Emergency Room Abuse

Ok, I've Alluded to this one a couple of times already so lets go ahead and finish it and put this one to bed for a bit.





I am taking patients to task for this one. You want honesty? Here it is.





For those of you that don't know the E.R. is one of the most abused and inefficient components of our medical system. Here is some of how it works on a day to day basis....the truth....really....no shit.





Chronic drug abusers. The bane of existance for E.R. staff. The leeches literally make a full time job out of floating from E.R. to E.R. with completely bullshit complaints looking for pain medicines (opiates etc). I am not exaggerating here. They come in at regular intervals with complaints of chronic back pain, ill defined stomach pain, those world famous migraines that usually occur on the weekend (aint it funny how that happens), and a plethora of excuses that are obvious lies. They will hit up each E.R. in a repeating succession scooping meds and prescriptions as they go. You know damn well when they are in with their 15th or 20th visit of the year with the same old complaints that have no explanation after ten to twenty thousand dollars of MRIs, CTs, blood tests, xrays, and consultations that they are FOS...and not in the literal sense. These folks are often recognized easily by staff that work in other E.R.'s. Before you go whining about confidentiality remember we are talking about seasoned drug abusers that use your tax dollars and the physician's time to get their fix.



Now lets look specifically at the 18-28 or so age bracket. These are the 10 mph fender benders that come in at the behest of their ambulance chasing lawyer or because some wise old sage in the family that had an ambulance chaser tells them to. They have "pain" , often neck or back. It is exquisitely tender to the lightest of touches...however they can laugh and talk on their cell phone, and when distracted seem to have full range of motion. When confronted with this they often admit to being "ok" and just "you know...wantin' to get checked out...in case sumthin comes up later". Taking Tylenol and/or Motrin at home is out of the question. Why?...."cause I didn't have none, and didn't have the money to buy it". Now this inevitably comes from the cell phone using designer clothes dressing manicure showing nice car driving cigarette smoking folks that have it so tough in life. This is a reason to have an "emergency" visit??????

This same group is infamous for the 1:3o A.M. dribbling penis/stinky vagina "emergency visit". Typical scenario is something like this:

Itchy penis dude comes in at 1:37 A.M. with a 2 wk history of "green stuff" coming from his penis. When asked why he waited so long, and oh yeah...WHY IN THE HELL IS IT NOW URGENT AT 1:37 IN THE A.M. AFTER 2 WEEKS OF FOUL GREEN PENILE DISCHARGE?, Rico Suave gives the classic shrug accompanied by Idunno(all one word).

Now here is where it gets really good. Without fail his girlfriend comes in at 3:02 A.M. and states that her boyfriend told her he had V.D. and she needs to go to the emergency room and get checked. She, by the way does no better explaining her urgency and why the heck she couldn't wait till morning since for 1 week at least "it's been kinda stankin down there".I AM NOT JOKING..this is really how it happens over and over and over.......



Now we get to the baby's mama. The baby has had a fever for 4 days. How high? Didn't check it..just knows it was real high. Tylenol or Motrin? No freakin way....see above....same stupid excuse from same people. Call the pediatrician? Didn't know the number, or they were just too crowded(verses 2:27 A.M......IN THE FREAKIN E.R.) Now the path diverges one of 2 ways here...either the child is awake, eating, drinking, shatting and generally being merry (MOST often the case), or is so toxic and dishrag limp the first phone call is to a helicopter to get them to a major medical center. Then there is the "my baby rolled of the _____(just fill in the blank with sofa chair table steps or whatever) and bumped his head. Did it knock little precious out? "No". Did they act normal after they quit crying? "Yeah". They been eating drinking playing shatting? "Oh yes". And you are here because....?????? " I just want him/her checked out". Hmmmm....emergency huh?....

How about the emergent asthma attack for the poor child whose mother smokes like an old Chevy Vega? True emergency but no one wants to tell momma she is the root cause of all of this. And oh yeah chuckles....smoking outside and coming back in is about the same.



Lets don't forget the Mama aint actin right crowd. The absolute best of these are the absentee children that drop in once every 18 mos and are shocked at Mama's mental/physical state. They demand she be seen, treated, and admitted(never mind the other 6 hospitalizations in the last 18 months as she steadily declines).



