Why Do Insurers Drive Patients to the ER by Denying Preauthorizations?

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docB said:
I think you're at least a little conflicted if you're quoting Robert Reisch and Ron Paul. The Devil is in the detalis of what you suggest. The definitions of what constitutes "rich," "super rich," "fair share," and even "middle class" depends on who you're talking to.

I think people making exactly what I make should not be taxed and someone who makes more than me should be taxed back to the stone age. Unless I get a raise😉.
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The term "fair" as it is most often used by those making the argument is a non-threatening word for wealth substitution. To them all wealth should be controlled by the government, and metered out to favored political groups.
 
I had a national insurer who last year began excluding in-house labs, such as UA, CBC, and flu tests. Required flu tests to be sent out, with results available in 5 business days (clearly too late to start Tamiflu). I was often doing the test at a discount, or for free just to get the results.

Got tired of fighting the insurance company, so I started ordering everything "stat" for that insurer's patients. That required the lab to send a special driver to my clinic and pick up the lab, and process it immediately with results available in 3-4 hours. Each time driver came out, cost the insurer roughy $400. 2 patients, 2 "stat" orders, 2 drivers, $800, etc.

I took exactly 3 business days for the insurance company to call and advise my office manager of their "revised" policy to allow us to perform in-house labs needed for in-office decision making. No problems with that insurer since then, and I felt like I had won at least one battle,
 
These threads are fun -- liberals and conservatives go back and forth, with points scored on both sides but with hardly anyone persuading anyone else. These kinds of arguments will (and should) go on until the world ends.

I love this sh## as much as anyone, but I'm starting to think that we should postpone these arguments between liberals and conservatives until we solve some problems that we should all agree are problems, and are worse now than they have been for a long time (and maybe ever):

My least controversial example: "corporatism." Conservatives know that free markets are great, and liberals know that fair government regulations are great, but both sides should be able to agree that corporatism sucks. A corporatist government regulates unfairly, with one set of rules for well-connected corporations, and another set of rules for everyone else. This hurts up-and-coming entrepreneurs that would out-compete the government-connected corporate behemoths, if the system were fair.

We face a choice in the debate over banking reform to adopt a pro-market approach, or to stick with the corporatist, pro-business approach that Tim Geithner and Larry Summers seem to love. Luigi Zingales puts it like this: "The finance sector's increasing concentration and growing political muscle have undermined the traditional American understanding of the difference between free markets and big business. This means not only that the interests of finance now dominate the economic understanding of policymakers, but also — and perhaps more important — that the public's perception of the economic system's legitimacy is at risk."

My example that should be less controversial than it is: the "global war on terror." We waste a ton of money, abandon the rule of law, and sacrifice our civil liberties in the name of protecting ourselves against something that is much less of an objective threat than the government makes it out to be.

This is still so controversial because the public misunderstands the nature of the threat, and because the authoritarians in government can use it to get so many of the goodies they've always wanted but never were able to get because of the public's inconvenient attachment to quaint notions like constitutional limits on the powers of government. But this post is already wandering off topic, so I'll wrap it up.

Pilot: congrats on beating the bejeezus out of those bastard insurance company bureaucrats. Your story warmed my heart.
 
glorfindel said:
My example that should be less controversial than it is: the "global war on terror." We waste a ton of money, abandon the rule of law, and sacrifice our civil liberties in the name of protecting ourselves against something that is much less of an objective threat than the government makes it out to be.

