Thank God for Private Medicine - irony alert
When folks talk about their fear of "socialized medicine", I'm always wondering what they prize in our present system? The instability of coverage, fear of being locked out by a preexisting condition, the craziness of reimbursement rules? Some will say a fear of Soviet-style lines for care, but we have them-- which I was reminded of last night as I went to the emergency room with my wife.
We went to the emergency room because she had intense pains, fever and other symptoms that her doctor said on the phone had a chance of being fatal if not treated immediately. So we ran to the local hospital-- luckily only two blocks from our home, one of the best in New York City (Columbia Presbyterian). With our lovely private health insurance --also one of the better ones (Oxford) -- the results were: a long wait to even see the triage nurse, and then being told my wife would have to wait EIGHT HOURS to see someone. The triage nurse didn't disagree with her doctor's diagnosis of the possibility of the fatal condition, but that was the timeline for everyone who wasn't basically bleeding to death on the spot.
I basically did what everyone knows you have to do with our screwed up system-- bargain and beg folks to jump the line. Which I did, getting her past the eight hour queue, but finding that there was another indeterminate queue even in the next internal waiting room. At that point, our 2-year old daughter was getting too anxious for me to stay; we asked whether my wife could rest at home and get a call when a doctor was available, since we were just a block or so away. But no, she had to stay, sitting up, suffering in pain, waiting.
I took our daughter home to put her to bed and my wife eventually got home, untreated, because it was unclear whether they would ever see her. So she decided that getting some sleep and rest trumped the CHANCE to see an emergency room doctor.
Now, she'll hopefully be able to see her regular doctor today, but I've had plenty of frustrations on care on day-to-day medicine that the emergency room insanity seemed to me not an aberration but pretty indicative of a system that spends crap loads of money but is not there for people when you need it, even if you have decent insurance. Some of the problems in emergency rooms we know are do precisely to the fact that many people don't have insurance, so they end up piling into emergency rooms as their only care-giving system. Which highlights once again what everyone, insured or not, has to gain from more universal coverage.
And yet we'll still have media cycles dominated by discussions of "death panels" even as the incredible number of stories of pain and suffering under our present system, most far worse than what I described above, gets downplayed. The insanity of the health care debate would be amusing, if it wasn't so deadly serious for so many people.
Did you ever stop to think that all those people ahead of you in line were there because they're socialists? Ha. Didn't think so. Gotcha.
All my best to your wife for a fast recovery Nathan. Kidding aside, I'm sorry you had to go through that.
August 18, 2009 1:49 PM | Reply | Permalink
"NewYork-Presbyterian Hospital (NYPH) and the other Member Institutions of the NewYork-Presbyterian Healthcare System (the System Member institutions) are each operated by a separate NOT-FOR-PROFIT corporation."
http://www.nypsystem.org/disclaimer.html
PS I hope your wife is better.
August 18, 2009 2:23 PM | Reply | Permalink
Hey Lalo,
That's an interesting find. I'm wondering though if a for-profit hospital would do any different, as they'd probably be trying to minimize staffing costs in the off-hours, forcing people to wait until the morning shift starts.
Since there is no fear of a competing hospital opening across the street (is there?), I suppose for- or non-profits can make life miserable for us and not suffer consequences.
August 18, 2009 5:42 PM | Reply | Permalink
I think "profit" only makes a difference to those who oppose it as a matter of principle.
There are plenty of examples of both for- and non-profits doing excellent work. And examples of both doing really badly.
August 18, 2009 6:07 PM | Reply | Permalink
Death to Capitalism, private property and profits.
August 18, 2009 2:47 PM | Reply | Permalink
Jeeezzzz! The first thing I would do is get another primanry care doctor, preferabbly one with hospitial rights to Columbia Presbyterian.
ex animo
davidfarrar
August 18, 2009 3:33 PM | Reply | Permalink
The second thing I would do is never, ever go to the Emergency Room yourself, always call an ambulance. What the hell, your insurance pays for it! True, it may not reduce the wait, but at least your wife will be laying down.
ex animo
davidfarrar
August 18, 2009 3:41 PM | Reply | Permalink
David, Some years ago I priced the cost of ambulance calls for a large health payer, not in NYC, where everything costs triple everywhere else. I expect that in NYC, one ambulance trip is 10% or more of the annual premium of a good quality health insurance policy. Just the trip.
If the emergency calls for an ambulance, the patient should certainly use it. But Newman specifically says he was two blocks from the hospital and it is apparent from the facts that his wife was able to travel under her own power. The ambulance would have provided no benefit, but it would still have cost 10% or more of the annual premium of Newman's insurance.
What I am driving at is that your advice is just the sort of thing that unnecessarily drives up the cost of health care in America.
August 18, 2009 5:46 PM | Reply | Permalink
df,
If you had died during this unfortunate wait, THEN what would you do?
August 18, 2009 4:01 PM | Reply | Permalink
Call for another ambulance, if not to go to another hospital, than to at least have a paramedic hold your hand and give you oxygen while you relaxed in the reassuring feeling that at last somebody was doing something to help you while you needlessly passed into oblivion
ex animo
davidfarrar
August 18, 2009 4:31 PM | Reply | Permalink
Indeed, my experience way back in 1993 was pretty similar. I got run over by a car (at 7:50 PM). The ambulance took me to the local hospital (Alta Bates—and before idiots like "lalo" go looking this up, their status now is quite different from 1993 due to a whole series of shakeups in ownership of various Bay Area hospitals). The wait was not quite as long; I was put in a taxi and sent home some time after 2 AM, so it was only about 6 hours, not 8 (and, more importantly, I did get treated: I eventually was taken out of the C-spine collar and my broken foot X rayed to confirm the status of the break, and only after all this, I was given a shot of demerol for pain and a referral to a local orthopedic doctor).
