Comments on: Liability is why your doctor told you to come right to the ER http://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-66296 Anonymous Fri, 18 Aug 2006 17:09:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-66296 I need some advice. Should I pack up my doctor bag and quit after only a year in practice? <br/>I am already being sued for prescribing antibiotics for a UTI in a 75 year old diabetic, who then got c diff colitis and died of dehydration after her nursing home doc didn't stop the antibiotics after the urine culture I sent turned up negative. I had a patient code on me (recovered and is fine now after a pacemaker) because the EKG looked like first degree AV block and was 3rd degree. And I misdiagnosed a spinal epidural abscess as pyelonephritis. I did well as a resident and never had any problems, but seem to be doing everything wrong this first year out. Should I quit? I need some advice. Should I pack up my doctor bag and quit after only a year in practice?
I am already being sued for prescribing antibiotics for a UTI in a 75 year old diabetic, who then got c diff colitis and died of dehydration after her nursing home doc didn’t stop the antibiotics after the urine culture I sent turned up negative. I had a patient code on me (recovered and is fine now after a pacemaker) because the EKG looked like first degree AV block and was 3rd degree. And I misdiagnosed a spinal epidural abscess as pyelonephritis. I did well as a resident and never had any problems, but seem to be doing everything wrong this first year out. Should I quit?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-66248 Anonymous Tue, 15 Aug 2006 21:10:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-66248 I can't believe that each of you are commending what the woman says and just blaming the system for the problem. People have to be able to trust their doctors; if your physician tells you to go to the emergency room, you have to assume that s/he's giving you the right advice. And having done what the doctor told you to do, why should we put up with the crap from the nurse? Because she's just as much at fault; let's not blame the patient when the medical profession is clearly futzing around on all sides. I can’t believe that each of you are commending what the woman says and just blaming the system for the problem. People have to be able to trust their doctors; if your physician tells you to go to the emergency room, you have to assume that s/he’s giving you the right advice. And having done what the doctor told you to do, why should we put up with the crap from the nurse? Because she’s just as much at fault; let’s not blame the patient when the medical profession is clearly futzing around on all sides.

]]> By: Nurse Practitioners Save Liveshttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-66246 Nurse Practitioners Save Lives Tue, 15 Aug 2006 19:41:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-66246 In our ER, we have a Fast track that takes care of the all of the "doctor office/clinic type" visits. It helps to decompress the situation. The person has most of the points right on though. They said what we all would like to. In our ER, we have a Fast track that takes care of the all of the “doctor office/clinic type” visits. It helps to decompress the situation. The person has most of the points right on though. They said what we all would like to.

]]> By: peds10708http://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-53026 peds10708 Fri, 27 May 2005 19:57:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-53026 I shouldn't have a telephone at all. There should be open office hours whenever I'm there (and not off someplace else trying to earn money at my second job, to subsidize my practice costs) and when I'm not there, the patient should go to the Emergency Department, or other open facility. <br/><br/>Telephone calls are 1) not paid for 2) dangerous. (After all, I haven't seen the problem at hand, have I? Why should I take responsibility for it?) <br/><br/>In an earlier era, the phone call was paid for by the subsequent, or earlier, office service. But now, the office service payment has been stripped of any additional amenities (and often downcoded, that is, payment reduced) by the insurance payor. <br/>The phone call can't survive as a medical service.<br/>After the last doctor has been driven out of practice, the ER will be what's left. Enjoy. I shouldn’t have a telephone at all. There should be open office hours whenever I’m there (and not off someplace else trying to earn money at my second job, to subsidize my practice costs) and when I’m not there, the patient should go to the Emergency Department, or other open facility.

Telephone calls are 1) not paid for 2) dangerous. (After all, I haven’t seen the problem at hand, have I? Why should I take responsibility for it?)

In an earlier era, the phone call was paid for by the subsequent, or earlier, office service. But now, the office service payment has been stripped of any additional amenities (and often downcoded, that is, payment reduced) by the insurance payor.
The phone call can’t survive as a medical service.
After the last doctor has been driven out of practice, the ER will be what’s left. Enjoy.

]]> By: The Platypushttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-53003 The Platypus Thu, 26 May 2005 14:17:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-53003 Pt think that if they say a doctor sent them it means something to us. It doesn't.<br/><br/>Often they demand that we call their doctor. I tell them that they're going to be seeing OUR doctor now. Their PCP is out of the picture once they hit our doors. Pt think that if they say a doctor sent them it means something to us. It doesn’t.

Often they demand that we call their doctor. I tell them that they’re going to be seeing OUR doctor now. Their PCP is out of the picture once they hit our doors.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-52934 Anonymous Fri, 20 May 2005 03:43:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-52934 I couldn't agree with the Graveyard Shift idea more.<br/><br/>Maybe the ER should spin off the Primary Care After Hours, and true ER.<br/><br/>Seriously, I think we should make it a national policy, aka standard of care, to send every single person who calls in the middle of the night to the ER.<br/><br/>In fact, NO ONE should be on call at night.<br/><br/>Every citizen in this country, afterhours, go the the after hour clinic or the ER.<br/><br/>There are cases of missed diagnosis of infant menigitis, tubal pregnancy, rupture AAA, progressive PE, etc.<br/><br/>Healthcare is such a mess. I am so deprssed thinking about it. <br/><br/>Anne I couldn’t agree with the Graveyard Shift idea more.

Maybe the ER should spin off the Primary Care After Hours, and true ER.

Seriously, I think we should make it a national policy, aka standard of care, to send every single person who calls in the middle of the night to the ER.

In fact, NO ONE should be on call at night.