This is still so controversial because the public misunderstands the nature of the threat, and because the authoritarians in government can use it to get so many of the goodies they've always wanted but never were able to get because of the public's inconvenient attachment to quaint notions like constitutional limits on the powers of government. But this post is already wandering off topic, so I'll wrap it up.
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👍 Our defense budget is sickening, imagine what they could do with only a fraction of that.
 
rmbsstock said:
Lets talk about Fair a little bit.
I am not attacking doctors, (I have two in my immediate family, a pediatrician and a dentist). However, how fair is it for a doctor to make over a million dollar a year, and a graduate of West Point Academy, an Army pilot, fought in Panama, fought in Serbia war, Gulf war, and Afghanistan, and left his family for a year at a time, can hardly keep his family as "middle class". Doctors are not better than West Point graduates.
Someone said to me that if Obama's plan comes through, some specialties better sit at home because they won't be making much money. She mentioned like Cardiologists (like her spouse), Gastroenterologist, etc. In my opinion, maybe they should. She lives in a three million dollar home, with security cameras,...
I know it is NOT an individual cases. But, this is NOT an individual case, this is the norm. I live it and I see it every single day.
I know everyone is going to be defensive, maybe to find a reason to keep their wealth. (and I am going to be slaughtered here😛 )
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I can't help but notice that your posts are very emotionally charged, and seem to come from an especially biased perspective (your tag says Semper Fi and you argue for the wages of military officers). And, in addition to the factual errors (it's quite rare for doctors to make a million a year - certainly not "the norm"), they don't make much sense.

I regret that you've had an unpleasant experience with the US medical system, but perhaps if you put forth a clearly stated solution, rather than bolded, capitalized rants, we could have a useful discussion.
 
rmbsstock said:
WilcoWorld, "especially biased perspective " based on what?
U.S. Physician Salaries - Ongoing Salary Survey
*Survey includes base salaries, net income or hospital guarantees minus expenses
June, 2003 - Present
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What's your point.
 
Whenever someone uses the word "fair" I generally stop arguing with them. Fair is a relative, subjective term most often based on emotion.

What is "fair"? Define it. What's "fair" for a doctor to make? $50,000? $100,00? $500,000?

Who has the supreme moral authority to judge "fairness" and a more important question is who is going to enforce "fairness"? "Fairness" as you define it is an inherently socialist ideal, whereby a central authority will determine what people should make, and how wealth should be distributed.

Have we really learned so little from history that people think socialism can ever work on any scale?
 
rmbsstock said:
WilcoWorld, "especially biased perspective " based on what?
U.S. Physician Salaries - Ongoing Salary Survey...
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I tried to make it clear in my initial post, but I'll say it again: Your perspective is biased based on the fact that you use the Marine's motto (which means always faithful, so presumably you consider yourself faithful to the military?) in your tag, and you argue for higher military officer salaries.

I do appreciate your posting a list of salaries to make my point, however. The fact that I could find only a single salary over a million listed (though I'll admit I could've missed something in that post) would seem to directly dispute your claim that million + dollar salaries are "the norm" for doctors.

Please understand that I'm not arguing for higher physician salaries, just trying to correct misconceptions.
 
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rmbsstock said:
Lets talk about Fair a little bit.
I am not attacking doctors, (I have two in my immediate family, a pediatrician and a dentist). However, how fair is it for a doctor to make over a million dollar a year, and a graduate of West Point Academy, an Army pilot, fought in Panama, fought in Serbia war, Gulf war, and Afghanistan, and left his family for a year at a time, can hardly keep his family as "middle class". Doctors are not better than West Point graduates.
Someone said to me that if Obama's plan comes through, some specialties better sit at home because they won't be making much money. She mentioned like Cardiologists (like her spouse), Gastroenterologist, etc. In my opinion, maybe they should. She lives in a three million dollar home, with security cameras,...
I know it is NOT an individual cases. But, this is NOT an individual case, this is the norm. I live it and I see it every single day.
I know everyone is going to be defensive, maybe to find a reason to keep their wealth. (and I am going to be slaughtered here😛 )
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To be "fair," many doctors are barely hanging on to middle class as well. I'm only there because I don't have a family and I'm making tiny payments on my loans.

That West Point pilot? Was educated to the tune of a quarter million dollars at taxpayer expense. Received a paycheck for all four years of college and every month thereafter. He has approximately 10 years of earning potential that physicians don't, not to mention the opportunity to retire (again, at some taxpayer expense) as early as age 42!
 
