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Amateur Night In The Emergency Room

Please read the important announcement about our acupuncturist Mari Stecker at the end of today’s Health Tip

Let me pass on a tale of woe a new patient recently shared. There’s a useful lesson in health care within, and while I wouldn’t classify the event as malpractice (since no permanent damage occurred), it’s the story of an innocent woman falling victim to amateur night in a large and well-known Chicago emergency room.

I’ll close with some suggestions on how to prevent this from happening to you.

Barbara was an otherwise very healthy and intelligent young woman from Eastern Europe living in Chicago on a student visa. She’d really never been ill before and, like most 20-somethings, hadn’t given much thought to either illness or health insurance, especially since she came from a country that provided subsidized health care for all its citizens.

One morning, Barbara awoke, went to the bathroom, and saw blood in her urine. You can imagine her staring into the toilet bowl, eyes widening, heart racing. An hour later, she had to go again and the blood was still there, but this time there was burning with the tiny amount of urine produced. Thirty minutes later, more burning, more blood.

You internet-savvy amateur physicians have already diagnosed Barbara with a urinary tract infection (UTI). If you were managing her care, you’d send her to a clinic at a Walgreen’s or CVS or to an immediate care center. There, a urinalysis would confirm the diagnosis, she’d receive a prescription for inexpensive antibiotics, and she’d feel a lot better by mid-afternoon. Her total out-of-pocket expense would likely be less than $100 ($80 to $90 for the visit and less than $10 for the drugs).

So Barbara telephoned her mother overseas, who told her (as expected) that she needed to see a doctor. Barbara typed “emergency medical care Chicago” into her Google bar, read down the list, and headed for the emergency room of the large and sleekly modern university hospital a few blocks away. And there her troubles begin.

Barbara’s extended ER stay
Barbara spent a total of eight hours in the emergency room–three hours waiting to be seen by a doctor and three hours undergoing various procedures and tests, including starting an IV, blood and urine tests, an ultrasound of her kidneys and pelvis, and a CT scan of her abdomen. Barbara waited another two hours for someone to review her tests and remove her IV line. She was finally released, armed with an antibiotic prescription, after learning she had a UTI. She was fine the next morning.

A couple weeks later, Barbara received a bill from the hospital for $10,000.

Frantically, she called her mother, who told her she’d better start making payments or she risked losing her visa (not true, but a frightening thought nonetheless). $10,000? Too bad Barbara had only a part-time minimum wage job. How did she manage to get such breathtakingly inefficient care at such an exorbitant price?

When you find yourself in the ER at a large teaching hospital, you’ll be seen by quite a few people, all of whom seem to be asking the same questions. After the usual admissions clerk and ER nurse, there’s Doctor #1 (usually a medical student or a first-year resident), Doctor #2 (a second-year resident), and Doctor #3 (a senior resident or ER fellow-in-training). If your case isn’t life threatening, you’ll likely not see an attending physician.

Understand that each of these doctors has to collect data on you before he/she presents your case to the senior doctor, the fabled pecking order of medical education at work. In a teaching hospital, more data is always better, and Doctor #1’s failure to collect as much as possible is met with scorn from #2. Even though the info collected may be utterly useless (like that from the CT scan), failure to collect the data is wrongly interpreted as “you could miss something serious.”

Since every student or resident working an emergency room believes some third party payer will pick up the costs, it never occurs to anyone how expensive each medical decision actually is. And the prices are all super-high: labs or x rays done in an ER are usually two or three times higher than when the same test is performed outside the ER. It’s unlikely any physician Barbara saw was remotely aware she’d be receiving a bill for every test ordered. Each of them would also probably be horrified to learn that the care provided left her responsible for $10,000 in charges.

Cash cow
Since most emergency room visits are indeed covered by health insurance, the combination of high charges and underpaid residents make the ER a teaching hospital’s cash cow. The same does not apply to community hospitals, where, with doctors who see fewer patients and know exactly what tests to order, emergency rooms routinely lose money.

Since Barbara was beginning to receive threatening collection letters from the hospital, I suggested a few ways she could get them off her back:

  • Bring two recent payroll stubs, documentation of student status, and a money order for $100 to the hospital billing department.
  • Tell the (usually quite pleasant) billing person that she’d followed up with a doctor (me) as instructed and that the doctor was horrified by how many unnecessary and potentially dangerous tests had been ordered. That care for a bladder infection should cost no more than $100.
  • Hand over the check, saying “this is all I can afford” and asking if this can settle the account. If the billing person suggests a payment plan, simply say, “Look, I don’t have any money. I have to struggle with my rent every month.” (As Barbara said to me, “Well, that’s certainly the truth!”)

How you can avoid Barbara’s mess

  • Any time you need prompt care and can’t get an appointment with your primary care doctor, use one of the drugstore quick-care clinics. Let the doctor or nurse practitioner who staffs the clinic decide if you really need an emergency room.
  • If you must go to an emergency room, use your local community hospital. These are generally staffed by very experienced physicians certified in emergency medicine who know to order exactly what’s needed to make your diagnosis and initiate treatment.
  • Always challenge any bill you think is unjustified.