And of course the "i got sinus/I got the flu" crowd. High fevers, body aches, congested nose and sore throat are all symptoms of a VIRUS people!!!! This is not an emergency!!!! Quit being such a damn baby. We all get at least one every year and they always go away. NO, antibiotics will not help so stop getting pissed when you don't get them. Tylenol and/or Motrin at home???......ah what the hell we know the answer to that, right? Call your regular doct.....fogetaboudit.



Now for those of you interested enough to really think about this realize all of this stupidity and madness is going on at the same time your grandma has decided to quit breathing, your dad is having crushing chest pain, and your little boy has an obviously fractured arm. All of that B.S. has to be waded through all day in midst of the true emergent patients.



Responsibilities?



If doctors quit writing the pain medicines to the leeches just to get them out quickly it would become a self limiting reaction that would fizzle out relatively fast.



If we had any sort of notion of responsibility and accountability for our children they wouldnt think it was normal to have early, unprotected sexual intercourse and even more acceptable to clog up the E.R. with that crap at 1:37 A.M. and 3:02 A.M. just to avoid the crowds at the health dept. or primary doctors office, and avoid paying a bill.



If it were not so easy for the personal injury sharks/lawyers to squeak money out of every fender bender, slip and fall or other minor inconvenience the shiftless excuses for young people wouldnt find it worth their time to clog up the E.R. (old people too just to be fair and honest) and the ambulance chasers would have to get a real job.



If these parents( and that's a damn stretch of the term in many cases) had any real care or concern about their children, any sense of responsibility for taking care of them, any accountability for the GIANT E.R. bill generated to "just get checked out" it might change a little.



If most people had to actually pay for their E.R. visits the sale of over the counter Tylenol and Motrin would set records.



There is a little of the truth for you...no exaggeration at all.

If any of the afore mentioned people is you it was strictly coincidental, as only generalized examples were used. But if you did match any of the above scenarios you oughta be ashamed..SO STOP IT.

Truth.....still want it?

National Healthcare?

Here we go again, election year and now we gotta have national health care(or not depending on your party affiliation), and we gotta have it now.

Do we? IS HEALTH CARE A RIGHT?

Lets ask a couple of questions. Does everyone "deserve" healthcare, the best we have to offer, all of the gifts God has graced us with, the latest technology all despite race, creed, color...........or ability to pay? AHA! Gotcha. This really is a philisophical and sort of societal question.

One one hand, dont we all deserve the best life improving and sustaining(if necessary) technology and care available? Should I get better cancer treatment or medicines that are clearly more effective just because I make more money than you, or because I have better political connections, or am the the right race or religion? Why hell no!

Should our veterans be forced to accept less affective medicines and rationing of care after the promises we made as they risked life and limb for this country. Doesnt seem right to me.

On the other hand who pays for all of this? Its obvious the poor can't, it's difficult and crippling at times for the middle class. Should the wealthy bear the brunt of a nationalized program because they work hard and make money?

Lets be clear here, we do have "nationalized" if you will, healhcare. It is an inefficient hodgepodge and makes no sense in its discrimination...but we do have it.

The Emergency Room is your garunteed access to "free" healthcare. It is no secret to most of the public that if you show up at an E.R. the staff has a legal obligation to treat you. If you never intend on paying your bill, and show up over and over, you are still gonna get your free checkup and treatment. You may get hounded over the bill, have to wait a looong time, but you can get your freebie. I am not talking about the heart attacks, traumas, and genuine emergencies here. I am talking about the MULTITUDE of common colds, back pain, hypertension, diabetes and exacerbations of other problems. Dont have a doctor? Can't afford one(cause your cigarettes cost to much)? Just need a work or school excuse? "Just wanna get checked out"? Come one come all, you can get it all at the E.R.

Next we have the conglomeration of mediciad, medicaire, and private and employer provided/subsidized insurance.