RMB:

Its also worth making the point that "no one ever joined the military to make money." You know it, I know it. And as SoCute pointed out, physicians don't make any money at all for at least ten years and as much as 14. Meanwhile friends who did other things (engineering, business, etc) end up making really good money and have a much higher quality of life than the physician during the same time....and better quality of life (in terms of time to do things other than work) after fellowship ends.....

Anyway, I think that there are really several big problems going on in this country that together make it ridiculously hard for most people to remain middle class. In no particular order:

1. The transition of this country from a primarily manufacturing state to something else in the late sixties. There go a lot of high-paying middle class jobs.

2. The fact that real wages (in constant dollars) have basically stagnated since the 70s while the cost of things like houses have increased several hundred fold at the same time. Thus in order to maintain a "middle class" life, many Americans must now be dual income.

3. Spending on the military is ridiculous. As Glorfindel said, the "War on Terror" is neither a war nor about terror. It's more about politics and control of budgets than about a thoughtful response to Islamic fundamentalism. Don't believe me? Look how we dealt with terrorism of any stripe prior to 9/11. As far as the budget, in 2007 $550 billion dollars on "defense"? Geebus.

4. A colossal transfer of money from young middle class and poor wage earners to the elderly via Medicare and Social Security.

5. As mentioned earlier, the fact that 40% of the wage earners provide the bulk of the tax receipts in this country.

Just my two cents.
 
EvoDevo said:
4. A colossal transfer of money from young middle class and poor wage earners to the elderly via Medicare and Social Security.

5. As mentioned earlier, the fact that 40% of the wage earners provide the bulk of the tax receipts in this country.

Just my two cents.
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The graying US population will increase #4 and #5 will shrink.
 
I find it interesting to see that those who were espousing subjective "fairness" have yet to define what "fair" is, and how they would enforce it.

I'm talking either an absolute maximum salary in terms of $$$ or a percentage in taxes. Come on, give me some numbers to work with!
 
rmbsstock said:
U.S. Physician Salaries - Ongoing Salary Survey
*Survey includes base salaries, net income or hospital guarantees minus expenses
June, 2003 - Present
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Note, only one of those crested the "norm" of a million dollars you stated earlier (Spine).
2010 Basic Officer Military Pay Chart
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The problem with you quoting that chart is that you are deluding yourself to what it means.
Number one, that is a military pay chart. It isn't a salary chart. So multiply all of those by 24 (pay dates per year). Here are lists of yearly salaries for you to see the difference (from 2009, including housing allowances, etc). Second, you put in your 20 years, and you get 50% of your highest 3 years for the rest of your life. Plus 2.5% for ever year over 20 up to a total of 75%. That's not invested money, it is just continued salary. I, for one, think that soldiers deserve it. But to ignore it is laughable.
So, is it "fair" for the O-10 that isn't on the battlefield to earn 500% more than the E-1s out there dying? Especially since most officers go through OCS and don't experience fighting to begin with? This isn't the Civil War, you don't move up in rank by taking the sword of the guy who fought and died next to you.

Also, I'm sure the dentist in your family makes more than the doctor in your family. Is it fair for the guy that makes teeth white to earn more than the one saving kids' lives? Do you rail about that on dental message boards?

As mentioned before, insurance companies aren't and never have been around to help people. They are there to make money, and always have been. That's why risky bids always cost more to insure. Think single teenage male vs adult married woman when it comes to driving.
I have had 3 elective surgeries simply because I was insured at the time. I was living before the surgery, but my quality of life might not have been as good. However, since I had paid into the insurance industry probably more than 40K since I started working, I damn sure was going to get some of it back rather than continue to give. Had I had to pay out of pocket, I would have waited for my surgeries. OTOH, I also would have had a lot of discretionary money laying around that I hadn't paid to insurance companies.
Remember, most of us are paying interest on insurance premiums we paid in college/med school with our loans, since they were required.
 
