Saturday, November 23, 2013

Day 23 - I Weep For the Future

One of the best lines from the movie "Ferris Bueller's Day Off."

I worked triage over the last couple of days during my ED shifts.  No where can you see the failure of the health care system, and society in my opinion, so readily as on the Front Line of medicine... the Emergency Department triage room.

- patient with three year history of stomach pain who came in because it hurt more the day before while they were driving but they couldn't get a ride to come to the ED until tonight and they came because their mother told them they should have it checked out because there might be something wrong.  Um...

- patient with very high blood pressure can't get needed prescription because insurance won't cover combination med.  Pharmacy has been calling cardiologist for over a week to get new prescription but no one returns their calls.  Insurance will cover meds separately so I write a prescription for them.

 - pregnant patient can't get doctor because they don't have MediCal yet and has to wait to be able to get into a practice that accepts MediCal.  She goes to a free clinic where she can get prenatal vitamins but none of the recommended blood work or other prenatal tests.  She's now almost 5 months' pregnant.

 - patient with kidney stone blocking their ureter gets sent home with scripts for antibiotics and pain medication and told to follow up in urology clinic to have stone removed.  They never get a follow up appointment because they don't have insurance and their MediCal application wasn't filled out because they neglected to do it.  They didn't fill their prescriptions because they "don't have any money to pay for medication."  Crystal meth, alcohol and "pain medication they borrowed from someone else with kidney stones" are what they've been using to help with the pain until tonight when 3 weeks later "the pain is like the first time."

 - patient with gallbladder pain who tells me they "can't just change my diet that easy" and who wants to see if they are "sick enough to have it taken out" because they are "tired of waiting for the referral from my doctor" to see a surgeon to schedule surgery.

 - child brought in with a cold.  They have a "runny nose and are congested."  Do they have a fever? "No."  Are they eating/drinking/peeing/pooping normally? "Yes."  What are you concerned about? "Well, I wanted them checked out."  Did you call your pediatrician? "Yeah, but they can't see them until Monday, and I didn't want to wait."

 - patient with chronic pain who was upset that they had to change doctors and insurance because of the ACA (affordable care act) and who now can't get the pain medication they were used to because it is no longer on their insurance formulary.  "Can you write me a script for it?"  Are you going to pay out of pocket for it?  "No, I don't have any money." Um...

**please read my disclaimer that these views are my own and do not reflect the medical groups for whom I work nor the professional organizations with which I am affiliated.


Anonymous said...

People do this on a regular basis and when the bill come they throw it in the trash...

Juli said...

I got to be honest here, I live in MA where we have had mandated HC for some time. I have been on it when I had to, and let me tell you it was the golden ticket. I now have BCBS, and while it is better, it does get pricey, even with just co-pays.

Still, today when the antibiotic my doctor gave me on Friday was clearly not working, my husband wanted to take me to the ER. Having access to MY doctor's building on a SUNDAY kept me out of the ER, not impacting anyone who truly needed emergency care, and get me properly diagnosed and treated, so hopefully I will get better.

There are huge issues with ACA that need to be worked out, but perhaps the problem is that we need more doctors offices available on weekends and holidays and the "go to the ER for everything" mentality out of our heads.

PS... Apparently my infection spread to my kidneys and I have a stone as well... Crystal Meth??? No way in hell. What are some people thinking??? There's bigger issues there than health insurance.

Veronica B said...

Juli, I agree with you. Accessibility to primary care is one of the biggest problems we face. A friend of mine who is a Family Medicine MD left her practice because they had to take a certain percentage of state insured in their practice. To make up the difference and keep the practice going, she had to see something like 30 patients during the day. That's 15 minutes a patient in an 8 hour day to not only have the office visit, but the paperwork, the charting, the return phone calls, eat something, etc. I live in a rural town, and unfortunately we don't have many physicians to begin with, so after hours and weekends just aren't going to happen.