrhoids are now ridiculously being likened to the Edith Rodriguez tragedy, who actually died in a L.A. ER waiting room after waiting for hours to be seen.
I'm an ER doctor and although I do agree that our health care system is in trouble and is riddled with problems, Glenn Beck's rectal pain does not showcase any of them.

As far as his 40 minute wait time goes, certainly he was in pain and this should be treated as expediently as possible, but I'm sorry to inform the general public that a 40 minute wait is really short! Although our hospitals only have a 15-30 minute wait, most hospitals routinely have 2 hour or longer wait times, sometimes 12 or more hours for less acute issues! It is unfortunate that he had to wait 2 hours for pain medications, but I would assume that in a busy ER, there were likely much more pressing issues from other patients like heart attacks and people trying to die. There are multiple reasons for prolonged wait times in emergency departments. The most common is because of triage protocols. From all of the patients presenting to an ER, we must take the sickest patients back first - strokes, chest pain, active bleeding, respiratory compromise, sepsis (severe infections), etc, come back first. Unfortunately there are many people that present to ERs that do not actually need emergency care and these people must wait for the more acute complaints to be take care of.

Bonus rant: These are patients with coughs, colds, rashes, some chronic conditions, and a plethora of other complaints that should be treated by primary care as an outpatient rather than in an emergency department. Some come because they couldn't get into their primary care doctor or don't even have one, some come because they didn't want to wait for primary care, some just want immediate gratification, and some just have noplace else to go. Regardless of the cause, primary care complaints clog up the department so poorly informed pundits screaming in peroneal agony need to wait until the other patients are cleared out. We are actually mandated by law to give a medical screening exam to any patient that presents to the ER, regardless of their complaint, be it emergent, chronic, or completely ridiculous. All this without requesting any information about ability to pay or insurance status, we must see them all. The most frequent abusers of the emergency system tend to be those on our public assistance programs, MediCal here in California. These are "heavy utilizers", people that choose to go to the ER for even minor complaints, because they know that they can be seen quickly and they don't have to pay a copay. Now the taxpayers get a $500 ER bill for what would have been a $75 primary care visit. Unfortunately, since there is no personal accountability built into our public health system, there is no incentive to use the system properly. In the same vein, a surprising number of patients utilizing our public health system are smokers, spending the equivalent of a low-cost heath insurance policy on a pack of cigarettes per day (~$150/month) and incurring billions of dollars collectively in smoking related healthcare costs and lost wages. These patients cost the system and the taxpayers a ridiculous amount of money and often will keep other emergency patients from being seen in a timely fashion.

The problem with our healthcare system today is not with the physicians, nurses, and other staff, we all strive to give our patients the best care we can considering the circumstances at any given time. We're there to help, and even though we didn't sign up to be spit on, cursed at, swung at, vomited on, sprayed with blood and other body fluids, plus have ridiculous lawsuits filed against us, we go to work anyway and try to give some help to whomever comes in, regardless or race, creed, disease state, wimpitude factor, or ability to pay. Many of you have seen Sicko, so you know that insurance companies are a big part of the problem. I think two other major contributors to our healthcare crisis are frivolous lawsuits (often from unreasonable expectation of care), and a lack of personal responsibility from a patient perspective. If insurance coverage is made non-profit, medical liability is reformed, and people have to pay the health costs of their lifestyle choices (ie: smokers pay for smoking related illness costs, obese patients contribute extra to care for cardiac disease and diabetes, etc), we'll see a significant decrease in cost to everyone and more efficient care. Leaving healthcare up to the free market is a recipe for disaster - right now we outspend every other country in the world by far, yet our health system ranks 37th!

How's that free market working for you?


1 Comments:

Blogger Julia Warhol said...

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7:40 PM  

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