Can I Get An MRI?

[southerndoc]

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I saw 4 patients today who came in with back pain requesting an MRI.

1. Do you really think we'll have somebody in the hospital doing MRI's on a non-emergent basis on a Thanksgiving holiday?

2. Just because you've had back pain for two days with radiation down your leg doesn't mean you need an MRI. Yes, you might have a herniated disc, but the vast majority of patients do well without an MRI.

3. No, I won't call in the tech to do your MRI when you've already got one schedule two weeks from now. Unless you have a suspected aneurysm or symptoms of cauda equina syndrome, you can't get an MRI in the ER.

4. No, don't ask me to sign your disability papers.

Sorry, just had to vent. Some people might call this rationing of care in a socialized health system, but it's not rationing if it's not indicated. We as a society think we need an MRI every time we have an ache or pain in our back.

On a side note, I'm not giving you 90 Vicodin and 45 Soma tablets either.

 

[Apollyon]

Hehe...where I am now, I don't even have a CT scanner! That is absolute truth. I'm doing 80s medicine with 21st century meds. (Do have a Sonosite, though.) No one - at all - asks for an MRI.

And 13 Vicodin and 8 Soma would be enough to cover until Monday to see one's doc. If that person doesn't actually have a doc, then it's see ya! Flexeril or Robaxin, and some kind of NSAID.

 

[Stitch]

I saw 4 patients today who came in with back pain requesting an MRI.

1. Do you really think we'll have somebody in the hospital doing MRI's on a non-emergent basis on a Thanksgiving holiday?

2. Just because you've had back pain for two days with radiation down your leg doesn't mean you need an MRI. Yes, you might have a herniated disc, but the vast majority of patients do well without an MRI.

3. No, I won't call in the tech to do your MRI when you've already got one schedule two weeks from now. Unless you have a suspected aneurysm or symptoms of cauda equina syndrome, you can't get an MRI in the ER.

4. No, don't ask me to sign your disability papers.

Sorry, just had to vent. Some people might call this rationing of care in a socialized health system, but it's not rationing if it's not indicated. We as a society think we need an MRI every time we have an ache or pain in our back.

On a side note, I'm not giving you 90 Vicodin and 45 Soma tablets either.

Tell him sure, but it will cost him $3000 out of pocket. See if he wants it then. People should get what they want, as long as they actually pay for it. 😉

 

[southerndoc]

Tell him sure, but it will cost him $3000 out of pocket. See if he wants it then. People should get what they want, as long as they actually pay for it. 😉

Seriously, this is why I think every American needs a high-deductible health plan coupled with a health savings account.

Want that MRI? Then you have to pay your deductible and not just a $100 ED visit co-pay. Most back pains do not need MRI's, yet we as Americans insist on them (just as we insist on antibiotics for upper respiratory infections). Healthcare spending is wasted not only because physicians order too many tests, but patients expect and demand too many tests too.

 

[GeneralVeers]

Tell him sure, but it will cost him $3000 out of pocket. See if he wants it then. People should get what they want, as long as they actually pay for it. 😉

You are assuming something that doesn't happen. Many people come to the ER for minor and/or common complaints. I ask them why the didn't see their doctor, and the answer is invariably:

"My doctor charges $75 to see me, but here it's free!"

They use the same rationale for an MRI. If they get it done as an outpatient they have to pay a co-pay or a portion up front. If it's done through the ER even if they get a bill, they have no intention of paying for it.

It must be nice to live without worrying about your credit score.....

 

[Stitch]

You are assuming something that doesn't happen. Many people come to the ER for minor and/or common complaints. I ask them why the didn't see their doctor, and the answer is invariably:

"My doctor charges $75 to see me, but here it's free!"

They use the same rationale for an MRI. If they get it done as an outpatient they have to pay a co-pay or a portion up front. If it's done through the ER even if they get a bill, they have no intention of paying for it.

It must be nice to live without worrying about your credit score.....

Good point. Perhaps I should have added 'cash up front and you get your MRI.'