Sigh.
Plenty of military wives go to school, so that argument fails at face value. School credits do transfer. Also the ad hominem attacks are weak.
If you're not getting paid what the pay tables state, you should call. Of course, I would start with the person that controls the checkbook. Those numbers you quoted are paid the 1st and 15th of every month. If, as you say, your significant other is deployed, they're also getting hazard pay on top of what the pay tables show.

I don't fault dentists for being successful at keeping their pay steady. The insurance companies haven't been successful at cutting their reimbursements like they have the medical profession.
 
Great you quoted me the average annual salary. Now tell me what "fair" is.

I went to school for 8 years, plus three years of training. The entire time earning negative income, or less than the median salary. What is a "fair" salary for me, now that I'm finally working? :shrug:
 
We have wandered off course here some. I had intended this as a discussion of how insurance company policies affect the ED. I appreciate that everyone has kept things civil but maybe we should get back to ED related stuff. The discussion about relative worth would be better served in Topics in Healthcare or Sociopolitical. Thanks.
 
docB said:
We have wandered off course here some. I had intended this as a discussion of how insurance company policies affect the ED. I appreciate that everyone has kept things civil but maybe we should get back to ED related stuff. The discussion about relative worth would be better served in Topics in Healthcare or Sociopolitical. Thanks.
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Insurance companies affect the ED in a negative way, however that affect is much less (in my opinion) than the negative impact government-run care, and government regulation would cause.

Ideally all patients would be cash patients and we wouldn't have to worry about collections. That ideal world will never happen, so in terms of reimbursement, what we have now is reasonable. The only way I can think to improve it would be to have greater market competition between companies and eliminate anti-trust laws. If insurers refuse to pay bills or give pre-authorizations, then consumers would be free to drop them and pick one who will. THAT would have a positive impact on us.
 
People generally get paid for the degree of mental anguish that they experience, combined with the degree of sacrifice that it takes to get to that position. Think of the CEO of a fortune 500 company who works 80 hour weeks, who thinks every minute of every day- "Is this decision going to bankrupt my company, cause thousands of people lose their jobs and make me forever infamous, and unemployable?" Degree of mental anguish- astronomical.

I'm friends with 8 guys who are in the military currently. Yes, it sucks incredibly that they are gone for 6 months at a time, but the majority of the time, they are home, and when they go to work, they are basically just killing time, producing paper-work. They admit that their jobs are pathetically easy when they aren't deployed. They surf the internet a lot, go to PT, and clean facilities on base. Degree of mental anguish- negligible, and only because they feel a little dirty for getting paid to do nothing.

Come on, the military generally recruits the dregs of the graduating seniors in America. To be an officer, the main requirement is that you need to have is be smarter than your recruits...not very hard. The sacrifice required to advance in rank is adeptness at navigating bureaucracy.

The wars in the Middle East, while no picnic, are also no Normandy. The risk of death and injury for the average soldier is about the same as a police officer here in the US. By your same reasoning, we should be paying the police officers here in the US $200,000 a year.

While it sounds great to pay soldiers and police officers more than anyone, it goes against the law of supply and demand. Doctors make a lot of money because the demand is huge, and the supply is small. To match the need, the reward has to be high. The demand for cops and soldiers, while high, has a large supply of people willing to jump into the military and the police force because there are no prerequisites. One day, someone thinks, "I need a job, why don't I join the military/police force?" A few weeks later, they are on the job.

When someone thinks, "I want to be a doctor, I wonder what that entails", they aren't on the job for a DECADE!

What you are desiring by lowering doctors wages and raising military wages is an abandonment of the free-market and the introduction of governement control of wages. This would be a loss of freedom... ironic for a military wife to be arguing this. Abdandonment of the free-market, and supply and demand, always leads to shortages in products, and services. In the end, quality of life goes down for the entire population. Be careful what you wish for.
 