Be well (on a budget),
David Edelberg, MD

Mari Stecker Fundraiser
As many of you know, our acupuncturist Mari Stecker has been battling non-Hodgkin’s lymphoma for the past year. She is now in her sixth round of chemotherapy. The lymphoma came in the wake of uterine cancer, which Mari overcame less than five years ago.

With all this treatment, Mari has been unable to work for more than a year. To help with her considerable financial distress (and provide a nice Valentine’s Day gift), WholeHealth Chicago is holding an unusual fundraiser.

A portion of the profits from all purchases in our apothecary on Valentine’s Day will go to Mari.

Please review your supplements now so you can place an order on Thursday, February 14. If you’ve not been a regular customer, consider using our apothecary this Valentine’s Day to help bolster our fundraiser. We stock the highest quality brands of virtually every type of supplement. Our knowledgeable staff can help you with questions. Contact them at 773-296-6700 ext. 2001 or click here to send an email.

Sweeter than chocolates or flowers, you can be certain this gift will be gratefully received.

Valentine greetings and messages for Mari may be written at the bottom of the Mari Stecker Fundraiser blog.

With our personal thanks,
David Edelberg, Paul Rubin, Casey Kelley, Cliff Maurer, Larry Stoler, Cindy Kudelka, Helen Strietelmeier, Marla Feingold, Seanna Tully, Sujatha Mannal, Samson Wong, Karen Meier, Katie Oberlin,  Janet Chandler, Lizz, Raquel, Nancy, Beth, Brenda, Sarah Jean, Cigi, Donna, Ellen, Heidi, Idette, Lori, Renee, and Kelly.

 

Leave a Comment


  1. Kathryn Hungness says:

    Our local community hospital charged $15000 for my 21 yr old granddaughter’s UTI. It’s happening everywhere, even way out in Kankakee.

  2. Don Schoenbeck says:

    Barbara’s experience is a reminder that three of the principle forces that drive up health care costs in the USA are greed, waste and inefficiency.

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Upcoming Workshops

**Facial Rejuvenation Guasha Class
The Ultimate DIY Anti-Aging Facial!

With Mari Stecker, LAc
Thursday September 21, 2017, 6:30-8PM, $65 course fee

Join us and learn a traditional Chinese facial rejuvenation technique that you can do yourself! Guasha treatment is a 2,000 year old Chinese massage technique that uses a flat tool to apply pressure to the skin to increase circulation as it moves along acupuncture channels.

Facial guasha is an easy to learn technique that:
* encourages blood flow and promotes radiance
* prevents wrinkles
* activates cells to regain facial elasticity
* drains fluids to detoxify skin and reduce puffiness
* sloughs off dead skin cells
* uplifts and tones skin
* firms up facial muscles
* minimizes dark circles
* promotes a healthy, younger and more radiant look

Space is limited and registration is required.
Register online or call WholeHealth Chicago at 773-296-6700
More>>

 

**Herbs for Lyme Disease
September 30th, 1:00 pm – 2:30 pm
With Seanna Tully, MSTOM, LAc, RH(AHG)

Join us for an introduction in the use of herbs in the treatment of Lyme disease.

In this workshop you will receive:
*A primer on herbs used for Lyme and herbal energetics
*Guidelines on dosing and correct use
*Gain self-help tools for you and your family

Space is limited and registration is required.
Register on-line or by calling (773) 296-6700

 

**Vaginal Rejuvenation
October 12th, 6:00pm – 8:00pm  Fee: $65
With Mari Stecker, LAc & Renee Zambo, RYT

Are you experiencing vaginal dryness? Or pain with intercourse? Have you been told you have vaginal atrophy due to menopauseAre you frustrated because you believe your sex life is overWell, it doesn’t have to be!

Come learn easy, non-pharmaceutical, non-hormonal, low cost techniques that you can do at home to help alleviate vaginal dryness, atrophy, thinning of vaginal skin and/or painful intercourse.

This class is appropriate for any woman who is experiencing discomfort during intercourse, pelvic exams or daily activities due to vaginal dryness and atrophy as well as women who are experiencing vaginal changes due to perimenopause, menopause, cancer treatments, hysterectomy or medications.

This class will include information on specific instructions for self-treatments that can be done at home as well as yoga postures and meditation that focus on the pelvic region.

Movement and breath will draw awareness to the pelvic floor, and facilitate both the full relaxation and activation of pelvic floor muscles. A short guided meditation will reconnect awareness to the feminine energy held within the pelvis.

Space is limited and registration is required.
Register on-line or by calling (773) 296-6700.

 

**Wellbeing for Seasonal Change
Three Saturday Workshops with Renee Zambo, RYT
October 28, November 18, and December 9 at 1:30-3:00pm
Fee: $49 for each or $120 for all three

Late Fall is the natural transition from our vibrant summer and harvest season, to a cooler and quieter time of year. While this transition is necessary for the natural world and ourselves, the shorter daylight hours and longer nights can have unique and challenging effects on many of us.

Space is limited and registration is required.
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