(They missed the knee ligament tear. It was not hurting at all due to blocking from the broken foot. The orthopedic doctor discovered it when I mentioned to him that my other leg was not working properly. He ordered a CT scan of the foot and an MRI of the knee, which took several more days, and assistance from friends, to accomplish.)
August 18, 2009 4:24 PM | Reply | Permalink
See! I'm telling you...it's the ambulance, man; the ambulance. You come to the emergency room via an ambulance you get looked at right away. I think the hospital gets some sort of kickback from them every time you use one.
ex animo
davidfarrar
August 18, 2009 4:37 PM | Reply | Permalink
There was a story here recently about there being no ambulances available because they're all sitting at the hospital waiting to hand over their patients to the ER.
August 18, 2009 5:30 PM | Reply | Permalink
Two things about "the ambulance."
Some policies pay nothing toward the ambulance.
Some policies require you to call THEM before you call the ambulance.
MANY policies only pay for the "fair market price" of an ambulance. Even though there may be only one ambulance service available (as in Louisville, KY), the amount my policy paid was still nearly $500 less than the charge.
August 20, 2009 12:38 AM | Reply | Permalink
Next time, try a public hospital... This one isn't that far from the hospital you went to:
Metropolitan Hospital Center
1901 First Avenue
New York, New York 10029
General Information Number: (212) 423-6262
But, I cannot speak for its ER response. I believe you will find this one responsive, although it is further away:
Bellevue Hospital Center
462 First Avenue
New York, New York 10016
General Information Number: (212) 562-4141
August 18, 2009 5:29 PM | Reply | Permalink
Have you ever walked around an ER and seen how many rooms they have, how many people they're treating?
I have.
My son's pediatrician's office is bigger. They can see more patients per hour than any ER. Granted, they aren't dealing with ER cases, but neither is the ER most of the time. Most of the time they're clogged up with people who don't have insurance.
I can only comment based on what I have seen, and what I have seen is that the ER is perpetually understaffed with undertrained people who work extremely long shifts and have probably the worst work morale of any people I have ever seen. Most of the doctors aren't even there most of the time. Hospital administrations make liberal use of the 'on-call' feature and nurses spend hours trying to find a doctor who will interrupt his leisure to drive down to the hospital to see a patient. I have been told that even a doctor officially "on-call" is under no legal or professional obligation to answer a call. My first son was delivered by a doctor we had never met, because they couldn't find our doctor.
My son's pediatrician's office usually has 4-6 doctors on location (not on call) and a full staff of nurses. Usual wait time is 15 minutes. What a difference the proper work atmosphere makes to the quality of care given. I have also been in ERs that are run right, and if not for the sign on the door you wouldn't know you were in an ER.
Nathan (and everyone else), here's a tip that I have found most useful. If your doctor tells you to get to the ER right away, tell your doctor to call the ER, tell them you are coming and why. They will listen to your doctor and if your doctor says this is urgent, sometimes they will usher you straight back. This extra little step seems to make a real difference in the initial quality of care you receive.
What happens after you get through the swinging doors ... that's a different matter altogether.
August 18, 2009 5:51 PM | Reply | Permalink
Then how come on the TV shows they run down three miles of hallways to get the bleeding patient in the operating room? Somebody's lyin.... :)
August 18, 2009 8:58 PM | Reply | Permalink
The operating room is usually on another floor, which gives you the opportunity to yell Hold the Elevator! as you race toward it. Plus, you need those long hallways to get up enough speed to make your gown fly up.
A few months ago I was at an orthopedic group that was absolutely enormous. There were fifty or sixty people in the waiting room the entire time I was there and they were cycling people through in groups of five or six every few minutes. They had five people at the front desk just to sign people in! The list of doctors was as long as I am tall. I waited maybe an hour.
August 19, 2009 10:28 AM | Reply | Permalink
I had a very similar 6-hour waiting experience in a Detroit General ER many years ago. Waiting with a bunch of people handcuffed to stretchers.
In a small upstate NY ER, I was seen quickly (there was no one else there), but my problem was misdiagnosed. I had no insurance, and I think they were in a hurry. Perhaps it was break time.
August 19, 2009 1:50 AM | Reply | Permalink
So imagine going to the ER, waiting a couple hours for a triage nurse, and then being told the ER doesn't handle your potential complaint, you have to go to another part of the hospital and start waiting all over again... (That's what happened to my spouse 4 years ago, also with perfectly good insurance. The emergency surgery 8 hours later was explained as "If we don't operate now, she'll be too far gone to operate later.")
Hope your spouse is recovered.
August 19, 2009 12:18 PM | Reply | Permalink
The comment made above: have you physician call the ER and tell them you are coming is an interesting one. Physicians all too often send their patients to the ER as a way of "covering their own ass" and not actually having to do anything. If the physician really believed that the illness was a "life or death" issue, why didn't they make a call to the hospital to have her admitted and given a bed, so that treatment would begin immediately? My best guess is that they didn't want to actually have to do any work on behalf of the patient, but instead let the patient do all the work and suffering.
Don't get me wrong, many physicians are doing the right thing, but to expect actual healthcare to be diagnosed and delivered by phone is not healthcare, it is CYA medicine.
August 20, 2009 11:20 AM | Reply | Permalink