Will your doctor be fined or jailed?

[peternap]

So am I saying that we need a health care program that works (like maybe Medicare)

yeah I guess so

We can afford it (if we cut off the Pentagon and end the Federal Reserve ) and it will improve the society we live in

I agree Windpower, but I don't see it anytime soon. The whole system is rotten with the only real healthcare coming from the Nurses.
Most Doctors I know are way too concerned with their income than they are with their patients.

I'm in the dog house this morning because I won't go to the Doctor. My comment was "Where would I find one except the Hospital?".

The era of Doc Adams (or in my case, Dr. Rowe) is long gone. Now it's Patient First or the ER.

[HoustonDave]

I've been involved in minor party politics for almost a decade (currently a national officer), primarily because I decided the two majors were incapable of reforming themselves internally, so they had no chance at fixing the government.

I've spent thousands of hours grilling people I know, including patients who have seen the system fail, people selling insurance (who are getting out now that Obamacare has passed) to doctors (my father in law).  The reality is, our medical system is expensive for several reasons (I'm only addressing cost here, not quality of care):

1)  No cost transparency.  Those who have insurance through an employer health plan don't realize their employer is paying a huge chunk of their premiums.  Strike one because now you are insulated from the true cost of your insurance.  That is money your employer could be paying YOU.  Then you never see the cost of services up front.  Strike two because you have no incentive to decide whether doing something is cost effective.  Then the bill goes first to the insurance company, who negotiates it down with the provider.  Then you see a bill for whatever is left.  Why should I care whether a procedure costs $500 or $5000 if my insurance company pays all but $50.  I see the $50 bill.

2)  Liability.  Equipment is used only once that could be sterilized and re-used because of liability.  Doctors over-test because missing something could be a liability.  People with minor conditions are not turned away at the emergency room and told to make an appointment with their doctor because of potential liability.  There is a HUGE internal cost of protection from liability (through overspending and insurance) and dealing with liability (defending suits and settling).  The problem here is widespread in our culture.  If someone gets hurt or dies, it practically MUST BE SOMEONES FAULT or even if it isn't, "someone" should be required to make it up.  We have become a society brainwashed into believing that life is safe, and when it isn't, someone is to blame.

3)  Cost of education.  Medical education is not only expensive, it is METERED.  That is, certain specialties (the highest paying often) are artificially limited in how many can practice it by limiting residency opportunities.  Every hear of supply and demand?  Keep the supply of those specialties low, and the demand for their services high, and you can justify the salaries.  Keep the salaries high, and the educational system can justify the cost of getting that degree.

Universal health insurance (which is what Obamacare really was) will not reduce costs, it will actually increase overall nationwide spending on healthcare, and distribute the cost among more people (the taxpayers).  To fix healthcare COSTS (quality is another matter) you have to fix the above three problems.

[Sassy]

Houston Dave, I agree w/your 3 points. 

Seems like some of the worst abuse are those who don't have to pay anything - the ones who don't have any income...  they will not hesitate to call an ambulance for the most minor problems (a sore finger) because they won't be charged, sometimes they get discharged from the ER & call the ambulance again & either go to the same hospital or another one. 

Then there are those who will go to ER for any problem - problems that I would never dream of going to ER for...  like, "I have a tickle in my throat."  How long have you had it?  "Three hours, I thought I better get it checked out in case I'm coming down w/something."   

I was talking w/my primary care doc - he said the dentists were smart, they didn't get all tied up w/the insurance companies, so they are making big bucks. 

A nurse I work with said her sister waited 5 years up in Canada for a hip replacement & has now waited 2+ years for her other hip & no guarantees that they will ever ok it.

I went to my primary care provider a couple weeks ago due to all the pain I was having, having difficulty walking, sleeping - in severe pain half way through my shifts in ER - he said he couldn't write for any time off from work, that my orthopedic surgeon needed to do that (although my primary care doc said the MRI of my back looked "nasty" & that I'll need surgery).  Saw my orthopedic surgeon, he said there wasn't anything they could do surgically except fuse it all but that probably wouldn't do me any good & besides I need bilat hip & knee surgery 1st.  So I asked him if he was taking me off work.  He said, "I don't do that, you'll have to talk to your primary care provider, I'm just a surgeon."  Didn't tell me whether I had any limitations or nothing.  Talk about being tossed around.  So, it is almost midnight, I've worked 12 1/2 hrs, I'm hurting bad, limping...  what do you do??? 

The medical system is messed up here for sure... 

[peternap]

Houston Dave, I agree w/your 3 points. 

Seems like some of the worst abuse are those who don't have to pay anything - the ones who don't have any income...  they will not hesitate to call an ambulance for the most minor problems (a sore finger) because they won't be charged, sometimes they get discharged from the ER & call the ambulance again & either go to the same hospital or another one. 

Then there are those who will go to ER for any problem - problems that I would never dream of going to ER for...  like, "I have a tickle in my throat."  How long have you had it?  "Three hours, I thought I better get it checked out in case I'm coming down w/something."   

I was talking w/my primary care doc - he said the dentists were smart, they didn't get all tied up w/the insurance companies, so they are making big bucks. 

A nurse I work with said her sister waited 5 years up in Canada for a hip replacement & has now waited 2+ years for her other hip & no guarantees that they will ever ok it.

