:: to the teeth ::   thoughts on social justice, medicine, race, hope and beats
"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::
"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Thursday, February 02, 2006
Clinic Vignettes - February 1, 2006
Yesterday a patient called from an ER. He had been there a few hours already with a cut on his hand and was looking at a long wait and a huge bill. We were open so he abandoned ship, left the ER, and with his hospital bracelet still on, came over to the clinic for stitches. 20 minutes, $40 and 4 stitches later, he was on his way home... it doesn't have to be that complicated.
A pregnant woman showed up at the clinic around 6 weeks gestational age. she was complaining of passing a clot vaginally. no cramping. she was concerned that she was having a miscarriage. she had already scheduled her first prenatal appointment, but it wasn't for 6 more weeks at the local hospital clinic for poor women. noone educated her that she could go there sooner if she had a problem. she was already concerned that the public hospital ER would not treat her well thru bad experiences of friends, neighbors and her husband, so she refused to even consider going there. With an exam and the ultrasound i was able to verify that she still had a viable pregnancy but was at risk of miscarriage. we are watching and waiting this week to see what nature will do.
i've mentioned this previously - Spontaneous miscarriage is one of the most frustrating health policy situations for me as a doctor. pregnant women hope beyond hope for a normal pregnancy and a healthy child. the medical system is geared for maximal cost and reimbursement. uninsured woman have no easy access to urgent care. most private urgent cares charge $150 up front so the ER looks alot more inviting since the bill comes later. Miscarriage early in pregnancy is a natural, often sad, but fairly uncomplicated medical problem that doesn't necessarily need much intervention, and there is NO WAY to medically prevent an early miscarriage. put it all together and you get financial injury compounding emotional distress. it's just not right. can some politician PLEASE take some leadership on this?
ths same woman's husband had already had an ER experience for a badly infected big toe. They removed his toe nail for him. guess how much he was charged. $800.00. blows my mind.
at what point does it become unethical and/or even illegal to charge someone exhorbitant prices for basic medical services? there is a law called the New Mexico Fair Practices Act that supposedly is there to prevent used car salesmen from ripping off unsuspecting customers. It;s about time to see if this law applies to healthcare as well...
these stories just keep on coming. i'm determined to share stories every week now, if nothing else to document the incessant toxicities of our health care system.
today a young women came to my clinic with one year of abdominal pain. she had previously had her appendix cut out at the public hospital for the same pain. turned out that the appendix was normal. (as a medical side note, that doesn't particularly bother me. for a surgeon to be sure that they aren't missing any life threatening surgical conditions, they have to have the flexibility to make some mistakes in the direction of unnecessary surgeries to some small degree. in a statistical and complex world, i'd rather have a surgeon make some mistakes like that than be too stringent and make mistakes that cost people their lives.) given all that, the problem in this case is once again, FINANCIAL. this young woman was given a bill of $50,000. did you catch that? $50,000. for removing an appendix. she is a citizen, but for some loophole she didn't qualify for the public hospital financial assistance so she is now paying this bill for the rest of her life. ain't right. perhaps $5,000. it just ain't right.
posted by andru | 2/02/2006 04:12:00 PM | |
Some of the things you speak of in this post are definitely better dealt with in a clinic setting. If these patients choose to recieve care in an EMERGENCY setting, then they should be charged an emergency bill rate. So many times i've asked a patient "did you go to your family doctor?" patient says "no, i don't have insurance" so what? does the patient think the ER is free? The hospital ends up eating the bill, and in turn cannot hire enough nurses, or provide necessary equiptment to provide care.
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