I just finished working six twelve hour shifts in a busy urban Emergency Room. I say that to give you a little view of where I am coming from and to make an excuse for my terrible grammar and spelling.
There are a lot of issues with health care. The one I am going to talk about/rant about is physicians and patients, particularly in the Emergency room.
Today I worked in the "subacute" area of my particular Emergency room. This area is suppose to get the flu/cold in and out type of patients. However, some days this simply does not work. Sure sometimes patients can be more than meets the triage nurses eye. However, there is a growing issue with certain doctors in the Emergency room. today I worked with the worst of the bunch.
Let me first say I think this physician honestly believes he is doing whats in the patients best interest. He is also very intelligent. I digress.
Patient after patient present to our area of 6 rooms. Several had head colds. Their symptoms varied slightly but in general most had reported pressure in their head, "sinuses feel full" type of comments, very few had any nausea, vomiting or diarrhea. On most days these patients would have gotten minimal treatment. Not today.
The particular physician I was working with ordered a combination of head CTs, IVs and antibiotics. As one could surmise there was not a SINGLE abnormal CT. There was not ONE abnormal lab value. But the physician felt he was doing right by the patient and the patients actually think they got good care. He literally ran up $3-$4,000 bills on people that had little to nothing wrong with them. At one point a patient that was there for something completely unrelated asked the physician for a pregnancy test so he ordered one. I pointed out to him that it was completely unrelated since we were not giving any medicine nor running any diagnostic tests and I mentioned that she didn't have insurance. Not that the lack of insurance should matter but she will get the bill! Giving her a test in the ER instead of just advising her to get a pregnancy test at the drug store is a price difference of probably $50-100.
It went on and on all day. People with the flu were giving IV antibiotics, people with urinary track infections were given abdominal CTs, people with sinusitis were given head, facial and cervical spine CTs. Seriously.
The problem with this is that the system in place rewards this type of behavior. The physician is not penalized at all for ordering ridiculous tests rather they are rewarded. They are compensated for the increased complexity of the patients because the insurance companies will look at a patient needing a head CT as more acute than one that needs a prescription and sent home. Or simply told to take some over the counter meds and sent home.
The other side to this coin are the days some of the other physicians work. The ones that treat and street you appropriately and with little resources. Patients moan and groan about how the last doctor gave them an IV medications and an abdominal CT.
So how do we fix both the physicians who are rewarded by the ala carte system? How do we adjust our expectations in care considering just over 85% of people think physicians order too much but less than 20% think they are the ones receiving the overkill care?
One way within the confines of the system now would be for both medicare and large insurers to crack down on the physicians. Instead of reimbursing 60% of every CT ordered they should reimburse more for those needed and little to none for CTs on patients that do not clinically justify the order. I don't know the solution but someone has to change the bottom line, which is money.
Rant over.