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I agree that the American Medical Association needs to allow more doctors to be licensed and educated, but society needs to compromise as well. Tort reform and medical education costs need to be compromised as well as elimination of the complexities of the insurance beauracracy.
As someone trying to become a doc or PA, I'd work for a lot less if my education was comped and I wasn't a target for lawyers trying to make a quick buck off settlements (if I make a mistake, yeah I should have to pay, but if I didn't maybe the lawyers and patient should have to pay me! no countersuit, they just have to pay for wasting resources and time that could have better been spent treating others). But if everyone is out to try to screw me or rip me off, then I have to make as much money as possible to survive. Thats a lousy attitude I know, but attitude reflects culture I think.
Just thought that I would chime in here and make the point that there are far more legitimate claims that never get litigated than there are examples of lawyers abusing the court system for a "quick buck." The fact is, most medical malpractice cases take years to settle and the attorney has to front tens of thousands of dollars of costs out of his/her own pocket with no guarantee of ever getting paid back. So they don't file these cases often. In fact, for every 100 or so people that walk through an attorney's door with a legitimate injury resulting from malpractice, only about 1 will file a lawsuit.
Second, the standard for proving medical malpractice is very high. You basically need another doctor in the same field to testify that the defendant was negligent and be able to support that claim with a tremendous amount of evidence. It's also pretty hard to win medmal cases even with the expert testimony because juries generally just like doctors.
Third, the notion that attorneys will file a medmal case unless it's a clear winner is a fiction created by the insurance industry. There are far more legitimate cases that never get filed because they are either not worth enough money to litigate, or they are too difficult to prove. This means that the vast majority of the cases that do get filed are clear cases of negligence by the health care provider in which someone was badly injured.
Fourth, medical litigation accounts for less than one-half of 1% of health care costs. The only reason people think it's more is because insurance companies spend millions on advertising telling their lies.
Finally, if you want to decrease the amount of lawsuits, then you have to address the reasons why patients are being routinely injured and killed by health care providers. Look at how hospitals work residents 80 hours a week for low pay so that they can make a larger profit. Look at how hospitals severely understaff nurses and patient care technicians in order to drive up their profits. Look at how the insurance companies control costs by denying legitimately needed care to patients. Look at how the CEO of United Healthcare was paid $1.78 BILLION in compensation all by himself in 2007. That's more money than was awarded for all the medical malpractice cases in AZ combined. The only reason we know his salary was because he was criminally charged for adjusting his options dates in order to make more money. Apparently at almost 2 BILLION DOLLARS of personal income he felt under-compensated!
The problem isn't the lawyers. It's the fact that we have turned health care into a profits-driven business. Lawyers are just the last recourse for people who have suffered terribly under our broken system.
And just to preempt the question, no I do not practice medical malpractice law.
March 2011:
I have no insurance and recently dislocated my shoulder and went to the TMC ER on Grant to have it put back into place. I must say I received very good care and it only took 2 hours but I was shocked at the bill I received the following week. The bill from TMC was ~$3000, another separate bill from the doctor(s) (SWEA) who pushed my arm back in was $1555 so the total bill for my 1 hour ER visit was $4500!
Doesn't that seem a tad high to you?
If able, I will think twice about ever going to TMC ER again as captive "money giver" to a “Community hospital”.
I should have gone to Urgent Care. happy but poorer
I work in TMCs ER. First of all I'm very sorry you had such a poor experience. How old are you? Did they diagnose you with the concussion, or is that your opinion?
Unfortunately you came in on a Monday, I know you don't choose when something happens, but Mondays are by far the busiest. It just seems that lots of people come in looking for a wa out of work or kids suddenly get sick or do something stupid. I came in that Monday night and there were about 50 people in the lobby waiting to be seen, plus the fifty in the beds there are usually only three or maybe four doctors in ER plus maybe a resident or intern and a PA. Very few providers to take care of a lot of patients.
Also there are staffing issues because of a lack of nursing. We can only move patients in and out as quickly as our staffing situation allows and it is hard to get nurses to come in to hear people yell at them and tell them how bad a job they do or how unreasonable it is to wait. I had one person yell at me after waiting one hour telling me how his insurance was to good for him to have to wait. Typically I get complained to about waiting 3-4 times a night plus abusive family members and the intoxicated patients that come in that we must see, but are physically threatening. Why should nurses come in for extra shifts if they already work 40 a week and come in to such an environment? Its a lot easier to work another floor, or agency.