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GeneralVeers said:
Insurance companies affect the ED in a negative way, however that affect is much less (in my opinion) than the negative impact government-run care, and government regulation would cause.
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Interestingly though, those countries that have 'universal coverage' do require the insurance company (whether it's private or government run) to pay any claim filed, usually within a week or so. Plus they cannot deny a claim.

Of course the catch is that they pay much less, something no politician cares about.
 
rmbsstock said:
I wanted to mention this story that happened to me, hopefully you won't get involved in something like this. I recently had laparoscopic gallbladder surgery. The surgery was not very bad with approx. 20 stones removed and a little of scar tissue. I was discharged home on the same day. Before I went home my surgeon visited me to check how I was feeling before discharge. I told him I feel VERY BAD with LOTS of pain. He laughed and said that I will be fine. That night I went to the ED since I was in so much pain, my surgeon was still on call, so the ED called him. The ED doctor didn't touch me since my surgeon was there. The Surgeon prescribed to me a strong pain killer. Day two, Saturday, I was throwing up all day, I went at night to the ED (my husband took me) the ED doctor read my file, and changed my pain killer and sent me home. Day three Sunday, I was screaming in bed and I couldn't move. My husband carried me to the ED. They did X rays. The Surgeon on call came laughing and said "you have constipation!!!!" They gave me another pain killers and sent me home. My friend the Pharmacist called my husband to tell him that we will be rich if we sell all these pain killers on the street (she was joking). Monday night I was running fever, unable to keep anything in, unable to move left or right. My husband called our friend who is a doctor and they decided to meet at the ED. The receptionist asked us to wait. My husband started yelling and asked her for a bed because I am not able to sit down, (I really wasn't able to move let alone sit). My husband started yelling and asking for the ED doctor when he found out that he is one of the ones that saw us before and sent us home without doing anything. (it was a bad scene, and I was in and out of consciousness either because of the cocktail of the pain killers or the pain). The ED doctor was upset seeing me again. The bottom line, after my doctor friend took me in and personally found another doc. to do an Ultra sound, they found that I have a bile leak. My stomach was so enlarged as if I was pregnant. The X ray showed that my intestines were so big because of Ileus because they were burnt by the bile and NOT because I had constipation. I had an ERCP performed with a stent placement and drain. I spent 3 days postop from the stent placement and drainage of bile (approx. 500 cc) - with continues extreme pain. My husband wanted to sue my surgeon and the ED doctor, because he refused to even take a look at me since there was someone from the surgeon's group that did my surgery on call. Is that right? (ofcourse, we did not sue anyone). But the surgeons refused to see us at their office every time (Friday and Monday) and that's why we ended up at the ED, and they did not want us either 🙁
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There are so many places in this thread where I could just say "Wow." But yours topped it for me.

I don't want to go OT; but really this kind of thing is exactly why, though we can do some things with tort reform, we can't totally try to abolish litigation processes. We need this as another part of the systems of checks and balances. Sadly, often what people should do is not necessarily what they will do.

I would write a letter to the hospital administrators as well. I know people are busy and very stressed; but it is not unreasonable to take a time out and stand back and re-think what's going on with a situation like yours.

I'm not a physician yet. But as a critical care RN I have learned a few things. One of them is to listen to the patients and children's parents (as the case may be). Yes there will always be people that are out there or have some other agendas going on. But I have to dispassionately stand back and think and re-think. If I jump to conclusions or avoid further investigation b/c of some foregone conclusion, I could seriously hurt someone or at the least take away for their ultlimate outcome and quality of life.

Sad thing even for the insurance is that you were admitted to the ED how many times. . . . what? It was at least no less than four times.
The situatuion progressed to worse and you suffered and were put at higher risk. Professionals have to be willing to be held accountable.