Every citizen in this country, afterhours, go the the after hour clinic or the ER.

There are cases of missed diagnosis of infant menigitis, tubal pregnancy, rupture AAA, progressive PE, etc.

Healthcare is such a mess. I am so deprssed thinking about it.

Anne

]]> By: Anonymoushttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-52524 Anonymous Sat, 23 Apr 2005 03:15:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-52524 What can you do?<br/><br/>Send the patient to the ER, in case their stomach ache turns out to be tubal pregancy that ends up in brain death. See previous post.<br/><br/>From now, I am sending EVERY SINGLE ONE OF MY PATIENTS who call in the middle of the night, to the ER. This way I can go back to sleep like a normal person. <br/><br/>Acutally, they should really open a graveyard shift primary care clinic in every ER to relieve the ER docs of non er issues. What can you do?

Send the patient to the ER, in case their stomach ache turns out to be tubal pregancy that ends up in brain death. See previous post.

From now, I am sending EVERY SINGLE ONE OF MY PATIENTS who call in the middle of the night, to the ER. This way I can go back to sleep like a normal person.

Acutally, they should really open a graveyard shift primary care clinic in every ER to relieve the ER docs of non er issues.

]]> By: THOUGHTS FROM THE HEADOChttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-52513 THOUGHTS FROM THE HEADOC Fri, 22 Apr 2005 16:03:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-52513 I'm a general psychiatrist who recently left the hospital jungle. I knew it was bad when I found myself treating an ER Physician. It's becoming a pressure cooker for those expected to provide care. <br/><br/>The ER unfortunately has become the pathway of least resistance for primary care overflow. Psychiatric emergency criteria has become limited to a loaded gun with clear intent or x amount of pills already ingested. Anything less usually doesn't qualify as medical necessity for managed care orgs. Yet the doctor must accept the liability for what choices a mentally unstable patient makes. Patients pick up on how the system is evolving and will do or say whatever necessary to get their perceived or real needs met. <br/><br/>We have created a monster that can become self defeating if all the providers are at great risk of high frustration and eventual burnout. I’m a general psychiatrist who recently left the hospital jungle. I knew it was bad when I found myself treating an ER Physician. It’s becoming a pressure cooker for those expected to provide care.

The ER unfortunately has become the pathway of least resistance for primary care overflow. Psychiatric emergency criteria has become limited to a loaded gun with clear intent or x amount of pills already ingested. Anything less usually doesn’t qualify as medical necessity for managed care orgs. Yet the doctor must accept the liability for what choices a mentally unstable patient makes. Patients pick up on how the system is evolving and will do or say whatever necessary to get their perceived or real needs met.

We have created a monster that can become self defeating if all the providers are at great risk of high frustration and eventual burnout.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-52497 Anonymous Thu, 21 Apr 2005 20:56:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-52497 well, its all the fault of the system.<br/>its no longer patient care.<br/>its business<br/>its<br/>money<br/><br/>and apparently the schools here dont teach doctors to care for patients, they teach you how to handle LOADS OF PATIENTS....all for the interest of the business. <br/><br/>people dont sue for their right, they sue for money.<br/><br/>meds? ...money business <br/>hmos? ...$$$$$$ business<br/>anywho...<br/>what can we do now.<br/><br/>sulea din panduri. well, its all the fault of the system.
its no longer patient care.
its business
its
money

and apparently the schools here dont teach doctors to care for patients, they teach you how to handle LOADS OF PATIENTS….all for the interest of the business.

people dont sue for their right, they sue for money.

meds? …money business
hmos? …$$$$$$ business
anywho…
what can we do now.

sulea din panduri.

]]> By: Carstenhttp://www.kevinmd.com/blog/2005/04/liability-doctor-told-er.html#comment-52495 Carsten Thu, 21 Apr 2005 18:26:00 +0000 http://clients.emmense.com/kevinmd/2005/04/18189.html#comment-52495 I completely agree with everything said. I can't count the number of patients that tell me that their doctor told them to come to the Emergency Department. This creates the false impression that they have an emergency, when in reality they have a simple medical condition that could have safely been handled in the office the next day. Are primary care physicians no longer keeping a few appointment spots open for "urgent" visits? Must be much easier just to dump on the ER, but this is a very poor solution, since the massive influx of patients who really don't need to be seen in an Emergency setting just makes wait times longer and allows ED MD's to provide less than perfect care. Not to mention providing care in the ED is the most expensive by far - no wonder health care costs are spiraling out of control. And guess what it all comes back to? CYA, because of the lottery-based incentives of the tort system.<br/><br/>And the rant about the unscrupulous PR department reminded me of <a HREF="http://www.subaquasternalrubs.com/archives/2004/11/14/shift-report-exhausted/" REL="nofollow">an incident</a> I had working as an ED Tech where a father nearly became physically violent towards me. I completely agree with everything said. I can’t count the number of patients that tell me that their doctor told them to come to the Emergency Department. This creates the false impression that they have an emergency, when in reality they have a simple medical condition that could have safely been handled in the office the next day. Are primary care physicians no longer keeping a few appointment spots open for “urgent” visits? Must be much easier just to dump on the ER, but this is a very poor solution, since the massive influx of patients who really don’t need to be seen in an Emergency setting just makes wait times longer and allows ED MD’s to provide less than perfect care. Not to mention providing care in the ED is the most expensive by far – no wonder health care costs are spiraling out of control. And guess what it all comes back to? CYA, because of the lottery-based incentives of the tort system.

And the rant about the unscrupulous PR department reminded me of an incident I had working as an ED Tech where a father nearly became physically violent towards me.

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