ERs are legally bound to take ALL patients. It doesn't matter insurance or not we have to take everyone. There is a large sign that says so. Lots of people with no insurance coming in for all sorts of things that they've neglected and have become worse because of a lack of insurance. These are problems that could easily be fixed earlier if they had gone to a PCP. There are also at least 5-10 infants that come in per shift (I work nights and the Children's Emergency is closed) or young people that do things they shouldn't have done, but have no insurance.
Then there's admitted patients, we have to wait on the other floors/departments to have beds ready for patients who need to be admitted. Unfortunately tat means a patient who is staying in the hospital has to be monitored and cared for, but its taking up a spot that could be filled by someone waiting. There are nights where almost EVERYONE that comes in needs to be admitted. That means you have to wait even longer because of those people working upstairs.
Lets not forget the ambulances, codes, and strokes and cardiac patients. Unfortunately if we see 1-2 of those an hour thats going to push a mild concussion further and further down the list and if they come in via ambulance, then it takes up more staff in order to get report from EMS and triage and draw blood, EKG etc.
Again I'm really sorry you had to be there so long, but you're going to find that with any ER and instead of complaining and demeaning the people that work there under the system created, perhaps you should complain to the people who created the system (and I mean those that think we don't need coverage for all so the 9 to 5 PCPs can pick up some more of the slack or those that make it worth more money for docs to go into pricey specialties instead of working ER which doesn't pay as much as OB GYN or surgical specialties) instead of those that go without lunch and breaks and work extra shifts in order to try and get you better care.
I hope you're feeling better.
everything posted here is common at hospitals around the city. my mother was a nurse for 50 years, and when she worked the ER, she saw similar issues. a number of years ago i went to the ER at kino community hospital, not my idea i was forced to go by my employer, i just wanted a band aide. it took more than four hours to be seen for a minor cut on my hand. the reason? they had a few cardiac cases that they needed to tend to.
there was a great line once in the show MASH where someone asked how long do people have to scream before they get treatment, and one of the doctors said, its the ones that cant scream that need the treatment the most.
while i agree that a concussion is nothing to diminish, it is not as life threatening as a cardiac case or some gunshot wounds, or other severe injuries. i am sorry that you were hurt, happy that things seem to be getting better, and i agree, next time drop in to the urgent care, or your primary care physician.
Yep, that's the situation with the ERs. A coworker of mine's wife spent just the same amount of time there as you (not sure in which one). Another coworker went nuts in TMC some time ago, too. If it's any consolation, that's how it is... nothing personal...
Next time you need something, go to Urgent Care, not ER. There are a few. I know only one - on Pima, just West of Wilmot, on the South side of the street.
The problem with Urgent Cares is they have no CT, or MRI so they wouldn't be able to do a head CT in the OP's situation. And without these studies, you really can't assess head pathology such as an internal bleed or ischemic damage.
Nonetheless, I agree with your point. More people should use Urgent Cares and Primary Care Offices that are willing to see patients immediately. Most things can be handled by both.
The problem is people without insurance are cheap and don't want to pay $50 to see a doctor in an urgent care. They would rather wait 13 hours for flu than pay a fee to go to an Urgent Care. Many people can't afford it and I understand that but many fundamentally believe health care should be free. These people have problem paying $300 for an I-phone but when it comes to health care, they don't want to pay a $10 copay. What's funny is doctors were afraid of pharmacies having these quick clinics staffed by nurse practioners and physician assistants. But what's funny is these pharmacies are losing money on these clinics and most of them are not busy because people don't want to pay $90 for a flu work-up, they would rather just wait in an ER.
The other problem with ER's is that unlike physician offices, they are required by law to see everyone whether or not they are insured or a U.S. citizen. A physician in an outpatient, on the other hand, is not required to see everyone. He or she can freely fire patients from their practice. They can choose to accept certain insurances. They don't have to take Medicare or Medicaid (AHCCCS) patients. The ER doesn't have this luxury.
So what happens is many uninsured and immigrants go to the ER to be seen for primary care issues such as flu, cold, strep throat, back pain, insomnia...you name it. Emergency Rooms were designed for emergent care. I would say 50% of ER visits are not emergent. So you have a lot of people who abuse the system.