For those that are hands down for government controlled HC, ironically the tolerance for this kind of thing would only increase. And it's kind of hard to sue the federal government. But when you are looking at over 300 million Americans, it will not be realistic to think they will all get the same quality of care or even enough of it across the board compared with what most of them were used to. People will be forced to wait and just shut up and deal. The "squeaky wheel" patient won't matter and won't be heard. At least now, "the squeakies" are more likely to be heard. Yes a number of squeakies may just be hyper-emotional or pains in the butts. But a good number of squeakies have legitimate concerns, fears, and reasonable expectations for treatment. And God always help those that are afraid to speak up and suffer horribly b/c of it. This as a nurse I have witnessed more times than I care to say.


Finally, I certainly understand HC professionals are often quite stressed and busy. But why is the perspective of "How I would I feel if it were me or my loved one on that stretcher bed?" so much of a ridiculous thing that every practitioner should keep in mind? No one is saying we are to lose objectivity--but empathy, perspective, understanding (as well as considering that things may be worse or changing or are not progressing positively and thus need to be objectively re-evaluated)--these things matters A LOT. This kind of thinking is a guide from within that can help us keep the priority needs of the patients in the forefront.



Personally, I will say that I have done literally months of writing and wrestling with our insurance. I knew they would have to cover certain things; b/c I had read the details and I also knew how they would try to get around them.

But really, what I truly believe, and I have been through this several times now, (most recently with my own child's surgery) is that the companies and SF groups know they will have to cover. Where applicable, they will try to hide behind what is in the employer's self-funded wording all they want. Mostly it's like the SF managers use the insurance companies as administrative "go-throughs"--with the ultimate objective of dragging things out.

The longer they drag out covering, the more they know the hospital, doctor, laboratory, whatever, will eventually kick it over to collections. At that point there can negotiate for less compensation. Meanwhile whatever goes for payment to those covered--the person/s covered--well, they hope they will just gives up in wrestling with the insurance company after numerous phones and being put on hold and passed around all over the place for hour, days months, etc.

It's a huge delay game. Does it need improvement? Does it need to change? YES.

Still, as much of a major headache as it has been in dealing with my insurance for what should be rightfully covered (and that for which we are contributions equal no less than $9000 per year minus co-pays and other %s we must cover out of pocket), I'd still rather fight with them RATHER THAN having the door slammed in my face summarily, and without much if any recourse, by a government run program.

It might take a while, but with the PI's, there are things I can do and I can appeal. Has anyone ever tried to appeal anything with the government. It's huge red tape that gets no where.


So, I also have some agreement with the physician-attending that stated we need to open up more competition with re: to the PI's. Absolutely. What is with all these state line restrictions? Why are we restricting the power of competition and free enterprise?



The "universal coverage" countries may not "deny a claim," but they can seriously delay and deny care and also seriously limit the patients' choices.

Americans overall are used to a higher standard of health care.
Going to a system that is government controlled will kill that.
Mathematically, w/ our given (and growing) population and our current "GInormous" deficit, it really isn't feasible.
It's one of those things that sounds good, but the reality isn't better, in fact ultimately, it is worse.

Yes we need to fix some things in our HC system. That cannot be denied. And greed cannot be the driving force; but too many people confuse free markets and capitalism with greed. Yes greed can be a factor, and that is something on which we MUST pull in the reigns. But greed and redistribution within a more socialistic system leaves more with less and lesses freedom and choice for more people.

We have to seek balance--not go to extremes.
 
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Stitch said:
Interestingly though, those countries that have 'universal coverage' do require the insurance company (whether it's private or government run) to pay any claim filed, usually within a week or so. Plus they cannot deny a claim.

Of course the catch is that they pay much less, something no politician cares about.
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My main problem with the plan in this country is the "guaranteed issue" part. If you cannot turn down coverage, then you no longer are running an insurance company, but a charity. I'm not making a moral or value judgment or hating on "poor sick people", I'm stating a fact. Two things would happen under the guaranteed issue clause:

1. Insurance rates would skyrocket for EVERYONE

2. Insurance companies would go out of business.

I'm betting on a little of both. As people pay more and more for insurance, and companies are less willing to write new policies for anybody, the people will demand that the government step in with a "public option", and overnight the dream of single-payer coverage is achieved.
 
