Woman billed $700 after sitting in ER waiting room for 7 hours, leaving without treatment

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  1. I've been slowly getting rid of my clinical shifts, and this makes me want to get rid of all of them. As an ED doc, I always imagine trying to grab people as they are trying to fall off a cliff. Having the training and willingness to be there when tragedy happens is what we signed up for. To be personally liable for that tragedy does not seem reasonable.

  2. Starter comment: I posted this first over in emergency medicine but wanted to share it here as Envision covers multiple service lines. A while back, they had talked about debt restructuring, and this is another step in the wrong direction. I have not heard anything from leadership about this yet, and I am interested in others' thoughts about what this would mean for employed physicians.

  3. I'm just a dumb ED doc, and understand some of these words, but it sure seems like many people tried quite diligently to save a life and to do the right thing.

  4. Med Onc here, we often do not act on "favor" in a pathology report unless a repeat biopsy is unfeasible, although sometimes we will if the clinical scenario is very straightforward or urgent. I find that pathology is less like radiology in that they are more likely to call it what they see and not list a differential for what could be going on, so when they DO list a differential that is usually a signal of "hey we aren't 100% sure here" although they often will hedge with "suggest repeat biopsy or obtain further tissue" which doesn't seem to be the case here.

  5. Ohh that’s fascinating. Today I learned.

  6. Without a drastic change to the organization of physicians, the long term career prospects are not good.

  7. Unless you’re running blinded trials, you as a physician are almost as susceptible to anecdotal evidence, confirmation bias, and placebo effects as your patients are. This is why homeopathic doctors believe what they do works. You are not objective (none of us is)— that’s why we had to invent very cumbersome and expensive RCTs so we don’t delude ourselves.

  8. This is such an important comment. Covid showed how poorly even physicians understood or could incorporate statistics into their practice. If you have a panel or 100 covid patients and give them each a cap full of bleach and only one died, that did not mean that you helped 99 of your patients. If you give them your homeopathic bullshit (that you sell for cash), and 99 survive, you did similarly did not provide a therapeutic that did anything. OP if you want to call yourself evidence based, gain an understanding of the literature and a working knowledge of statistics and look at what is out there. You are not the first person to consider if the alternative medicine you mention has utility. Turns out however, it does not.

  9. Increased complexity, increased liability, decreased pay through my career, less autonomy. I’m treated like a cog and when issues arise that cause true patient safety issues I am helpless to fix them despite being ?responsible when shit goes wrong. Yea no. I’m out of clinical medicine. Recently I spoke with another ER doc who transitioned into research and despite not knowing them, we were like old friends and had the same gripes and sadness at leaving bedside medicine. Not to pat myself on the back, but when your dying loved one comes into the ER, I’m the sort of doc you want there. Yet despite that.. I won’t be because this system is so completely fucked.

  10. Reach out to the folks at emrap. I would imagine they would lend you access to their database which is great for everything emergency medicine.

  11. I would say that the biggest contributor is loss of autonomy in practice.

  12. I agree with everything you say. I would emphasize that we are not supported by our employers or systems. This has been the case since I've been an attending but became much more apparent during the pandemic when hours and benefits were cut, when masks were taken off our faces, when we got sick and were told that it must have come from community spread - not the mass of covid patients coding and being intubated.

  13. Well said. I'm an MBA (complete) and in law school... but I am curious how you decided on a PharmD/JD. I thought my career path was out of the ordinary, but yours must be fascinating.

  14. What is your plan with MBA JD? Must relate to medicine to be here.

  15. At what point do we get any power back in our profession? I’m sad to be leaving clinical medicine but this sort of shit is insane and I don’t see it getting better.

  16. I'm keen on leaving clinical medicine, but other than teaching and research not sure what else is out there for doctors. Can I ask what you are aiming to get into?

  17. Research with pharma with plan to transition to the business side. It has tons of room for growth and advancement. I expect it will become more competitive as people look for more outs from bedside medicine.

  18. Thank you for the reply, I'm wondering where do you look for jobs such as that? I've tried linkdin and seek, but haven't found much. In addition many of the pharma jobs require you to have your letters, which I don't have yet. I'm not junior but just not keen on the ongoing slog to finish.

  19. I looked into a few jobs and had recruiters reach out to me about others before the right one came up. Research seems to be a certificate and title heavy field. I have an appointment at a university, and am fortunate to have a reasonable number of publications despite primarily working community ER and I think that’s what caused me to get noticed places such as LinkedIn. When looking for jobs for research “investigator” is a term you may want to use. When looking for tech, don’t be afraid to look for CMO positions. It’s not the same as what you think of as a hospital CMO. There were a lot of opportunities for pay i wasn’t willing to take, but eventually something did come up that was equivalent and I couldn’t be happier.

  20. Both glide scope and cmac have standard geometry blades as well as hyperangulated blades. With hyperangulated you should make sure you also order the correct stylets (like Saturn). McGrath also makes a standard geometry blade with hand held screen. I personally prefer cmac titanium as it seems to be the most rigid and functions most similar to traditional DL with an awesome screen.

