I'm finding some of the attitudes expressed on this thread disturbing.
I find your stunning idealism and lack of touch with reality disturbing.
For starters copro, you should not be forced to volunteer for anything.
I am, on a daily basis, forced to take care of patients who don't want or need my help, ultimately, to get better. Many of them have been
brought to me usually after car wrecks or gunshots or whatever else, and they will not pay their bill. Because I am in a training program and Uncle Sam foots part of the bill for my training, I am "volunteered" to provide their care. I do not select them. I have them selected for me by those assiging me to the work. So, knowing they won't pay into the system, and often that I've already gone above and beyond my duty as a resident in providing care to other patients, I consider this
being volunteered, not that I'm personally outright volunteering to take care of them. They aren't going to pay, no matter what. Let's just get that straight right off the bat.
I don't think the healthcare system was drastically different when you applied to med school than it is now; the point being you knew what you were getting into.
No, you are wrong. What's happened is a drast expansion of JCAHO, nursing advocacy, and implementation and enforcement of EMTALA, all of which has handcuffed us in administering effective care. In 2001, when I entered med school, there was a strong movement afoot for less government involvement (falling on the heals of the disastrous Hillary Clinton plan in the early/mid-90's, which almost completely ruined medicine) with the Bush administration. The patient Bill of Rights was being expanded, there was more autonomy for patient decision in their healthcare choices (with talk of allowing patients to actually select their own doctors through medicare/medicaid instead of being assigned), there was more competition for services, more choices for patients, and less involvement with third-party clinicians who dictate care. There was even talk of disbanding Medicare (a social experiment come disaster) and Social Security.
Flash forward to 2008.
Formularies are now the rule. Drug companies are no longer allowed to market their products in hospitals. Thanks to expanding nursing rights, nurses can refuse to proceed with your order, and have approval and endorsement from state nursing boards to do so. The "electronic revolution" in healthcare has actually created
more burdensome work, at the expense of facilitating ancillary staff's jobs (for example, time it takes to enter orders in a computer, no longer having "verbals", no overrides - thanks again to JCAHO - until a
pharmacist verifies the order, etc.).
And, what's worst of all?
There is now talk of
mandatory government healthcare plans that will
require physicians to work part of their time as
government employees, something we already effectively do if we accept Medicare. Government wants to expand even more into the healthcare business (you know, just like we're bailing out private investment firms now) and dictate more and more what we, as physicians, can and
cannot do. This is
FAR different than the "less government" promises of the early Bush administration.
Yes, things have changed
drastically since I entered med school in 2001.
Re: whether this guy should be able to sue you, I think physicians should be required to provide standard of care. If you choose not to do that, you can stabilize him and then refuse to treat.
What, pray tell, constitutes "standard of care" for someone admitted emergently with, say, a gunshot wound after cocaine and ethanol intoxication? And, what, pray tell, is "stabilize and then refuse to treat"? These are grand issues that EMTALA can't even get a handle on, yet you seem to know. So, please enlighten us, with examples.
If you do a mediocre job reasoning that it is his fault and he deserves it, then I think a lawsuit would be justified.
Huh? I never do a "mediocre" job. And, who's making value judgments? I'm a civil libertarian. I could care less if the guy wants to do coke and jump off a building. I just
want him to pay for the care I give him. Why is that so hard to understand for some people? If you can't
pay for the care, don't engage in the activity. Why should I
be required to treat someone who, at their own hands, did something bad to themselves -
repeatedly - without any intention
of ever paying me to provide that care.
I take it that in psych when you learned about the criteria of substance abuse and dependence, you scoffed and thought to yourself, anyone who lets alcohol or drugs ruin their lives should get what's coming to them.
Dude, do
not put words in my mouth or assume you know what I'm thinking. In doing so, you are exhibiting the
worst form of moralism and judgment - ironically what you are accusing me of - which has
no place in medicine. I strongly suggest that you get over that weakness right now, or you will be judging your patients in the wards on a daily basis, and it will affect your ability to give them care - something I
absolutely do not do.
Again, for the record, I
do not give one iota of care what patients choose to do or not do in their personal lives. If they are irresponsible, though, why should
I and the rest of society have to pay the burden of their irresponsibility?