GeneralVeers said:
1. Insurance rates would skyrocket for EVERYONE

2. Insurance companies would go out of business.

I'm betting on a little of both.
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I hear what you're saying, and most of my research on the various European models (and they really can't all be lumped together as 'socialist') confirms the continued funding problem. All of them have made insurance companies non profit, yet just about everyone has had to resort to infusions of government money to stay afloat and continue to cover everyone. A sort of insurance bail out.

The only country where this setup has seemed to work is Switzerland, however they are noted to be the highest spenders on health care in Europe (though still less than the U.S.). On the other hand, they also rely the most on regulated profit making insurance plans in addition to a fundamental catestrophic coverage plan that has to cover everyone.
 
​
:cry:
jl lin​
 Thanks for your understanding

out
 
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GeneralVeers said:
My main problem with the plan in this country is the "guaranteed issue" part. If you cannot turn down coverage, then you no longer are running an insurance company, but a charity. I'm not making a moral or value judgment or hating on "poor sick people", I'm stating a fact. Two things would happen under the guaranteed issue clause:

1. Insurance rates would skyrocket for EVERYONE

2. Insurance companies would go out of business.

I'm betting on a little of both. As people pay more and more for insurance, and companies are less willing to write new policies for anybody, the people will demand that the government step in with a "public option", and overnight the dream of single-payer coverage is achieved.
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Honestly, I agree with many of your points. On principle and although it is a separate philosophical discussion, I disagree that fairness in its truest sense is totally relative. Furthermore, fairness is not a principle founded in some form of socialism. It is is a principle founded in simple, Judeo-Christian principles. But again, that's a philosophical discussion earmarked for some other thread.

At any rate, I do believe physicians should be compensated well--very well, since the WHOLE process is just too long, hard, and since so many have basically nothing for years after all their work. It is also fraught with untold stressors and things, which those that don't work in it or at least around it have any idea. I mean these people aren't making more like hedge fund managers.



But I also feel that people should be willing to be held fully accountable for falling short of standards of practice. So, if that means financial responsibility, so be it. I wish to God you could make everyone compelled to do the number one, top thing in all situations for all people b/c of their uncompromising core values. But there is often enough some percentage that will not do that. And for the rest of us, there is the extra impetus of further legal and civil accountability and the financial ramifications--for those moments we are weak and tired or could have a momentary lapse.

But come on. Yes. Physicians should be compensated very well for essentially giving up much of their youth, their lives and energy, and often times their freedom. (The demands of the sick or those in need can often interfere with the freedom of the physician to come and go as he or she pleases--even on their scheduled days off. I've seenPLENTY of examples of physicians that weren't the ones on call yet they came in anyway for their patients!!!)

And reallly it is utterly unfair to me to do what some that support universal HC propose, and that is to make physician salaries under $100,000. Unless the glorious government is going to pay for the physicians medical school education, such a proposal is completely idiotic!
 
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docB said:
You mean as opposed to the Vegas special where the patient says "My doctor sent me in and said he'd meet me here to admit me. Who the Hell are you and where is he?" and then when you call their doc he says "No, I don't want them admitted. I didn't even want them in my office. I just wanted you to be the last doc to see them to divert any liability away from me. Send them home and tell them I'll see them 8 months from next Thursday."
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I always get "My doctor sent me in, he said he was going to call you". Then they begin a very vague history until I tell the patient they need to tell me everything. Then they look at you like you're stupid as if you didn't get the memo "because my doctor called the ED". Um, no he didn't call and I have no idea about you. Not really the patient's fault since they don't know how things work, but man is it annoying.
 
