Wednesday, April 27, 2011

ER Visits and Cost Control

I was quite intrigued as I was reading this article from It discusses the mistaken idea that simply disallowing "non-urgent" ER visits will decrease healthcare costs. As it turns out (I was surprised to read), such an idea might actually INCREASE health costs.

I, of course, identified strongly with the last sentence: "Furthermore, by targeting the ER, such policies also miss the true cause of the problem: a profound lack of primary care access." I wanted to take this one step further, though. Primary care docs need to do a much better job of EDUCATING patients. The article includes the quote, "the perception of urgency after reviewing a medical chart is often different from the perception of the person seeking emergency care." I would say this is at least partly on the PCP's shoulders. Patients need to be educated on what are urgent vs non-urgent situations, so they don't unwittingly misuse the ED. A lot of times, people utilize the ED as a means of satisfying themselves that their symptoms are not truly something to worry about. They wouldn't need to do this if they were educated ahead of time.

Of course, the reason PCP's don't often do that, is because they aren't paid to do that. And THIS is one place where healthcare reform is desperately needed.

Wednesday, April 20, 2011


My attending doctor (a neurologist) and I were sitting at the nurses' station discussing a patient who had presented with a "seizure" (who was then later caught crushing up and snorting his Percocet and pocketing his Xanax, but that's another story) when his pager beeped. "Hold on, I have to call this in", he said. I listened to snippets of the conversation. "How long has he been like that?" "How far away is the helicopter?" "Alright, let me run to my office and set up my equipment."

He hung up the phone and got out of his chair while I jumped up to follow. "That was Small Community Hospital," he said. "They have a suspected stroke patient." We jogged down the stairwells and across the skyway that connected the office building to the main hospital, making it to his office in short order. There he showed me the stroke network tele-medicine computer that had been set up there. We fired it up and he put on his headset. Within a minute or two, we had video and audio feed of the ER bed at Small Community Hospital where our patient lay.

My preceptor proceeded to examine to the patient, asking him what had happened, if he was able to move various parts of his body, etc. Turns out the patient had aphasia, or an inability to speak. This was his biggest symptom, though he also had partial paralysis of some parts of his body. We got most of the story from his wife. We asked questions about what had been going on, his past medical history, what medications he was on, etc, while the nurses at the hospital took the blood for the necessary lab tests.

To cut the long story short, we ended up deciding that he was a good candidate for tPA, a strong clot-buster that should minimize the effects of his stroke. Medflight showed up and loaded him up for flight to our main hospital while they mixed up the tPA. Given the age and condition of this gentleman, tPA was required to be given with the first 3 hours after his symptoms began...using tele-medicine, the decision was made in just over 2 hours. If tele-medicine had not been available, he might have exceeded the 3 hour window by the time he had been flown in. With the timely intervention of a large network of healthcare providers working together, there's a good chance he'll regain his ability to speak. Job well done, everyone! Tele-medicine is pretty cool. I'm glad I got to see it in action!

Sorry for the long hiatus from posting, everyone. It's been busy!! My daughter's due date is coming up...June 17!! All else is coming together nicely, and I have most of my 4th year of medical school all planned up. Hard to believe I'm almost in my last year! About time! Thanks as always for reading.