Then you have a lot of people who are addicted to narcotics that show up to the ER to get pain medication. I would argue 5% of all ER visits are narcotic abusers. They want IV pain meds because it's absorbed faster and is more potent. They will fake chest pain and other conditions to obtain Dilaudid, Morphine, Oxycodone etc. They will say they are allergic to weak pain meds like Toradol, Tramadol, Morphine and say "Yeah but that Dilaudid worked really well last time"
Finally, you can thank lawyers for this one: defensive medicine! Thanks to lawyers who sue doctors for anything and everything, doctors are now forced to practice defensive medicine. 20 years ago, a kid who hit his head could be sent home on tylenol and reassurance. Now, every kid who hits his head has to get a CT scan of his head to rule out the less than 0.5% chance that he has a subdural hematoma. Guess what, that takes up time and makes your wait longer. It also increases your insurance premiums and health care costs. The reason is it is cheaper and less stressful for hospitals and doctors to settle out of court than it is to go to trial.
And if something happens, a lawyer will always find a way to blame the doctor. Case in point, we had a patient who left AMA meaning the patient left the ER out of his own will even after being informed of the risks. The lawyer will then blame the doctor and the hospital for allowing the patient to leave and will sue them for not declaring the patient incompetent and placing them in restraints. It happens folks.
March 2011:
I have no insurance and recently dislocated my shoulder and went to the TMC ER on Grant to have it put back into place. I must say I received very good care and it only took 2 hours but I was shocked at the bill I received the following week. The bill from TMC was ~$3000, another separate bill from the doctor(s) (SWEA) who pushed my arm back in was $1555 so the total bill for my 1 hour ER visit was $4500!
Doesn't that seem a tad high to you?
If able, I will think twice about ever going to TMC ER again as captive "money giver" to a “Community hospital”.
I should have gone to Urgent Care. happy but poorer
Isn't that just the billed amount before insurance? These are always outrageous. Or you don't have insurance...?
The problem with Urgent Cares is they have no CT, or MRI so they wouldn't be able to do a head CT in the OP's situation. And without these studies, you really can't assess head pathology such as an internal bleed or ischemic damage.
while what you say is true about the lack of CT and MRI equipment, there are still ways to determine if a head patient has a possible concussion, and how bad it appears to be. same with many other injuries. i learned some of those techniques in the mid 70s in high school as a student trainer. while it is nice to have the equipment, if you know what you are doing, the equipment just verifies a diagnosis.
Quote:
Originally Posted by azriverfan.
The other problem with ER's is that unlike physician offices, they are required by law to see everyone whether or not they are insured or a U.S. citizen. A physician in an outpatient, on the other hand, is not required to see everyone. He or she can freely fire patients from their practice. They can choose to accept certain insurances. They don't have to take Medicare or Medicaid (AHCCCS) patients. The ER doesn't have this luxury.
So what happens is many uninsured and immigrants go to the ER to be seen for primary care issues such as flu, cold, strep throat, back pain, insomnia...you name it. Emergency Rooms were designed for emergent care. I would say 50% of ER visits are not emergent. So you have a lot of people who abuse the system.
Then you have a lot of people who are addicted to narcotics that show up to the ER to get pain medication. I would argue 5% of all ER visits are narcotic abusers. They want IV pain meds because it's absorbed faster and is more potent. They will fake chest pain and other conditions to obtain Dilaudid, Morphine, Oxycodone etc. They will say they are allergic to weak pain meds like Toradol, Tramadol, Morphine and say "Yeah but that Dilaudid worked really well last time"
Finally, you can thank lawyers for this one: defensive medicine! Thanks to lawyers who sue doctors for anything and everything, doctors are now forced to practice defensive medicine. 20 years ago, a kid who hit his head could be sent home on tylenol and reassurance. Now, every kid who hits his head has to get a CT scan of his head to rule out the less than 0.5% chance that he has a subdural hematoma. Guess what, that takes up time and makes your wait longer. It also increases your insurance premiums and health care costs. The reason is it is cheaper and less stressful for hospitals and doctors to settle out of court than it is to go to trial.
And if something happens, a lawyer will always find a way to blame the doctor. Case in point, we had a patient who left AMA meaning the patient left the ER out of his own will even after being informed of the risks. The lawyer will then blame the doctor and the hospital for allowing the patient to leave and will sue them for not declaring the patient incompetent and placing them in restraints. It happens folks.
a lot of truth in this post.
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Hope you feel better today.
These are always outrageous. Or you don't have insurance...?
