I fully support this MD’s stance. But recent news tells us that vaccinated or not you are likely to be carrying the same viral load if you are infected with Delta.
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I desperately need some major good news…
It’s just a drop in the bucket, but this was nice to hear: U.S. Eliminates Student Loan Debt For Some Borrowers With Disabilities : NPR
The U.S. Education Department announced Thursday that it is discharging the outstanding student loans of more than 323,000 borrowers who have significant, permanent disabilities, and will remove barriers for borrowers who qualify for this relief in the future. The announcement will erase some $5.8 billion in debt and marks a significant step toward fixing a troubled debt relief program meant to help borrowers with disabilities.
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Medical Ethics is an important field because rarely are there easy answers to the questions posed throughout this thread. Discussions around ethics can be some of the most heated in medical training - there are only so many arguments to be made about reordering a differential diagnosis, but the who/when/why of treatment? - that shit can get personal, and everybody has an opinion.
Starting with the most straightforward - the Emergency Room.
He’s correct. The EMTALA law, passed in 1986 in response to for-profit hospitals in LA dumping indigent patients on skid row instead of treating them, ensures that anyone - regardless of the ability to pay - may be seen in an ER (if the hospital offers 24-hour emergency services and accepts federal payment, i.e. Medicare). No matter who you are, if you present to a qualifying ER (basically all of them), a provider there MUST perform a “Medical Screening Exam” to ensure no emergency exists. The providers have a lot of discretion as to the nature of the MSE, but usually it involves a pretty serious workup - defensive medicine and all that.
If an emergency does exist, the provider is obligated to stabilize the situation or to transfer you to a center that can. In fact, the hospital with more services MUST accept the patient referred as long as there is bed capacity. Tertiary care referral centers fill up fast in crises, which is exactly what’s happening now, with patients being stuck in the ER of hospitals that can’t provide all the services needed - no place to send anybody.
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Primary care providers have a lot more discretion in treating, if they’re not employed by an outside hospital or larger healthcare organization (unfortunately, there are fewer and fewer independent practices - another discussion for another day). There may be a lot of different factors in the decision not to treat somebody. At least a couple of them have been mentioned already.
First, the willingness of a patient to follow the instructions given by the provider – you’re not gonna follow the advice I offer? Okay, maybe you get put at the bottom of the queue for additional advice & treatment. Of course, it’s rare to have a patient follow every detail of advice and prescribed treatment, so there’s something like a sliding scale here. Having trouble managing everything? Sure, let’s keep working on it - that’s more or less the bread and butter of primary care. But if you’re actively hostile to the doctors recommendations? Maybe you need to find another provider.
Second, the risk of harm to other patients from a potentially infected, non-vaccinated patient. Honestly, this may be a bit less of a concern at the moment. COVID is EVERYWHERE right now, and a medical practice trying to avoid infected patients is akin to visiting the beach and trying to keep sand out of the car on the way back - it might be possible, but it’s unlikely. To be sure, in a large patient population with unknown COVID status (infected vs not), the unvaccinated are more likely to be on the infected side of the fence; excluding them from your waiting room is one way to decrease the sand on the floor mat, but it doesn’t eliminate the risk altogether.
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Thank you. That was right in the era of the second KKK, although I was off on the exact years.
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I’m pretty sure doctors turn away patients who can’t/won’t pay, every day.
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cant be 5g coverage sucks ass in the usa…
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Except this isn’t the same - anyone can be vaccinated. It’s more like demanding that, say, people wear masks into the office.
Except, of course, that you’re a lot less likely to get infected in the first place if you’re vaccinated.
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Less likely, but perhaps not ‘a lot less likely’. From what I’ve read it seems that they now think that sooner or later everyone is going to get exposed to Delta, it spreads so virulently, and it is not yet clear that vaccines prevent you being infected quite as much as they absolutely do dramatically reduce the chances of getting seriously ill with it if you are infected. It seems likely a lot of vaccinated people are totally asymptomatically carrying it around at one time or another.
But, yeah, this doc is quite right to refuse to see unvaccinated people, on the basis that they are more likely to be asymptomatically infected and shedding Delta than the vaccinated are.
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Are you sure about this? That one study that was used by the CDC to recommend masks again from the July 4th spread seemed to show that the vaccinated were just as likely to catch delta as the non vaccinated but were less likely to get symptoms.
Well, if that is the case, then @Shuck’s
… is not the case
Which is kind of what I was saying in my previous post but I bowed to Shuck’s suggestion that the likelihood was reduced if vaccinated.
I’m not too bothered either way, as the critical take-away is that those who are vaccinated MUST NOT assume they are not carrying Delta, and must realise they probably will be at some point.
Mask up whether you are vaccinated or not!
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I don’t think Dr’s in private practice are bound by those kind of rules. If there is something in their rules of conduct, they can choose to fire the patient. They’d have to cover them for 30 days, but after that, they’re on their own (probably head to the ER).
Probably the former. Central Nebraska has very few people. Arthur County’s 2010 census population was 460.
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