 

[DrMom]

"My doctor charges $75 to see me, but here it's free!"

I get the same response frequently, as well.

None of those patients would be willing to work for free, yet they don't seem to comprehend that it is patently offensive for them to tell the EP that they expect *them* to work for free!

 

[docB]

I get the same response frequently, as well.

None of those patients would be willing to work for free, yet they don't seem to comprehend that it is patently offensive for them to tell the EP that they expect *them* to work for free!

You are correct in that many don't care, can't care because they're sociopaths, etc. However I'm always surprised how many members of the general public, regular, functional people with jobs, assume that the government somehow covers the deadbeats. They are always amazed when I explain to them that we and the hospitals eat/pass on to them the costs for the no pays.

 

[Stitch]

I get the same response frequently, as well.

None of those patients would be willing to work for free, yet they don't seem to comprehend that it is patently offensive for them to tell the EP that they expect *them* to work for free!

That's because it's healthcare, and people assume they are entitled to it.

 

[Jeff698]

"My doctor charges $75 to see me, but here it's free!"

I had a patient ask me today to write her a prescription for benadryl. I told her it was cheaper OTC than getting an RX filled. She said "no it's not, it's free. I'm on <our local county health plan>".

In one of those moments where you know you're saying the wrong thing but can't help it because if feels both so good and so right, I blurred out "oh, so you want me to pay for it".

Sadly, she honestly had no clue. The government pays for it and clearly that money comes from trees.

Take care,
Jeff

 

[Toohotinvegas33]

Im suprised this thread has gone this long without the appropriate response. Here is a little training video for these situations where patients ask for things they dont need.

[youtube]http://www.youtube.com/watch?v=owNO5s3eln4[/youtube]

 

[enfuegoEP]

Seriously, this is why I think every American needs a high-deductible health plan coupled with a health savings account.

Want that MRI? Then you have to pay your deductible and not just a $100 ED visit co-pay. Most back pains do not need MRI's, yet we as Americans insist on them (just as we insist on antibiotics for upper respiratory infections). Healthcare spending is wasted not only because physicians order too many tests, but patients expect and demand too many tests too.

👍

I had a lady come in who not only demanded an MRI for her chronic back pain, but also insisted on seeing a neurosurgeon.

 

[kungfufishing]

Equally aggravating are the "sent in by PCP and expects nonemergent MRI immediately".

 

[southerndoc]

The best I've seen was a patient who brought a letter from her attorney stating she needed an MRI. I laughed (internally) and told the patient "not emergently."

 

[leorl]

"I got a cut in my finger and I just want to make sure I don't have swine flu in my finger." Me: Go home sir.

 

[GeneralVeers]

"I got a cut in my finger and I just want to make sure I don't have swine flu in my finger." Me: Go home sir.

Sometimes my brain nearly explodes because I'm not allowed to make a House-esque response to some of the clearly idiotic worries people have.

 

[gutonc]

"I got a cut in my finger and I just want to make sure I don't have swine flu in my finger." Me: Go home sir.

Did you laugh before or after you kicked him in the nuts? More importantly, did you rip the Press-Ganey survey out of his hands and eat it first?

Just to spread the pain, you should have called ID and Plastics consults. the more people who get to mock him, the better.

 

[Jeff698]

Did you laugh before or after you kicked him in the nuts? More importantly, did you rip the Press-Ganey survey out of his hands and eat it first?

You know, the ones who are truly ignorant and simply want reassurance, I don't mind so much. I'm happy to do a bit a education and send them on their way, hopefully to sleep better tonight.

The ones that give me ulcers are the ones with these types of complaints who refuse to believe my reassurances and want some type of 'test' to prove it.

Grrrr.

BTW, I had a patient with a truly horrible back (oodles of chronic badness) that had been seeing pain management for months. She comes in today with intractable pain saying she just can't manage at home and wanting admission. I confirmed nothing new (CT, of course) and tried outpatient meds. She was really playing the admissions game. I asked my hospitalist to send down our social worker to help avoid an admission. It was a thing of beauty and a wonderful lesson in economics.

