Demystifying Medicine One Month at a Time

Tag: Crowding (Page 1 of 2)

“Crowding,” and Other Items

The stock market is up. But the economy sputters along–it grows, but only slowly.

The health care sector has been an exception to the trend of slow growth. It continues to employ more Americans than ever before, without much sign of slowing down.

[Correction. Here’s a sign of some slowing.]

The health care industry has become so huge that it comprises nearly 1/5 of the economy. Now 1/9 American workers are somehow in health care (think medical coders, billing specialists, and various administrators). It’s astonishing. Whole cities (Hello Cleveland, Pittsburgh, etc., etc.) rely on health care as their #1 sources of jobs/income/investment.

[For a superb treatment of this phenomenon, read Chad Terhune’s piece here.]

A while back I read a great essay by a health care pundit who talked of health care spending “crowding out” other forms of public investment.

Think of it this way: a government collects taxes. If it spends an increasing amount on health care goods and services each year, there is less available for education, roads, infrastructure, etc.

It may not quite be a zero sum game, but it’s darn close.

Don’t You Just Love Those Drug Ads on TV?

I wrote new essay for NPR’s health blog, Shots, in honor of the 20th anniversary of drug ads appearing on TV in the U.S.

You can click on the box below to have a look. It ran with more great collage art by @KatStreeter.

Call Now to Reserve Your Spot in the E.R.

Emergency Rooms are a bellwether of the U.S. Health Care “system.”

I’ve explained in other posts why the E.R. is a tough place to work and a tougher place to be a patient.

Now comes news that some Florida-based hospitals are piloting an E.R. reservation system. The goals are intuitive:

  1. Minimize patient waiting times, thereby
  2. increase patient satisfaction.
  3. Improve the working and waiting environments for staff and patients, and
  4. boast about the new idea, providing the for-profit hospital chain (Tenet) a marketing advantage.

Ding! The old-fashioned way.

All it costs is $9.99. No joke. You have to put the money down on a credit card to reserve your spot, which guarantees that you’ll be seen within fifteen minutes of the appointment time that you are given.

And what If you’re not seen in fifteen minutes? Money back guarantee!

So these hospitals are going to let us reserve a spot in the often horridly long E.R. queue? That’s ten bucks I’d be glad to spend. What’s not to like?

According to the article, the system works well for those whose health situations are not true emergencies. But for those with serious issues like heart attacks or strokes, waiting for your reservation time can be a big mistake.

“Time is tissue,” we are taught in medical school.

Come to think of it, isn’t making an appointment for the E.R. kind of like what you’re supposed to do at your doctor’s office?

If you can make an appointment in the E.R for the same day and be seen in fifteen minutes of that time guaranteed, why bother with a primary care office that makes you wait anywhere from two to six weeks for an appointment with your doctor?

Makes me wonder…

Push or Pull?

Chances are if you’ve never been admitted to a hospital, you know someone that has.  If that admission was unplanned, you likely waited a long time in the ER before you or your friend/loved one was transported up to the hospital floor.

If hotels ran like hospitals, they’d run themselves out of business.  Imagine the desk clerk, instead of giving you your room key (swipe card?), telling you, “I’m sure your room will be ready in the next 2-4 hours, or at change of shift, Mr. and Mrs. Cunningham…”

What is it about hospitals and all this waiting?

For one thing, hotels have the tremendous advantage of their customers planning their departure dates.  All the hotel has to do is enforce a “checkout time,” after which a guest is threatened with paying for another day’s stay–voila!–let the march of checker-outers begin!

Hospitals wish they could do the same thing, but there are major differences.  The main difference is that you and I aren’t paying directly for the hospital bed–insurance is.  So there’s no personal incentive to get out quickly.

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Un-Maligning the ER

One last post on the ER….for awhile.

As I mentioned in an earlier post, the ER is the portal of entry to our hospitals now, for better and for worse.

On the plus side, this means that most patients being admitted to general medical and surgical services (the big exception here is elective surgery–patients having elective operations don’t need to be triaged) have a workup at least started and are triaged appropriately to their destination.

A good ER evaluation should answer the following questions:

1. What’s the nature of the illness?

Are we dealing with the heart, the brain, or an abdominal organ?  Is the cause an infection, a blockage, or a blood clot?

2. Based on #1, where will the patient best be situated?

Will the patient need intensive care, or will the “regular” floor be sufficient to attend to the issues at hand?  Should the patient be admitted to a surgical team or a medical (non-surgical) team? Continue reading

The Mystic Portal Awaits

And waits, and waits, and waits……

The ER is the portal of admission to the hospital for what we might call undifferentiated illness.  Shortness of breath.  Chest pain.  Fevers with localizing symptoms (like pneumonia, appendicitis, or gall bladder infections).  “Changes in mental status”–confusion, delirium, or dementia, caused by Alzheimer’s, strokes, and many other diagnoses.  Of course, other emergencies are usually well taken care of in the ER: fractures, lacerations, bleeding, etc.

Why do we have to wait so long to get seen and treated in the Emergency Room?

Well, crowding is one problem.  You’ve heard endless commentary about ER crowding.  Too many people using the ER for non-emergency issues: colds, sprains, back pain–all things that could be better treated in the office or over the phone. Too much difficulty getting seen by your primary care physician.  There are simply more people waiting to be seen than can be accommodated in a “reasonable” time frame.  [Of course, this all depends who is defining ‘reasonable.’]

The ER is a victim of its own success.  The ER “brand” if you will, is sexy.  Start with those TV dramas that glorify the gritty heroes who work on the front lines.   Then, the simple message of an ER’s mission:  “We’re always open, and we can’t turn you away.”  For people who don’t have insurance, or who are frustrated by lack of access to their (or any!) doctor’s office, the idea that the light is always on makes the ER an attractive beacon.

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