I went to my primary care provider a couple weeks ago due to all the pain I was having, having difficulty walking, sleeping - in severe pain half way through my shifts in ER - he said he couldn't write for any time off from work, that my orthopedic surgeon needed to do that (although my primary care doc said the MRI of my back looked "nasty" & that I'll need surgery).  Saw my orthopedic surgeon, he said there wasn't anything they could do surgically except fuse it all but that probably wouldn't do me any good & besides I need bilat hip & knee surgery 1st.  So I asked him if he was taking me off work.  He said, "I don't do that, you'll have to talk to your primary care provider, I'm just a surgeon."  Didn't tell me whether I had any limitations or nothing.  Talk about being tossed around.  So, it is almost midnight, I've worked 12 1/2 hrs, I'm hurting bad, limping...  what do you do??? 

The medical system is messed up here for sure... 

There isn't much I can say about this thread Sassy. Kinda like talking about pure cane sugar, I don't use it....but I sure feel for you right now!
A whole lot of prayers are going your way!

[MountainDon]

A nurse I work with said her sister waited 5 years up in Canada for a hip replacement

This sort of report is confusing to me.

My Mom, life long resident of Canada, broke a hip when she was 85 just a few years ago. They had replacement parts in her within days of the break and had her in rehab right soon after that. I was surprised to say the least, but also happy. Unfortunately due to other things she never fully recovered and had to use a walker, then a wheelchair until she died. But she was never denied care. She did refuse some things near the end, but that was her choice.

Just had to toss that into the mix as it is something we experienced first hand, no second hand anecdotes.

[peternap]

A nurse I work with said her sister waited 5 years up in Canada for a hip replacement

This sort of report is confusing to me.

My Mom, life long resident of Canada, broke a hip when she was 85 just a few years ago. They had replacement parts in her within days of the break and had her in rehab right soon after that. I was surprised to say the least, but also happy. Unfortunately due to other things she never fully recovered and had to use a walker, then a wheelchair until she died. But she was never denied care. She did refuse some things near the end, but that was her choice.

Just had to toss that into the mix as it is something we experienced first hand, no second hand anecdotes.

It's always good to hear two different sides Don.
I expect different situations are treated differently and maybe dependent on the locality or even the facility. The horror stories always make better press.

All the emergency rooms here brag about their triage and priority procedures. Chest pains are always on the top of the list as is severe trauma.
I took a business partner to the ER in a local hospital a few years ago with chest pains and he passed out in the waiting room, in the 3 hours he waited to be looked at.

I also took one of my carpenters to the same hospital (There aren't many around) who had nearly severed a finger on a table saw. After an hour, he started raising hell and the police were called. They escorted him off of the property without being treated..

Point is, health care is never black and white.

[Sassy]

Thanks for the prayers, Peter!  I always can use them.  I had one of the docs I work with look at my report, he deals with a lot of trauma & has also had problems w/his back.  He read my report & said I had multiple levels of severe problems w/my spine & I needed to see a neurosurgeon & need surgery.  My primary care doc said the same thing about surgery.  Anyway, I definitely won't be going back to that ortho surgeon!  The doc I work with also works in the community & is one I would trust w/my life & he is very conservative - he wouldn't tell me this if I didn't need it.  He said I should not be working in the ER, shouldn't be lifting etc etc & that I needed to be put on disability, see a neurosurgeon ASAP & get things taken care of.  Not good news but at least I know what I'm looking at.  He says that I should feel significantly better after the surgery - I have bone fragments that are probably giving me so much pain. 

As far as hip surgery - I'm sure a fracture would be taken care of right away.  Something like I have, severe osteoarthritis, bone on bone in both my hips & knees would go under the case of waiting like the one I cited above who had to wait 5 yrs.  The fracture can't be ignored, someone in pain & restricted mobility can, without being accused of malpractice.  

In our ER we take anyone w/chest pain immediately & place them on a monitor, do a 12 lead ECG within the 1st 10 min of their arrival - we are also required to do the ECG on any pt who c/o light headedness, shortness of breath, abd pain within 10 min & show it to the doc so he can see if there are any acute changes that show either ischemia (less blood flow) or an actual heart attack.  We are required to have a 95% completion rate for those problems.  Our hospital is graded & funded on these & other parameters met.  Someone w/a lacerated finger or even other lacerations (except head injury - they will be seen right away & get a head CT to make sure there isn't a bleed) will have to wait if the ER is busy - it isn't life threatening, although it may be scary to look at & hurt like crazy.  If they are bleeding a lot or possibly an internal organ is effected, then of course their triage priority would be a lot higher & they'd be seen asap.  Depending how much acting out a patient does, if he's a danger to others, yes, he might be escorted out by the police.  One hour is not very long to wait in most ER's because we are usually so busy - unless it is one of the problems I mentioned above.

Again, there are good docs & bad docs...  Good hospitals & bad...  most people say that the hospital up where we live is terrible, only go there to die.  My experience when I had the problems w/my gallbladder, they were fantastic.  They diagnosed it correctly & due to the complications of it causing pancreatitis & my liver getting messed up from it, they transferred me out to a higher level hospital (actually one of the best in Calif) within 3 hrs I was on my way by ambulance.  They medicated me for pain & nausea right away, did a CT, blood work & all - I couldn't have asked for better care.  So, I guess everyone's experience is different.