SW says we'd be happy to admit for pain control. Unfortunately, mean old Medicare won't pay for it. Just sign right here saying you'll pay the bill in full and we'll get you the room.

Shockingly, the 'home' option suddenly looked much more attractive.

Take care,
Jeff

 

[Stitch]

You know, the ones who are truly ignorant and simply want reassurance, I don't mind so much. I'm happy to do a bit a education and send them on their way, hopefully to sleep better tonight.

The ones that give me ulcers are the ones with these types of complaints who refuse to believe my reassurances and want some type of 'test' to prove it.

Grrrr.

Take care,
Jeff

Agree completely. 👍
It's like they want something to be wrong with them.

 

[J-Rad]

"I got a cut in my finger and I just want to make sure I don't have swine flu in my finger." Me: Go home sir.

Did you ask him what he was doing with the pigs to make him so worried?

 

[EvoDevo]

Agree completely. 👍
It's like they want something to be wrong with them.

Or they're scared and they want some sort of objective "proof" that they're not sick/dying of cancer/injured for life.

*shrug*

 

[EctopicFetus]

Had a lady from texas.. 22 and fat.. comes in with bilateral heel pain for 6 months, just moved here from texas.

I literally walk in the room and she and her mom are like "are you the orthopedic surgeon?" I nearly piss myself..

I said no. They said we need an orthopedic surgeon. I said at 10pm on Friday night they are at home and no I wont be calling them in.

It all ended well but WTF do people think?

 

[enfuegoEP]

I don't get this much in the ED, but in my part-time job at an urgent care (nice suburb all insured pt's) I get flooded with people who want antibiotics. It's a welcome change from the habitual NSAID allergy stricken big city ED patients who the only drug that relieves their pain starts with a D. No matter how long I explain to these well intentioned polite people that they're suffering a viral illness (or sometimes no illness) and antibiotics will only cause nausea and microbial resistance, it falls on deaf ears and they MUST have a Z-Pack. It's always a Z-Pack. Sometimes it gets so bad I wish someone would come in damanding percocet.

 

[Stitch]

it falls on deaf ears and they MUST have a Z-Pack. It's always a Z-Pack. Sometimes it gets so bad I wish someone would come in damanding percocet.

Haven't you heard? Z packs work great for viral illnesses!

I've actually had patients tell me that the urgent care center diagnosed them with a viral respiratory infection then gave them a z pack 'just to be sure.'

They said we need an orthopedic surgeon.
I get this pretty routinely, especially for GI patients. "But the appointment isn't until next week!" they scream. "You can call anyone here if you wanted to..."

Yeah, and those subspecialists are just waiting around doing nothing just in case someone strolls into the ED with months of abdominal pain... 🙄

 

[GeneralVeers]

They said we need an orthopedic surgeon.
I get this pretty routinely, especially for GI patients. "But the appointment isn't until next week!" they scream. "You can call anyone here if you wanted to..."

Yeah, and those subspecialists are just waiting around doing nothing just in case someone strolls into the ED with months of abdominal pain... 🙄

Once again, you've identified why any "reform" efforts are doomed to failure, until patients (all of us) are forced to pay more out of pocket for our care. When things no longer are "free", people will ration their own care.

 

[Jeff698]

Haven't you heard? Z packs work great for viral illnesses!

I'm pretty sure it's the world's best anti-viral... in adults.

Everyone knows that amoxicillin is the best anti-viral in kids. 🙂

Take care,
Jeff

 

[deleted65604]

No children have viral syndromes that I treat with antibiotics.

They all have mild, early otitis media. (F-u in 3-5 days with PCP, when nobody can second guess me... "Ears look good now? Of course, they had an ear infection, I treated it and it got better!"... Pat self on back.)

All my adults I prescribe abx to have likely secondary bacterial sinusitis.

 

[Stitch]

No children have viral syndromes that I treat with antibiotics.