All of these entities suffer from abuse by doctors and hospitals(creative billing) and by patients(too damn lazy to buy some tylenol so they come to the E.R. with a "fever" of 99 degrees or just don't take their medicines...or just keep smoking, and so on), and by the gargantuan beauracracy/goverment than burdens it down with asanine paperwork and regulations written by people that dont know a damn thing about how things are in the real world.

Yes Virginia...there is a "nationized healthcare system" and it sucks. It began to suck tremendously when Nixon thought letting HMO's make money off a system already squeezed was a capital idea. What in the hell have HMO'S,PPO's and the rest of the alphabet soup done to make the system better? I submit not one damn thing....their promises of better care, "maintainance", and cost controlls were a joke then, as they are now. The profits of these companies speak volumes, especially when the unethical practices by which they make their blood money are reviewed.

So what to do? I say bite the bullet, take all these pieces and put the money into a system that truly attempts to provide some semblence of universal care. Sounds good huh? Not so fast skippy. We as Americans want our CT scans MRI's Cardiac Caths hip replacements skin biopsies etc etc etc...and we want the YESTERDAY. Why should we have to wait? Well get ready cause if you want everyone to have the same access some of those things will wait, be prioritized if you will. Need a cardiac catheterization to figure out that pesky non emergent chest pain? Go home, quit smoking, take your medicine and we will call you when your number comes up. Same thing with that stiff damn hip, take some tylenol and we will get to you in time. Gotta do the ones that fell or broke them in a car wreck first. You gonna stand for that my fellow americans??? LOL...I doubt it. Hmmmm, not quite utopia is it?

There will never be a perfect way to provide everything to everyone in a way that makes all people happy. We will ultimately end up with a two tiered system. A "socialized" system that provides the basics, but you gotta wait your turn, and the doctors will be salaried employees. On the other side will be people that can afford supplemental and/or private policies so they can go where and when they want to get their health care. Thats how its gonna work folks.

Suck it up America and decide...do we all have a "right" to the same access to healthcare or not? Are we just gonna leave the putrid cesspool of a system as it is or bite the bullet and put something together that works a little better? As long as there are profits to be made, and politicians to to be bribed...oops, lobbied, I think we are gonna have a tough time seeing any meaningful change, it's profit driven and thats a powerful thing.

I could be wrong.....but I'm not.

Why is it so expensive? Give me a freakin break!

Ok, same question all the time,"why is everything in health care so expensive?" Well lets look at some of the truth as I see it...and since it is all about me that's how we're going to do it.

Lets start with the thieving, opportunistic, soulless, greedy, shameful insurance companies(you though I was gonna say lawyers right? I'll get to those bastards). These companies are licensed to steal. Take your premiums, and drop you when you get sick. They arbitrarily decide which treatment is appropriate for you based on the profit margin, and refuse care at every given opportunity. Pay doctors bribes to "keep costs down"(translate..don't order things your patients need), make near record profits every year, and pay corporate whores (oops, CEO's)insane sums of money to run the corrupt system. How do they get away with it?? "Lobbying", folks, which is such a nice term for the bribing of our politicians. The ones with the most money buy the politicians and write the policy, and hence the laws.
Lawyers? This isn't even hard. They are all "waiting on the million dollar brain dead baby case" (yes I have heard the comment more than once). The entire thrust of the personal injury demons is to manipulate the system so that anything can be construed as malpractice. The VAST majority(in my humble opinion) of their disgusting petty suits are self serving distortions of the truth to go after the "easy money" known as malpractice insurance. Here is how it works folks. If anything ever happens to your health there MUST be someone to blame. Things never "just happen"..someone must be at fault, and if someone is at fault "somebody gonna pay". So these bottom feeders encourage every sniffle, strained neck, developmentally delayed child, and less than ideal surgical outcome to sue. No matter that many of these people not only brought the illness on themselves(smoking, alcohol, drugs, obesity etc, etc, etc), but often don't do whats prescribed to treat their illness anyway. Now for the easy part...sue every doctor, nurse and therapist that even glanced at the patient. Fling the proverbial fecal matter on the walls and see what sticks. With the cost of the litigation, most insurance companies will give up a little free Christmas cash because in the long run its cheaper. Now...how do you think they recoup that money? They charge physicians from $50,000 to HUNDREDS of THOUSANDS of dollars per physician every year that HAS to be paid to keep their practice open. How do physicians and hospitals recoup that expense? YOU. In the meantime physicians are forced to order more and more primarily useless tests to "cover their ass" for the lawsuits that WILL eventually arrive. Helluva system huh?
Finally, it wouldn't be truth if we didn't include the patients. WHAT? Yes the patients. Don't take your medicines, don't lose weight, keep smoking, eat foods that are terrible for you, skip your appointments, don't check your blood sugar, abuse the emergency room room for trivial problems(much more on that to come) and ALWAYS expect that someone else is responsible for your health problems.
I haven't even touched on the multi layered hospital bureaucracies loaded with middle managers and overpaid administrators.
None of this addresses the inherent problems of so many that cannot afford to obtain their basic health care(much more on that to come too), but that is not the thrust of this entry.
There my friends is just some of the truth people don't like to say out loud.
I did.

