{"id":5437,"date":"2013-02-11T13:00:01","date_gmt":"2013-02-11T19:00:01","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=5437"},"modified":"2021-09-06T12:01:17","modified_gmt":"2021-09-06T17:01:17","slug":"amateur-night-in-the-emergency-room","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2013\/02\/11\/amateur-night-in-the-emergency-room","title":{"rendered":"Amateur Night In The Emergency Room"},"content":{"rendered":"\n

Please read the important announcement about our acupuncturist Mari Stecker at the end of today’s Health Tip<\/strong><\/h3>\n\n\n\n

Let me pass on a tale of woe a new patient recently shared. There\u2019s a useful lesson in health care within, and while I wouldn\u2019t classify the event as malpractice (since no permanent damage occurred), it\u2019s the story of an innocent woman falling victim to amateur night in a large and well-known Chicago emergency room.<\/p>\n\n\n\n

I\u2019ll close with some suggestions on how to prevent this from happening to you.<\/p>\n\n\n\n

Barbara was an otherwise very healthy and intelligent young woman from Eastern Europe living in Chicago on a student visa. She\u2019d really never been ill before and, like most 20-somethings, hadn\u2019t 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.<\/p>\n\n\n\n

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.<\/p>\n\n\n\n

You internet-savvy amateur physicians have already diagnosed Barbara with a urinary tract infection (UTI). If you were managing her care, you\u2019d send her to a clinic at a Walgreen\u2019s or CVS or to an immediate care center. There, a urinalysis would confirm the diagnosis, she\u2019d receive a prescription for inexpensive antibiotics, and she\u2019d 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).<\/p>\n\n\n\n

So Barbara telephoned her mother overseas, who told her (as expected) that she needed to see a doctor. Barbara typed \u201cemergency medical care Chicago\u201d 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.<\/p>\n\n\n\n

Barbara\u2019s extended ER stay<\/b><\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

A couple weeks later, Barbara received a bill from the hospital for $10,000.<\/p>\n\n\n\n

Frantically, she called her mother, who told her she\u2019d 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?<\/p>\n\n\n\n

When you find yourself in the ER at a large teaching hospital, you\u2019ll 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\u2019s 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\u2019t life threatening, you\u2019ll likely not see an attending physician.<\/p>\n\n\n\n

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\u2019s 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 \u201cyou could miss something serious.\u201d<\/p>\n\n\n\n

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\u2019s unlikely any physician Barbara saw was remotely aware she\u2019d 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.<\/p>\n\n\n\n

Cash cow<\/b><\/h3>\n\n\n\n

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\u2019s 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.<\/p>\n\n\n\n

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