They all have mild, early otitis media. (F-u in 3-5 days with PCP, when nobody can second guess me... "Ears look good now? Of course, they had an ear infection, I treated it and it got better!"... Pat self on back.)

so true! We actually get the occasional nasty gram back from a parent who is upset that we didn't do anything for their child's 'fever' of 99.9 yet when they actually saw their PCP the next day, he gave them amox for AOM.

My feeling is that diagnosing AOM is just deciding whether you want to put the kid on antibiotics.

 

[enfuegoEP]

I've actually had patients tell me that the urgent care center diagnosed them with a viral respiratory infection then gave them a z pack 'just to be sure.'

Yea, basically the UC doc is saying in my clinical judgment you have a viral infection requiring supportive, but I can clearly see by the puzzled angry look on your face that you paid a 25 dollar co-pay and are hellbent on walking out of here with something in your hand...So here's you z-pack. Go pay another copay for the antibiotics..thanks for playing and have a nice day. Sometimes you try to bribe them with a sample of Robitussin AC hoping that will placate them. There's about a 20% success rate with this method. The other 80% will give you the stink eye until they get they're abx.

 

[Retired]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

 

[EKGdoc]

Did you wind up getting emergency or urgent surgery? My guess is no, and that this injury was treated conservatively. The MRI could have been done outpatient and not changed your outcome (unless you had emergent surgery which I think is unlikely). If your husband is a surgeon he likely could have gotten you seen by ortho the next day (most of our ED pts don't have that option), and many orthopods have MRI in their offices. I know it's nice to get "the answer" but sometimes the answer can be done outpatient, with no change in ultimate outcome. We can control your pain and work hard to get u the right follow up.

 

[Birdstrike]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

Doctors would love to be able to order all kinds of tests on demand. But ha ha ha, it's just not that simple, ma'am. There is pressure from all ends:

Patients wants mri, "Yes, NOW!"

Radiologist says, "No." Not needed unless neurovascular injury, and won't approve it without a fight.

Press Ganey says, "Yes!" Make patient happy at all costs.

Hospitals says, "No!" Mri's take too long, increase length of stay and slow the department down.

Insurance company says, "No!" we don't pay for that mri ordered by the ER doctor for a muscle tear that could have/should have been treated outpatient.

American College of Emergency Physicians, your textbooks and medical training says, "No" MRI for muscle tears, "choose wisely" and do outpatient.

Lawyer says, "Yes!" get MRI you can't miss ANYTHING or we'll sue you bastards.


But why am I lecturing you because after all the "patients know best"? Someday we'll just be waiters handing out menus for the "important players" (everyone but the doctor) can decide what's really needed. Maybe that's how it should be. You come in, I hand you a menu of test and treatments on a touch screen and you just click away.

 

[TooMuchResearch]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

Emergent MRI was most likely still not indicated.

 

[LaBusqueda]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

Sorry, still not a surgical emergency assuming neurovascular status normal.
Pain meds, there is no excuse there.
I would not order an MRI unless really, really concerned about subtle occult hip fx. Even then, admit and done non emergent next day likely.

I don't care who/family member is, or specialty. Trust me. It's happened. We are all physicians in our own specialties, no one comes in and dictates care, period.
.

 

[Doctor Bob]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

Translation...
I am a new poster with an anecdote, replying to a thread that's 6 years old. That means you need to practice medicine the way I'm telling you to!

 

[WilcoWorld]

@Retired #I'mjealous

A complete hamstring avulsion is a very unfortunate injury, but it's not an emergency diagnosis. The ER doctor's initial plan of rest, ice, compression and elevation was correct and appropriate with or without the MRI.

Are you aware that, even in the best of ERs, by "demanding" an MRI you tied up an ED room and may have delayed treatment for a woman's heart attack or a child's case of meningitis?

 

[southerndoc]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

No, this was unnecessary. A hamstring avulsion is not emergent and does not need an emergent MRI. It can wait for follow up in an orthopedic surgeon's office.

