Friday, April 12, 2013

#563 - K is for Kum Ba Yah

There's a big push in the ED recently to get our patient satisfaction scores higher.  When asked, I said the only thing to add to what we're already doing is to serve drinks and offer a moist towelette.  A little tongue in cheek, I know, but now with the government trying to get into the business of managing healthcare, they are trying to cut costs by all means possible.  And, that includes not paying ED's that fail to meet a certain standard of patient satisfaction.  Imagine that, you provide a service that you are legally required to perform and you don't get paid even when you do everything right because someone decides to give you three stars instead of five.

What they fail to realize is that when someone gets something for nothing, and has no responsibility at all for the privilege of taking someone else's money and using it as their own, everything from their EBT card to medical care becomes an expectation.  I work in an area where something like 65% of our patients are on some sort of government assistance.  They come to the ED for their coughs and colds and pregnancy tests because they can, and they're not expected to give so much as a $5 co-pay.  They come in demanding their CT scans, MRI's, antibiotics with a twist of lime and a pillow because they don't have to pay for it.... ever... if a bill comes, it doesn't matter.  They HAVE to see me in the ER.  I can't go to the doctor's office because I owe money, but not the ER.  They HAVE to see everyone.

They get upset because they're made to wait 30 minutes, an hour, maybe two.  I know of ED's that have 5 hour waits on a regular basis.  They get upset because I didn't give them the antibiotic WebMD told them they have to have for a condition they read about.  They expect to come in and have a full physical, lab work, and imaging done because their primary is "taking too long," "has it ordered for a month from now," "thinks I should have this other test first and I think I need to have it done now for this chronic problem I've had for the last 6 months."

So we get poor patient satisfaction scores and comments when we say no.  When we remind them it's not an emergency.  When we tell them that we're not a pharmacy, radiology suite, lunch counter or hotel.  When we ask them to be patient because someone else's family member is dying, and they can't be seen right this minute for the viral illness that's been going on for the last week and for which they haven't taken even a Tylenol because "I don't get my check for another week, and I don't have any money right now, but hey watch my kid play on my new iPad mini while I go out and have smoke."

So while I face the prospect of getting paid even less per patient while still trying to maintain the same level of service and face the real possibility of losing even more staff because the hospital can't afford that extra nurse because it's not getting paid or collecting as much per patient, we're all expected to come together and hold hands and keep the cheery smiles going.  If you think about it, the ED really is a "come by here" kinda place.

Sorry about the rant coming at the end of working the last 6/6, but sometimes you just gotta vent.

And, as always, the views expressed here are my own and in no way reflect the views of the physician's group, hospitals or professional organizations with which I am affiliated.

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