Reply to "America's Health Care System"

And some are in the health insurance industry.

I usually studiously ignore these kinds of discussions but reading this after just getting home from my frustrating shift in the Emergency Dept. tonight required comment. Any ER doc or nurse could write you books full of examples of both the cases you guys illustrate. You can literally multiply these two cases by hundreds of thousands in our country right now.

I took care of one of our "frequent fliers" tonight whose visits when added up had been to the ER over 750 times in the past 8 years. When you consider that I have worked about 1000-1200 days at the same ER over the same time period, you can see that this person has been there almost as often as I have; AND I WORK THERE. Multiply that by $300 to $3000 per visit paid for by tax dollars and add it up.

Larry, I love the Grp5 lights I bought from you, and they look great on my car, but can you see that a large part of the reason for the neglect of the people that your article talks about is the resources wasted by the ones Dennis (the headers I bought from you look equally as nice on my car) alludes to in his quote?

To those of my friends who tend towards the more liberal side-there is not enough resources and manpower to continue to try to give everybody everything they want all the time. When we do people that really need it go wanting as per Larry's article.

To my more conservative friends, one way or another we are going to end up taking care of people who won't take care of themselves. We can do it now or we can do it later. There is no getting around this. And if you don't want to change the system because there would be "rationing" you are kidding yourself. Right now it is the insurance companies (private and governmental) doing the rationing.

To my lawyer friends who resist malpractice reform with the argument that lawsuits improve the safety of medicine in the US- I pay $22.50 of malpractice insurance for every hour I work. Every doctor that works in an ER pays at least this much. That amount is approximately the hourly wage for a skilled ER nurse. Do you think the ER is more safe by having the threat of a lawsuit hanging over the staffs head than it would be if that money was used to have an extra nurse in the ER for EVERY hour that EVERY doctor works?

To my friends that have bad experiences in the ER and dealing with medical matters-yes, there are some bad doctors out there, and mistakes are made. However, most doctors and nurses are trying to do the right thing for the right reasons. Often disappointment and displeasure in the medical experience is due to unrealistic expectations. I can't get them an MRI at 3am in the ER because their knee has been bothering them since they played high school football, I can't give them a prescription for "liquid morphine" because Tylenol doesn't help with their menstrual cramps, I can't tell them why their right shoulder hurt 2 weeks ago but feels better now, I know they have been waiting here much longer with their twisted ankle than the guy that just got here, but he is having a heart attack and I have to take care of him first. And yes I totally agree with you that there should be more doctors and nurses here right now to take care of all these people that have been waiting a long time-could you please tell the hospital administration about your concerns as they are the ones who do the staffing.
One of the first things I try to teach residents is to find out what the patient wants. If it is something that is reasonable, appropriate and within my power I will be happy to help them with it. If it is something that is unreasonable or not doable we save tons of energy and resources by telling them upfront that it can't be done. If people realize the limitations of what can be done, and why or why not, they are much happier with their experience.

I apologize for my whining. I expect much flaming, however this thread caught me at a very frustrating time where all these problems are being used to play politics and nothing is really being done to help the situation.

We now return you to your previously scheduled Pantera content.

Mike MD
Assistant Professor
Department of Emergency Medicine
Emergency Medicine Residency Program
Texas A&M University Health Sciences Center School of Medicine