If you weren't able to bear weight on it, I would've CT'd it to make sure you didn't have an occult hip fracture. However, I would not have ordered an MRI even if your husband is a surgeon.

 

[Psai]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

Haha post trying to argue that the patient knows best but demonstrating the complete opposite

 

[Arcan57]

I've worked many years in the medical field. Four months ago I fell from a ladder and ended up in the ED. Excruciating right hip pain. No pain melds in the beginning. XRay negatives. The MD said go home and follow up with primary in the morning. I insisted something was wrong and insisted on a MRI. I was told it was not necessary. When my husband arrived( he is a surgeon) he just asked that a MRI be done. Within 2 minutes I had pain medication and was on my way for my MRI. I had a complete hamstring avulsion that was separated by approx 4 CM.
My point is sometimes your patients know best and we just need to learn to listen.

Not to trivialize what is a devastating injury and a lengthy course of rehab, but you know in your heart you used your husband's influence to obtain inappropriate care.

 

[Docinthetrenches]

I just tell them their health insurance will not cover an MRI unless very strict criteria are met (and I go over cord compression, cauda equina, etc) and tell them that since they don't have that, they have to get it as an outpatient. Most people won't pay 5000$ for a procedure if they know it's going to cost them that much out of pocket (whether or not that's actually the case with their insurance - but I personally feels it's a waste of health care dollars and just perpetuates bad behaviour from patient when you acquiesce on these things).

 

[deleted480308]

It's part of the problem with our insurance/gpvernment pays everything process. If everyone was self pay it would be simple. "I know you say you want an mri but you don't need one. They are $3000 and here is the number to the outpatient facility if you won't listen to me. If you insist on doing it here, it's $7000. Let me know, I'll be back in 5."

 

[Cytarabine]

It's part of the problem with our insurance/gpvernment pays everything process. If everyone was self pay it would be simple. "I know you say you want an mri but you don't need one. They are $3000 and here is the number to the outpatient facility if you won't listen to me. If you insist on doing it here, it's $7000. Let me know, I'll be back in 5."

I dig it. Let's apply to other situations. "You're in septic shock w/MODS, we're going to recommend you step up to the unit, prob spend some time on the vent. Rough cost will prob be about $100k. We can throw in the pressors for free if you pay up front. Let me know, I'll be back in 5." We can prob cut the percent of GDP spent on healthcare to the single digits overnight

 

[deleted480308]

I dig it. Let's apply to other situations. "You're in septic shock w/MODS, we're going to recommend you step up to the unit, prob spend some time on the vent. Rough cost will prob be about $100k. We can throw in the pressors for free if you pay up front. Let me know, I'll be back in 5." We can prob cut the percent of GDP spent on healthcare to the single digits overnight

I do think all people should be paying their bills sans government and that insurance should only be catastrophic for the large ticket items like these

 

[Zebra Hunter]

I do think all people should be paying their bills sans government and that insurance should only be catastrophic for the large ticket items like these

What you are proposing would be devastating to the poor and lower middle class in our country. Obviously medical care prices would drop significantly, but there is still a very large percentage of the United States that cannot afford to shell out $500 for an ER visit. I'm sure I'll have someone chime in that healthcare is not a right, but understand that healthcare is a basic necessity and people are going to seek emergent medical attention regardless of their ability to pay. Maybe we get rid of EMTALA and only treat those that can pay? Then now we have millions of people losing all of their savings for something completely unforseeable. We will never have this free market utopia that so many of us dream of because when applied to medicine people will either start going broke to pay or accept that their treatable condition cannot realistically be paid for and suffer the loss of life or limb. Also, can you imagine the number of fights people will have with their insurance company on what constitutes "catastrophic"?

 

[deleted480308]

What you are proposing would be devastating to the poor and lower middle class in our country. Obviously medical care prices would drop significantly, but there is still a very large percentage of the United States that cannot afford to shell out $500 for an ER visit. I'm sure I'll have someone chime in that healthcare is not a right, but understand that healthcare is a basic necessity and people are going to seek emergent medical attention regardless of their ability to pay. Maybe we get rid of EMTALA and only treat those that can pay? Then now we have millions of people losing all of their savings for something completely unforseeable. We will never have this free market utopia that so many of us dream of because when applied to medicine people will either start going broke to pay or accept that their treatable condition cannot be paid for

I get it's not the majority opinion but yes, I think people should pay for the services/goods they consume.

