I have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services.
Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a finger fracture that was threatening to derail a visit by my grandchild?
Well, not only was I billed for an exam that never occurred, but I was billed way too much — totally out of proportion to any value received. As a physician trained in emergency medicine, I received my board certification in 2001 from the American Board of Emergency Medicine. It’s pretty unlikely that I would feel the necessity to consult with a physician assistant. In fact, I said exactly that as I registered in the ED, hoping I would be able to obtain some relief from a digital block and perhaps, if appropriate, a reduction of the fracture. I was, at the very least, curious about the nature of the obvious fracture I had incurred. I asked to see a doctor.
I’ve already discussed this with peers. One did ask: “Why on earth would you go to the ED?” Well, frankly, I went on the advice of other colleagues, who suggested it was a good idea to determine the extent of the fracture — I didn’t get that x-ray vision with my medical school diploma — and some fractures truly need a hand surgeon. Again, a three-day weekend and the pain was significant; the last time I went to an ED was for a lumbar puncture, so it’s not my first response.
The PA failed to examine my hand. In my own residency, I would have been fired for failing to document a patient’s neurovascular status in the presence of a fracture — but I suspect he documented something and I’m going to get my records this week. I sat in the ED for 90 minutes, and no one bothered to ask me where my pain was on a scale of 1 to 10. The first sixty minutes, I would not have cared.
But after 90 minutes, my ibuprofen was wearing off, and it would have been nice to have someone ask — maybe a nurse? Even a ginger ale would have been welcome. As it ended up, I said: “I’ve been here 90 minutes, can I see a doctor? No one has even offered me a Tylenol for pain and I would like to see my x-rays.” The nurse or assistant, who knows, returned twenty minutes later with a prescription for 12 Norco and a poor reproduction of my x-rays on an 8 x 10 piece of copy paper.
For this, I received bills of approximately $1,500. The hospital customer service representative implied that if I had not been paying the bill personally, the charge would not have been disputed. Well, as a taxpayer, I think it’s time to start disputing these absurd charges. In this case, if any documentation of an examination was submitted, it must be fraudulent. The PA stuck his stethoscope on my chest, and I’m sure that increased the bill. As far as the finger exam, it didn’t happen; he never got within 2 feet of my finger. And I never got a reading of the x-ray, except for this: “It’s broken.” Really? I knew that before I got the x-ray. That’s why I came to the ED.
Unbelievably poor quality care, but it’s motivated me to keep a closer eye on health care costs, both personal and global. If we don’t pay attention, we have no one to blame but ourselves.
Karen Shackelford is an emergency physician.
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