1) Panda Bear suggests that ED physicians are upset when the default PCP telephone advice is “go to the emergency room”.
My take: Over the phone, it is impossible to obtain an accurate clinical picture. You can’t visually assess the patient and the chart is often unavailable, leading to zero context for the symptoms. If someone calls with a “headache”, the causes can include things like sinusitis, migraine, tension headache, or a brain hemorrhage. No way to conclusively tell over the phone. If it turned out to be the latter, you can bet that the lawyer grilling the PCP on the stand would ask, “Why didn’t you send the patient to the ED?”
Just as some ED physicians’ default plan for bogus low-probability chest pain is “admit, rule-out MI”, some PCPs advise everyone over the phone to go to the emergency room.
Panda, you know this is simply another form of defensive medicine. We both know what game is being played.
2) WSJ op-ed: “Making health insurance more affordable would be a lot easier if they [politicians] would stop legislating what it has to cover.”
My take: You can’t have a Cadillac for the price of a Hyundai. Politicians are pressured to include everything in their mandated health plans. Chiropractors, wigs for cancer patients, massage therapists and naturopathic practitioners are “must-haves” in health plans for a number of states. While those options may be nice, they also drive up cost, making plans less affordable.
Lowering health plan costs is the surest method to ensure the greatest amount of coverage. Stripping down some of the “benefits” health plans are mandated to offer would be a good start.
Hyundais are good cars too, and sometimes that’s all you really need.
Related posts:
- Unintended consequences of mandates
- Holding doctors hostage for universal care
- Niche Market: Truckers
- Telephone medicine
- ER visits and health care costs rise in Massachusetts due to lack of primary care access
- Primary care shortage
- The cost of “free” healthcare redux
{ 11 comments }
Kevin –
Really like these little snippets. Keep them up!
Agree that focus of insurance should be more on what is being covered and less on the deductibles. Perhaps an “a la carte” approach rather than a “buy everything and negotiate your deductible” approach?
-WC
is he upset that they can’t be squeezed into an already triple overbooked schedule or upset that they don’t call and discuss? my filter has blocked his site from reading his comments.
I agree, these snippet / comment posts are great.
When you strip down the plans though, then you get the guy who complains about how it costs $45 to come see you and $40 for his biopsy and $25 dollars for the presciption.
Patients can’t have it both ways. If you buy a stripped down plan to save on your monthly premium, then you are going to have to reach into your pocket to pay when you receive a service.
Kevin,
If you read Panda’s post he is not really deriding PCP’s at all and acknowledges that they don’t have time to see all the crap either. I think he is more just saying that it is what it is.
Given all the patients that get admitted from ER’s with no evidence of any effort make a judgement call, I don’t think he can really complain.
I agree. I just want a plan to pay the really big expenses and don’t want coverage to see quacks and witch doctors–but in my state I have to pay for it.
Lets put the “free” back in “free country”
Kevin, how many times has a doctor been sued for an incorrect phone consultation?
In fact, why would a doctor ever GIVE a phone consultation? Even absent the nonsense claim of “defensive medicine”?
The “Go to the ER” debate in interesting. I know when certain PCP’s send their patients to the ER (usually at night or weekends), it is often a dump. The patient is very annoying and I know the doc just wants to get rid of them. Others are the complete opposite – they always try to handle nonemergent conditions on the phone before sending them in – and when they do, the findings or history completely back up the decision to send them in. Just like some PCP’s are almost helpless without the teaching service and call a million consults. Others can handle most things themselves and only call consults when there is a good reason. It clearly is a quality issue. There are good and there are bad PCPs. Just like there are good and bad ERP’s (I know because one of my colleagues is pretty bad!).
Hyundais are good cars too, and sometimes that’s all you really need.
Important correction: It’s rare that anyone ever needs anything other than a Hyundai to get from one place to another. It’s just that folks understandably want the Mercedes ride. This is especially true when someone else is paying for the Mercedes.
The cure for our health care problems: Create a Hyundai quality tax supported health care system. Basic transportation, no requirements for excessive documentation, possibly generic meds only, liability for gross negligence only, no payment for bad outcome. It will get you to your destination just as fast as the Mercedes. I suspect that overall outcomes would be no worse than the current system, although there would be well publicized occasional spectacular failures.
People who want the Mercedes would be welcome to go to the Mercedes dealership and pay cash.
jb is exactly right, except instead of liability for gross negligence only, just make it strict liability, likes workers comp.
This issue cannot be addressed until a baseline of care is established for what the government is paying for.
CJD
I’ll accept strict liability if it’s limited to paying for whatever is required to fix/ameliorate the results of the bad care outcome. Pay for the extended hospitalization, additional surgery, loss of wages, physical therapy. No payment for pain and suffering, loss of consortium, loss of chance for cure. Some payments would go up, of course, but just about all payments would go to the patient. No need for lawyers, except to help fill out the paper work in questionable cases. Can CJD accept that?
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