 

[VA Hopeful Dr]

What you are proposing would be devastating to the poor and lower middle class in our country. Obviously medical care prices would drop significantly, but there is still a very large percentage of the United States that cannot afford to shell out $500 for an ER visit. I'm sure I'll have someone chime in that healthcare is not a right, but understand that healthcare is a basic necessity and people are going to seek emergent medical attention regardless of their ability to pay. Maybe we get rid of EMTALA and only treat those that can pay? Then now we have millions of people losing all of their savings for something completely unforseeable. We will never have this free market utopia that so many of us dream of because when applied to medicine people will either start going broke to pay or accept that their treatable condition cannot realistically be paid for and suffer the loss of life or limb. Also, can you imagine the number of fights people will have with their insurance company on what constitutes "catastrophic"?

Uhh, see stuff doesn't have to be that expensive though. The ED does since y'all have to be prepared for the worst 24/7/365, but the rest of us don't have that problem.

Insurance should be reserved for the catastrophic - major surgery, admissions, trauma, MI and stuff like that. An ED visit that only costs $500 could easily be managed with decent primary care.

 

[Zebra Hunter]

Uhh, see stuff doesn't have to be that expensive though. The ED does since y'all have to be prepared for the worst 24/7/365, but the rest of us don't have that problem.

Insurance should be reserved for the catastrophic - major surgery, admissions, trauma, MI and stuff like that. An ED visit that only costs $500 could easily be managed with decent primary care.

Sure, that's great in theory, but how is a patient supposed to know their condition isn't an emergency? Also, would a C-section be considered catastrophic? I doubt it. What about elective surgeries that while not emergently or urgently necessary, are important for the morbidity or mortality of the patient? Sure all of those would be cheaper, but still cost a couple thousand dollars.

 

[turkeyjerky]

Uhh, see stuff doesn't have to be that expensive though. The ED does since y'all have to be prepared for the worst 24/7/365, but the rest of us don't have that problem.

Insurance should be reserved for the catastrophic - major surgery, admissions, trauma, MI and stuff like that. An ED visit that only costs $500 could easily be managed with decent primary care.

I wonder, if catastrophic insurance plans became the norm, would you guys be willing to change the SOP of your staff to send patients to the ER whenever they call in with a new complaint?

Plenty of people abuse the system, but everyday I see at least 2-3 reasonable people w/ nonemergent complaints who start off with, "well I really didn't think it was that serious, but I called my doc and the nurse told me that I had to come in right away".

 

[WilcoWorld]

I dig it. Let's apply to other situations. "You're in septic shock w/MODS, we're going to recommend you step up to the unit, prob spend some time on the vent. Rough cost will prob be about $100k. We can throw in the pressors for free if you pay up front. Let me know, I'll be back in 5." We can prob cut the percent of GDP spent on healthcare to the single digits overnight

I do think all people should be paying their bills sans government and that insurance should only be catastrophic for the large ticket items like these

You're both making good points, but there's also a problem you're both overlooking: Healthcare charges have become so opaque that doctors' prospective estimates of cost are less reliable than a contractor's bid for building a 3 story home addition on a steep slope.

 

[deleted480308]

You're both making good points, but there's also a problem you're both overlooking: Healthcare costs are so opaque that my prospective estimates of cost are less reliable than a contractor's bid for building a 3 story home addition on a steep slope.

They are only opaque because there is no incentive to make them transparent. Direct primary care/okc surgery center/lasix surgeries/vericose vein procedures....all show it can be pretty darn transparent if someone wants it to be

I've also been a cash pay patient...if you are "that guy" who says I need to know the cost and I'll sit in this bed until someone tells me, they can find out