Alot of the people you are complaining about are poor and addicted to drugs/etoh, thats why they get themselves into these situations. Its not because, they are moochers who are trying to get something for free.
Yes, they are poor and addicted. But, you're wrong, they are moochers, hustlers, scumbags, ****-for-brains, low-lifes, mother-f*ckers, etc. If you haven't come to realize that yet, all I can say is that you haven't had enough interaction with them. You patch 'em up in the ER, and I guarentee you there's a lot of them who'd hold you up in the parking lot on your way home.
Why do you bleeding hearts always have such a hard time understanding this? We
are forced by EMTALA to treat society's scum. And, I'm not talking about the random dude who can turn his life around, I'm talking about the same guy you see every week who's looking for three hots and a cot. They
are gaming the system and have
no interest in changing their lives, no matter what you falsely believe you can do for them. They will continue to sponge off the system... over and over again... and they are
never going to contribute positively back into it.
PLEASE tell me, why should I care about and be forced to treat these people - repeatedly - when I could focus my energy towards someone who will appreciate the care I give them as well as pay for it? If you can explain that, aside from some dogmatic religious claptrap or tree-hugging kumbayah circle-jerk feel good b.s., then I'm happy to listen.
Newsflash: Society has bad people in it. They consume a
huge portion of healthcare dollars. They rob resources from deserving people and run up their costs. They want you to fix them - without paying for it - so they can go back to their bad habits.
WHY SHOULD WE?
I TOTALLY agree that people should be required to pay their own bills. If this person can afford to buy cases of beer a day but can't afford to pay a dime on his hospital bill, then I agree there is something wrong systemically.
FINALLY!!! HALLELUAH! We seem to agree!
But the answer is not to withhold care.
The answer is
debtor's prison.
This discussion has evolved into anti non-english speaker rants, as well as talked about when to unplug the vent. It has strayed far from what the OP was talking about. If any of you think that the healthcare crisis today is the result of illegal immigrants and poor people who continue to drink and smoke themselves to death just so they can get free SICU beds, you are mistaken.
NO! But, it's a huge part of it. Did you even know what EMTALA was before you read this thread? Probably not. It's ill-informed people like you who haven't really been out there yet who are dictating what we
all should do.
Everyone pays cash. Up front. That fixes everything. It's just that simple.
So now, I suppose we will refuse to provide chemo to lung cancer patients who's disease is clearly linked to smoking. Then we will not do CABGs on people who continue to eat crap and be sedentary.
PLEASE read this carefully:
IF THEY CAN PAY FOR IT,
everyone should be entitled to the best care they can get.
The system does not expect everyone to pay right now, and we literally "give away" care because it makes us feel like we are true humanitarians.
What many people don't realize is that, if you allow people to suck off the teet and not fend for themselves, they will get dependent on that teet. And, you're screwing everyone else by driving up their healthcare costs.
So, your bleeding heartism actually is f*cking a lot of hard-working, innocent people who contribute to society and pay into the system.
The way to attack these problems are PREVENTIVE medicine, not PUNITIVE medicine.
This is something a college sophomore would say. It's meaningless. It's a soundbite.
Preventive medicine has been pushed hard on the public for the past 20-30 years. The results? We're fatter and more unhealthy as a society as we've ever been. Or, unless you can figure out some way to convince everyone to go see their doctor, lose weight, stop smoking, wear their seatbelt (etc.) with a high-degree of compliance that no one else has, this little saying is meaningless.
Punitive medicine... hmmm... if there is all carrot and no stick, then people learn that they'll just get the carrot without much (if any) effort. The difference is, we don't even expect them to get off the couch for their carrot anymore... and, worse, if they don't get their carrot, they're going to
sue your ass.
Yes, my friend, you're an idealist. You don't yet understand how it really works out there. Someday you will. I hope you don't become as cynical as I am, but wait until the first time you get a call from Risk Management telling you you've been named in a lawsuit... it ain't fun, my friend.
-copro
I feel like I am riding on a run away train and just have to figure how the heck to get off this thing before it hurls itself over the upcoming cliff.
...chicks, money, power, and chicks... i think you're talking about Bruce Wayne...heck you can even save people at night as Batman..
