Pursuing Holiness

This Happy Hospitalist post really got me going this morning. Grunt Doc points out that the people who have to pay some portion of their ER expenses use it less. Well, when you consider the conveniences of the ER - you show up when you like, any required tests are usually done right on the spot with no pesky scheduling issues or having to go somewhere else to get them, and you very often leave with a prescription that solves your problem - why wouldn’t you get medical care this way if you aren’t prevented from doing so? It’s a one-stop shop. Compare that to scheduling an appointment with your general practitioner, waiting just as long in their waiting room as you would in the ER, getting sent all over town for testing (completing paperwork and paying at each stop), waiting for your doctor to get the results and making another appointment so he can tell you what the problem is. If all other things were equal, the choice would be easy.

We have an insurance policy with a $5,000 deductible. That has done wonders for keeping our medical expenses down. We weren’t profligate before, but having that first 5k out of pocket is a useful, if sometimes uncomfortable, tool for keeping our medical expenses in check. The fact is that we don’t need to run to the doctor for every little thing. Most illnesses are self-limiting and common sense care at home relieves a lot of symptoms. For example - I’ve treated the symptoms of several sinus infections with ibuprofen and saline nasal spray while my own body’s immune system did its job fighting the infection. The ibuprofen treated the pain and inflammation, the saline nasal spray washed out my sinuses, relieved the pressure and made me feel better. $5 with of over the counter treatment versus a $75 trip to the doctor and the cost of a prescription between $10 and $100 - AND I avoided taking antibiotics unnecessarily. A little common sense is called for - if waiting it out/home treatment didn’t improve matters within a few days, I’d have gone to the doctor for help.

Although we are pretty good at controlling our medical expenses, there are times we feel completely out of control. My daughter will (hopefully) be in her first opera Saturday night. After the final dress rehearsal last night, she passed out in the parking lot. When her friends called us, they said she was “in and out” of consciousness. We got her to the ER as soon as possible, they did every test under the sun, and the doctor said we’re down to two choices, at this point - she was just too dehydrated and hungry after hours under the hot lights in a huge dress with layers of petticoats during a strenuous rehearsal, or there is some neurological issue. Since something not unlike this happened two years ago, we’re concerned. I really do think that the first explanation makes the most sense, but obviously we’re going to follow up and get the EEG. But before we even got to that point, we racked up a massive bill in the ER. Blood work, urinalysis, chest X-ray, EKG, CT scan… All standard, I guess, but we barely spoke to the doctor and have no idea what his rationale was for all those tests, and no idea whether they were really necessary or CYA.

From the minute we entered the ER, we had no control over the situation. The doctor and nurses stepped up and did their thing, and the only communication was one-way - they wanted our version of what happened. Having asked both us and her about drug use and pregnancy, they did the tests anyway to confirm we were telling the truth. (We were.) They then did a whole bunch of stuff that was never explained, administered tests without telling us what they were looking for or what was going on, and finally hustled us out the door at 4:30am with a copy of test results and the phone number of a neurologist. We have no idea, really, which explanation the doctor leans toward or why, or what he ruled out to get to the two remaining explanations. We have no idea how much of what we said he really “received,” or how relevant it was or was not to her semi-diagnosis or how much the various tests were worth in the equation.

Well, it wasn’t a traditional doctor’s visit, and I didn’t really expect them to have time to chat. Obviously any input from us was not desired. But a little more information about what was going on would have been welcome. As to the bill - I’m very upset about it, because I have no idea how much of it was really necessary, nor do I really know if the EEG we’re going to try to schedule is necessary for my daughter’s health, or for the doctor’s liability in case something goes wrong later. We met our deductible a month ago, so it’s not coming out of our pocket. But I have a hard time just blowing it off. The only control we have over ER expenses is whether or not to show up. I’m wildly guesstimating based on anecdotal evidence that at least half of the people who do show up at the ER could stay home and call the doctor the next morning instead. But for those of us who try to be responsible about these things, more information and being part of the decision making process might have helped keep the bill down. For example, what was the point of that chest X-ray? Could it have been avoided?

Is there some way for ER patients to have more information and input without impacting their care (or that of other patients, by taking up too much of the doctor’s time)?

written by Laura