a highly suggestible setting

How stupid! Why didn’t I just phone my internist or the person taking calls for him? When I didn’t do that and went to the ER instead, why didn’t I just answer the first physician, ‘No, that’s not necessary,’ when she suggested referring me to a couple of specialists?

In most settings, the doctor has far greater incentive than disincentive to order excessive services — that is, those that aren’t indicated by practice guidelines or evidence-based medicine. – Jack Coulehan in Health Affairs, reprinted in the WaPo

This reminds me of my own ER story.

I travel a lot for work. A few years ago, during a convention in Denver, I began feeling a little ill. I called off the evening plans and went to bed early. The next morning, I had incredible nausea which ended with projectile vomiting — think “Ren & Stimpy.” It was actually kind of funny, in the few clear-headed moments I had. All throughout the day, I attempted the usual things (principally ginger ale) but couldn’t keep anything down at all. By the end of the day, I was beyond lightheaded — I’d now gone 20 hours without fluids, my abdomen was sore from all the retching, and in the most recent episode (at a bagel shop) I’d noticed flecks of blood amidst the soup. I needed fluids, and fast. I somehow managed to pack up what I was doing and told a cab driver to take me to the nearest hospital.

That hospital turned out to be Denver Health, the recently privatized county general hospital — but still the city’s primary safety-net provider. (Where I was on 17th was actually a bit closer to St. Joseph’s or St. Luke’s, it turns out, but the drive down Speer is faster.) I walked into the ER and waited as the triage nurse saw patients. He was doing an admirable job: although his Spanish was no better than mine, he maintained his composure far better than I would’ve in the face of a parade of misery that included gunshots and gangrene among other ailments. Quite a lot of them looked to be in much worse shape than I, but when I was called up I pretty quickly gained admittance to the ER. I suspect that I might have been turned away had I been just another one of the uninsured out there.

Once in, I did get an I.V. drip for fluids and a couple pills of a strong antiemetic; after a brief nap, I felt okay. Yet the attending physician, not seeing any obvious cause for this, said that perhaps the abdominal pain was from appendicitis (when no, it was just sore after spending a day violently vomiting) and that a CT scan might be in order. Even at that moment, I highly doubted it, but ended up playing along. Soon after the CT scan, I was discharged and told to follow up back at home in a week. Several weeks later, I get some confusing statements from my insurance which clearly say “do not pay” — and soon thereafter, a notice from a collection agency, even before I was instructed to pay anything. Since I was out of state, the reimbursement rate was lower than it would have been at home, and that pointless little trip through the CT cost me $1,000.

Contrast this with my most in-depth experience with a single-payer system of sorts: Kaiser Permanente. A month before I left for college, my brother and I went mountain biking on some trails near home and I endo’d on a downhill — braked too suddenly up front, flipping myself over the handlebars, and breaking my right collarbone upon landing. (This is a common injury among cyclists, since the clavicle is a pretty wimpy bone.) I didn’t know it at the time; all I knew was that I couldn’t really move my right arm, and therefore couldn’t bike out of the park. We walked our bikes along a few miles of equestrian trails — the most direct, if muddy, way back out. It just happened that the Kaiser medical center was not far from the park entrance, so we stumbled in — bloody and smelling of horse shit — scanned the little ID cards that brought up our records, and waited a little while. I got called from the waiting room, got a bit of cleaning up and an X-ray, and got a bit of joking from the staff as they pointed to the fracture. There’s not much one can do about a clavicle, anyhow, but what was equally notable was how there weren’t huge bills afterwards. Our premiums (and co-pays) covered basic services like, well, X-rays for broken bones.

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3 thoughts on “a highly suggestible setting

  1. If you haven’t already, you might want to check your free credit report to make sure that collection agency isn’t showing up on there. You can contest it and get it removed. I had a similar billing confusion, and my credit score jumped quite a bit when I had them correct the collection confusion.

  2. I had the same issue with my sinus surgery a couple of years ago. The hospital gave several of its contractors bad address information for me, so I never received a number of bills before the collectors came calling. I paid it all promptly, but it sucked. And of course, it sucked even more that I had insurance that didn’t cover a dime of the surgery because it was for a pre-existing condition. Crooks.

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