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.