GoBuckeyes913 said:
I always get "My doctor sent me in, he said he was going to call you". Then they begin a very vague history until I tell the patient they need to tell me everything. Then they look at you like you're stupid as if you didn't get the memo "because my doctor called the ED". Um, no he didn't call and I have no idea about you. Not really the patient's fault since they don't know how things work, but man is it annoying.
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The only better one is when they say: "My doctor told me he'd meet me here. Why do I have to talk to you?"

Do doctors actively lie to their patients, or is this just wishful thinking on the part of the patients?
 
GeneralVeers said:
The only better one is when they say: "My doctor told me he'd meet me here. Why do I have to talk to you?"

Do doctors actively lie to their patients, or is this just wishful thinking on the part of the patients?
Click to expand...

It may be both, but I think a lot of it is the latter. When I'm on call (I'm an oncologist) and tell a patient to go to the ED in the middle of the night, about half the time, they'll ask "so will you meet me there?" I then explain that, no, I won't be driving the 200 miles to their nearest hospital (we have patients from throughout the state) to meet them, but I will call the doc @ the ED to let them know they're coming.

And yes, I do call the ED to let them know what's coming.
 
gutonc said:
It may be both, but I think a lot of it is the latter. When I'm on call (I'm an oncologist) and tell a patient to go to the ED in the middle of the night, about half the time, they'll ask "so will you meet me there?" I then explain that, no, I won't be driving the 200 miles to their nearest hospital (we have patients from throughout the state) to meet them, but I will call the doc @ the ED to let them know they're coming.

And yes, I do call the ED to let them know what's coming.
Click to expand...

I really appreciate it when the primary docs call for two reasons:

1. It makes my job a lot easier, and the patient's treatment faster as I already have some idea of a plan.

2. You won't get called 5 hours later in the middle of the night getting asked what you want done with the patient.
 
GeneralVeers said:
I really appreciate it when the primary docs call for two reasons:

1. It makes my job a lot easier, and the patient's treatment faster as I already have some idea of a plan.

2. You won't get called 5 hours later in the middle of the night getting asked what you want done with the patient.
Click to expand...

Amen to this. 👍

Honestly, I think a lot of patients just flat out lie about it. Somehow they believe that if they say "Dr. X sent me in" or "Dr. X mentioned that a CT would be helpful" then they'll be seen faster or get what they want.

A number of my friends from residency are now in private practice. We're all still pretty close, so I'll call and ask, and they're like "Dude, I would NOT send that!"

I'd also love to do a study on nursing triage lines. I think they're worthless and dump a lot on ERs (which isn't the patients' fault). Take a set of symptoms that show someone is mildly sick, but could be seen in the AM and call around to different practices. See how many get sent in for eval.
 
GeneralVeers said:
I really appreciate it when the primary docs call for two reasons:

1. It makes my job a lot easier, and the patient's treatment faster as I already have some idea of a plan.

2. You won't get called 5 hours later in the middle of the night getting asked what you want done with the patient.
Click to expand...

1. That's why I call. It's not usually an issue at our hospital but since so many of our patients live out in the woods, the EPs out there are less familiar with our patient population.

2. I usually get called anyway. But it's usually a much shorter conversation.
 
docB said:
We have wandered off course here some. I had intended this as a discussion of how insurance company policies affect the ED. I appreciate that everyone has kept things civil but maybe we should get back to ED related stuff. The discussion about relative worth would be better served in Topics in Healthcare or Sociopolitical. Thanks.
Click to expand...

You're going against the spirit of the EM forum.


Ooooh, shiny.



Let's go ride bikes.
 
GeneralVeers said:
Do doctors actively lie to their patients, or is this just wishful thinking on the part of the patients?
Click to expand...

Lately, we've been calling the PCPs (we're in an integrated system/large group practice where we know each other) about patients that were told to come to the ED but on whom we didn't get a call.

It turns out that, in the majority of these, the PCP didn't know anything about it. After some investigation, the receptionist at the PCP's office either said "the doctor thinks you should go to the ED" without asking anyone or the patient heard what they wanted to.

Take care,
Jeff
 
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