Getting Started

Lets just get rolling right off the bat. Today's subject is the prolonging of death.

I am going to tell you some of the things EVERYONE should know.
If you or your loved one is age 70 or greater, and you arrest(die) in or out of the hospital your(or their)chances of ever leaving the hospital alive are abysmal. I mean the odds stink that you(or they) will ever leave the hallowed institution vertical and ventilating.
Why bring this up? Every day we see the same sad story...poor septuagenarians and octogenarians (our 70 and 80 year olds) are pounded relentlessly with everything "medicine" has to offer, and we know damn well most of them are going to die regardless of what we do. There are plenty of studies to look at but know that rarely do people survive that arrested with any quality of life just to the point of discharge from the hospital, almost none are "alive"(depending on how you define it) at 1 year.
There are several factors at work here but lets just take a gander at a couple of the glaring problems.
The seeming inability of physicians to take the time to sit down and be honest about just how grim the situation is would be laughable if not so damned wrong. I am shocked daily as I watch as plethora of consultants each check their own little system as Grandma slowly circles the drain. I know its wrong, the nurses by god know its wrong, and yet most people let it drag on until we have thoroughly exhausted the patient, the family and the system.
Lets don't forget the families. Many of us have the propensity to be selfish about losing someone we love. I am continually shocked though at those family members that just blindly say "do everything to keep momma alive...EVERYTHING YOU CAN. Ok. Lets stick her 83 year old body with needles every day, lets let her lay there and poop and pee herself, lets plug every orifice with some sort of tube, lets keep her sleep deprived....lets do all of this knowing that at her age momma aint gonna make it out of here, much less have any quality of life for another year or more. Its important that WE feel ok about it...we did EVERYTHING we could to keep the body "alive", the pain and discomfort to momma be damned. Worst of all a lot of you don't even show up to see what your commitment to momma is putting her through.
This isn't hard folks. Ask yourself if momma or daddy could have seen into the future 20 years ago, have known that at this age they would be in this sad/sick shape...before the dementia, the strokes, the depends, the amputations,the heart attack, the diaper rash, the nursing home....if they could have looked ahead and answered the question of whether they would want to "survive" like this what would they have said? I think most of you know.
So why in the hell don't we give them at least that peace, dignity, relief if you will.
DOCTORS need to discuss this early and frequently.
FAMILIES need to discuss this early and if needed frequently. Ask them while they can answer if possible. BE SPECIFIC...do they want to be on a ventilator, do they want artificial feedings if they are unable or unwilling to eat, or unable to even sense their hunger? Do they want I.V. fluids and medicines in the vein if that is the only thing keeping them hanging on?
Damn people, take some responsibility here. Just because we can do all this doesn't always mean we should. While money is not the primary concern here, realize that the more medicare dollars are spent on the final year of life than any other entity. Think about that for a minute.
And by the way, most of the "cookbook" living wills and advanced directives are so general that they are not worth the paper the are written on. Moreover, a large majority of the families can't even define the "life support" that momma did or did not want. BE SPECIFIC...then honor them by honoring their wishes.
The last best thing we can do for our parents, grandparents, friends, is honor their wishes(gotta know what they are first) and provide them with as much peace and dignity as we can as it relates to the concluding days of their lives.