Comments on: Don’t have a GI bleed on the weekend, and why you’re more likely to die on Saturday and Sunday http://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html#comment-90184 Anonymous Tue, 10 Mar 2009 02:24:00 +0000 http://clients.emmense.com/kevinmd/2009/03/dont-have-a-gi-bleed-on-the-weekend-and-why-youre-more-likely-to-die-on-saturday-and-sunday.html#comment-90184 "Patients don't choose the days they get sick." It sure seems like it somedays. Our ER gets flooded on Monday and Friday, then runs light on the weekends. We have a huge spike starting ~1700 when parents get off work (and the PCPs office closes), and on Sundays either after church or after a Cowboy game (during the game feels like protected time). I understand the morning ~0700-0800 jolt, but the others are kind of annoying. “Patients don’t choose the days they get sick.” It sure seems like it somedays. Our ER gets flooded on Monday and Friday, then runs light on the weekends. We have a huge spike starting ~1700 when parents get off work (and the PCPs office closes), and on Sundays either after church or after a Cowboy game (during the game feels like protected time). I understand the morning ~0700-0800 jolt, but the others are kind of annoying.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html#comment-90180 Anonymous Tue, 10 Mar 2009 01:53:00 +0000 http://clients.emmense.com/kevinmd/2009/03/dont-have-a-gi-bleed-on-the-weekend-and-why-youre-more-likely-to-die-on-saturday-and-sunday.html#comment-90180 We should just stop paying as much for procedures and pay cognitive specialties to cure the GI bleed with their pen. Everybody hates a specialist until they need one to bail them out. We should just stop paying as much for procedures and pay cognitive specialties to cure the GI bleed with their pen. Everybody hates a specialist until they need one to bail them out.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html#comment-90174 Anonymous Tue, 10 Mar 2009 00:40:00 +0000 http://clients.emmense.com/kevinmd/2009/03/dont-have-a-gi-bleed-on-the-weekend-and-why-youre-more-likely-to-die-on-saturday-and-sunday.html#comment-90174 Anon 12:45<br/><br/>With respect allow me to correct your terminology:<br/><br/>It is very cost-effective . . . the cost for saving a life is very very reasonable. The cost is far less than the value.<br/><br/>What it is not is financially worthwhile while for the doctor. The cost, which is a tiny % of the value, is deemed already too high to the third parties who pay for them to agree to a slight increase in that cost to make it pay for the doctor.<br/><br/>The real problem is that the "third party" who makes that choice aren't the ones getting the value. Anon 12:45

With respect allow me to correct your terminology:

It is very cost-effective . . . the cost for saving a life is very very reasonable. The cost is far less than the value.

What it is not is financially worthwhile while for the doctor. The cost, which is a tiny % of the value, is deemed already too high to the third parties who pay for them to agree to a slight increase in that cost to make it pay for the doctor.

The real problem is that the “third party” who makes that choice aren’t the ones getting the value.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html#comment-90171 Anonymous Tue, 10 Mar 2009 00:03:00 +0000 http://clients.emmense.com/kevinmd/2009/03/dont-have-a-gi-bleed-on-the-weekend-and-why-youre-more-likely-to-die-on-saturday-and-sunday.html#comment-90171 But I thought that the physicians today were the ones who worked long, hard hours during residency and aren't going to punch the clock?<br/><br/>Oh wait, that's just a line that they feed the residents when they're trying to milk them for all the time they can possibly get. The attendings aren't going to come in on the weekend. Bunch of crap. But I thought that the physicians today were the ones who worked long, hard hours during residency and aren’t going to punch the clock?

Oh wait, that’s just a line that they feed the residents when they’re trying to milk them for all the time they can possibly get. The attendings aren’t going to come in on the weekend. Bunch of crap.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html#comment-90165 Anonymous Mon, 09 Mar 2009 17:45:00 +0000 http://clients.emmense.com/kevinmd/2009/03/dont-have-a-gi-bleed-on-the-weekend-and-why-youre-more-likely-to-die-on-saturday-and-sunday.html#comment-90165 "They have very little motivation to get involved in Saturday night urgencies at high risk and minimal reimbursement."<br/><br/>Ultimately, it is not cost effective to do emergency GI procedures on the weekend. Perhaps we should just cut our losses and quit pretending that someone's life is really worth more than money. “They have very little motivation to get involved in Saturday night urgencies at high risk and minimal reimbursement.”

Ultimately, it is not cost effective to do emergency GI procedures on the weekend. Perhaps we should just cut our losses and quit pretending that someone’s life is really worth more than money.

]]> By: jbhttp://www.kevinmd.com/blog/2009/03/dont-have-gi-bleed-on-weekend-and-why.html#comment-90164 jb Mon, 09 Mar 2009 17:07:00 +0000 http://clients.emmense.com/kevinmd/2009/03/dont-have-a-gi-bleed-on-the-weekend-and-why-youre-more-likely-to-die-on-saturday-and-sunday.html#comment-90164 What can be done to "rectify this statistic" is to restore some market economics to medicine. Real tort reform will help also.. Years ago, there were actual CPT codes that were used to compensate docs for after hours work. If a doc came from his office or home for an urgent situation, there was a code for that. After hours, a different code. After midnight, another code. Use of these codes went a long way to compensate the doc for the inconvenience of interrupting whatever he was doing to tend to the patients with urgent needs.<br/><br/>Today, an upper endoscopy done in the hospital pays ~$130, add $100 if a bleeding source is found and controlled. There will be another $100 or so for a consultation. No increase in compensation to account for the interruption of other activity, increased risk, and inconvenience. <br/>The only way to earn a reasonable wage doing endoscopy is to be able to do a dozen or so in a morning. It's just not reasonable to expect a GI specialist to spend a couple of hours in the middle of the night or on a weekend trying to stop a bleed under terrible conditions- in the ICU, poor lighting, support staff not optimal, all for a couple of hundred dollars. The patients are sick and frequently unstable, outcomes are poorer, and lawsuits are more common. <br/>Most GI docs earn a comfortable living doing elective procedures, many in their own profitable endoscopy suites. They have very little motivation to get involved in Saturday night urgencies at high risk and minimal reimbursement.<br/>Tort reform and free markets will save lives. What can be done to “rectify this statistic” is to restore some market economics to medicine. Real tort reform will help also.. Years ago, there were actual CPT codes that were used to compensate docs for after hours work. If a doc came from his office or home for an urgent situation, there was a code for that. After hours, a different code. After midnight, another code. Use of these codes went a long way to compensate the doc for the inconvenience of interrupting whatever he was doing to tend to the patients with urgent needs.

Today, an upper endoscopy done in the hospital pays ~$130, add $100 if a bleeding source is found and controlled. There will be another $100 or so for a consultation. No increase in compensation to account for the interruption of other activity, increased risk, and inconvenience.
The only way to earn a reasonable wage doing endoscopy is to be able to do a dozen or so in a morning. It’s just not reasonable to expect a GI specialist to spend a couple of hours in the middle of the night or on a weekend trying to stop a bleed under terrible conditions- in the ICU, poor lighting, support staff not optimal, all for a couple of hundred dollars. The patients are sick and frequently unstable, outcomes are poorer, and lawsuits are more common.
Most GI docs earn a comfortable living doing elective procedures, many in their own profitable endoscopy suites. They have very little motivation to get involved in Saturday night urgencies at high risk and minimal reimbursement.
Tort reform and free markets will save lives.

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