ER is defensive medicine. If you walk in you’re a stranger to us, and if we send you out and something bad but unlikely happens, it can be very bad. So if you walk through the door and say you have a cough, you are very likely to get a chest X-ray, an ekg and yes engage the devices of a triage nurse, a primary nurse, an ER doctor, an X-ray tech, a cardiologist (viewing your ekg remotely after the fact) and a radiologist (reading your chest X-ray after the fact). We will weed out any possible reason you have a cough, even though many of them are exceedingly unlikely. That’s unfortunately the way it works. You could quite possibly end up getting a ct scan for a pulmonary embolism, even though that is very unlikely too. But the acceptance for a miss on one of these diagnosis and doctors liabilities are such that to an extent their hands are forced.
I have gone to Urgent Care myself for a persistent cough and done pretty much the same thing. It happens.
But I’m not surprised that this cough drop costs $10. Delivered by a nurse that I hope is making at least $32 an hour.
I like what I do but I can not stress to you how difficult it is and yes, it is frustrating to have people come engage emergency services for minor things. It’s not good for them (inevitably subjected to unnecessary radiation from testing) either.
Worst ER complaint thus far was fingernail fungus. That was invisible to anyone other than the patient.
But my point is not to complain about my job or say that US health care is amazing. It’s awful and I’m fully in support of single payer. I will just reiterate that this is a terrible example of that.
So when you take your own cough drop, I don’t need to verify that you are you and not the patient next door, I don’t need to get your cough drop from the gigantic machine that has all the medicine in it. The pharmacist doesn’t need to stock it. It doesn’t need to go in a little barcoded container. There are actual reasons why all these things have to happen that don’t really involve cough drops but all medicines, cough drop just being a poor example.
You can definitely kill someone with Tylenol. So that’s perhaps a better example.
We have trouble going after corrupt politicians with hard evidence, or making any decision one way or the other on gun control. I think we could screw up a nationalized healthcare system, if the problems with Veteren’s Affairs are any indication on what is to come.
Doesn’t mean we shouldn’t nationalize our healthcare, and even make healthcare a right. But let’s also be realistic with our expectations. Costs will be above what is projected, waste will be high, some policy decisions will seem inane after-the-fact, and there will likely be some level of corruption in the system. (hopefully small)
Nursing care rarely appears on itemized hospital bills, nor do pharmacy services. It’s usually rolled into “room”. You may want to factor in the healthcare professionals ensuring that your single dose packet contains the cough drop you need and not something else that might kill you.
If hospitals aren’t sadistic black holes of soul-leeching capitalism, then this would mean their price gouging is actually what’s keeping them in the black. This is worrisome, and it’s something that needs to be addressed in the discussion we’re having about healthcare.
I think there are plenty of problems to fix, most importantly that insurance companies tack on a large percentage of profit to everyone’s suffering while offering no value whatsoever.
Honestly I’m kind of disgusted by how little money I make and how hard I work. I would not call it a good salary (I’m know other people would love to make what I make. But pondering the cost of school, the crushing amount of work and being up all night and the ways that it distances you from normal people, it’s kind of a pittance.
The same way other OECD countries handle those same costs, with additional efficiencies (e.g. from not paying the myriad of parasites who hang off the system feeding on its brokenness) and better health outcomes.
I’ve met nurses and physicians from Canada and Western Europe over the years, including ones who practised or went to school here for some time. All are making or were realistically expecting to make at least good middle-class salaries, work full-time, have excellent benefits, some working in hospitals staffed 24-7-365.
None are suffering, and none of them has expressed any interest in dealing with private insurance companies, full-time medical billing specialists, and no-value-added middleman consultants to help them navigate the for-profit system.
No system is going to be completely free of them, of course. The every state-run programme (e.g. the VA and Medicare here) has its own serious problems, the billing still has to get done, and private add-on insurance can exist in a single-payer system. But one way or another those doing these jobs will definitely have to go on a diet or find another line of work once a single-payer system kicks in.
Five years ago, my partner had to have an 1 1/2” gash sewn up at a small hospital in the north shore of Massachusetts.(that party kicked ass)
I think we were maybe in the ER for an hour? Anyway, when the bill came a couple months later, I was astonished to see a price tag of $2700 (give or take. I was also not actually astonished, not one bit.)
When I called the hospital to inform them that I would pay the bill when pigs fly, I asked the person if the hospital used gold thread. They were not amused by my attempted levity, but hey, Upton Sinclair had something to say about that…
The Electronic Medical Records Act has forced many GPs out of business; the rest now work for large (impersonal) healthcare companies. Just try to find a doctor (not a clinic) that will take you on.
I know physicians who’ve wrestled with this. It’s not a cost issue that makes them shy away from HIPAA-compliant EMR systems. Rather it’s a combination of what are mostly poorly designed ones (though they’re getting better – Practice Fusion is pretty good) and a cultural resistance in the profession to computer technology that isn’t built into a medical device.
A doctor’s office is one of the few workplaces you’ll see other than a legal firm in 2018 where the fax machine is still in regular use. I expect this to change in the coming decade as older and more change-averse GPs retire and younger digital natives start taking over practises (and try to avoid working for those impersonal companies)
In any case, having to use an EMR system is far from the highest administrative overhead cost that’s put solo practitioners out of business. The biggest complaint I’ve heard is that a one-doc shop just can’t afford a full-time medical billing specialist who spends 40-hrs/week negotiating with several private insurers using several different coding systems for what now regularly turns out to be $0.50 on every single dollar claimed. They’d gladly trade that situation for a steady single-payer one where they average $0.75+/claimed dollar and only have to have a billing specialist in for 4-hrs/month.
HIPAA penalties are the driver here. Using email and apps, there are so many ways that medical information can be misrouted through malice (maybe 1 percent of the time) or simple user error or confusion (99 percent) that I expect the fax machine to persist in medicine for decades.
I’m not sure of that, given that the EMR Act @Alfred_Packer1 mentioned above is formalising a process that’s already underway with younger physicians.
One of the benefits of a practise going digital is that it offloads a lot of HIPAA compliance requirements from the practise onto the software or service vendor (that’s especially true for cloud-based and SaaS ones). For HIPAA’s first decade or so relying on a fax was an easy way for doctors to “prove” they were being compliant while the government allowed them their transition period, but in the last decade it’s no longer enough.
Also there’s a huge business incentive in the healthcare sector in terms of scheduling, logistics and supply chain for labs and large hospitals and pharmacies, so they’ll be pushing for less faxing from their end, too.
I see the regular use of faxes in medical offices petering out over the next decade as the last of the Boomer doctors and the first of the Gen Xer ones start leaving the profession.
Except that there are still many possible breaches which can originate at the hospital or doctor’s office for which the system vendor can easily dodge responsibility.