  21. Lots of residents on here who don’t know s*t about either economics or staffing. Movinmeat has the best take, we don’t really know yet. The biggest issue was volume loss from the pandemic. I’m hiring back physicians and am not increasing APC’s - plus I have so few qualified APC’s, I’m not sure that I could even if I wanted to. Most of the APC’s are NOT going into EM, btw. Residency applications are also dropping ( although not sure if there is enough data to see if that holds ), and lastly if you can PERFORM you will be fine. Gone are the days when you sit on patients and sandbag your colleagues - no one talks about that change. A good number of people I have hired from older respected programs ( especially the SE ) can not move patients and admit everything from a stubbed toe to a sore throat- all with the adage ‘just to be sure’. It’s not just the new programs, the old ones are not doing much better

  22. Regarding your knowledge of economics and staffing - how many PPH does one of your docs need to see to pay for themselves?

  23. This is an awesome and eye opening article. The question I have is.. what do we actually do about it? I am part of AAEM as well as a committee member. I just.. don’t know what we actually do?

  24. I’ll leave this here though this thread has taken off and likely will be buried:

  25. Have you considered direct primary care? There are a few here and so far the consensus is the patients love it.

  26. Considered similar things but problem is that it very difficult to switch specialities. We go through years of training and testing to end up in a speciality. I’m a board certified emergency doc, not primary care. Some of the routes people do go seem at times a little unethical. Med spa, teledoc, or simply practicing outside of your training (which is legal but again quite unethical from my view). There are other things to do other than bedside medicine though, but options are limited and those of us who can get out of this system are few.

  27. I’m happy to see an article like this calling out ACEP for selling out as it has. Ever been to a conference? It’s pretty obvious who’s exploiting us.

  28. But that’s what it’s approved to do. Even the company itself says there is no evidence of efficacy against COVID so as it stands, it’s still just an anti-parasitic.

  29. See my edit. There are human indications. I am absolutely against ivermectin as a treatment for covid. This ruling and case is abolutely insane. I'm just pointing out that calling it a horse dewormer is not helpful in persuading people out of the false beliefs they have developed at this point.

  30. Well, let’s be honest it works for human deworming too. I think the reason they say that though is to highlight that it’s current use isn’t really related to anything like COVID so people should be very careful.

  31. Pointing out that it is useless in Covid would be the better argument. CNN or anyone else saying it is a horse dewormer silos people.

  32. Sure the optics are egregious, but since when do frontline workers get to care about politics?

  33. Agreed. That being said I think there is a debate to be had. I don’t honestly know which side I fall on. I believe Justice is the particular principal which applies. I’m sure there would be ways to argue for both sides. As you mentioned, one group is at higher risk. However, as with other situations such as liver transplants, we also give the limited resource to those who are most likely to comply with therapy and achieve the best long term outcome.

  34. we treat drunk drivers and murderers and child molesters, no questions asked.

  35. I get where you are coming from and generally agree with the sentiment that we care for anyone anywhere with anything. However, there seems to be to be some difference in this case between the scenarios. It is the problem with treating situations that are related but different with universal rules. This pandemic is not drunk driving. The approach to each need not be the same or equal in order to ensure the best outcomes. Also I think we are all just tired of the constant conflict with patients and families. Conflict that is there before we even walk into a room to establish care. It makes the relationship and care of these individuals extremely difficult. And we all only have so much to give before we get burnt out. Which it seems we are all doing in droves.

  36. I think it's important things be framed scientifically. Just saying you have more training doesn't mean much unless results are shown to differ.

  37. I disagree. Not everything needs to be studied to know there is a difference. I don’t need a study to tell me how comparable the NP from clinic is to a physician when they send patients to the ER with completely mismanaged chronic conditions with an SBP of 180 to “rule out stroke.” Studies that show a NP caring for otherwise healthy 20 year olds showing no difference in outcome is not demonstration of equivalence in outcomes across the board. Comparing NP education to a hypothetical MD+ degree is like comparing a blanket to a parachute for skydiving safety.

  38. FSEDs however are frequently not in some small critical access area. This one for instance was extremely close to the hospital. Per the report it took EMS less than an hour to arrive, get an LMA in, and get the patient to the cardiac center. There is pretty much no reason for it to exist except to bill patients as much as possible.

  39. Reading through this, I find this more of a reflection of the dangers of FSED than true malpractice of the physician. I am not a fan of the FSED model as things like this can and do happen in a facility with limited resources and backup. I agree with the articles commentary that the expert testimony is not very strong.

  40. It’s different because the patients views, demands, and attitudes are different. I have never had more conflict with patients over anything else before. I can generally have a good discussion with a parent about the harm and lack of benefit for antibiotics for a viral uri their child has. With covid there is no changing any patient’s mind excuse they have set beliefs based on misinformation. So have enough family and patients yell, swear, and threaten you and yea.. I’m fucking upset at these hucksters who are daily making my shifts suck.

  41. People don't flee the field because of an inability to pay student debt. People are fleeing the field because we are treated like absolute shit at every level. By patients. By family. By administration.

  42. You are spot on. I love my bedside nurses and it’s so hard of see many of them leave. I can’t do my job well without them and it’s so sad to see them go. I’m on the same page as you, actively working on my out from medicine. I don’t see it getting better. Pay will go down. Metrics will go up. Patients will become more complicated and time consuming. We will never have admin standing up for staff in meaningful ways and will be continue to have lectures about how we need more resilience.

  43. Short sighted. As has been talked about again and again, midlevels have worked hard to alienate the actual experts. This won’t end well for the midlevels who are actually working, for patients, or for healthcare in general. What started off as collaboration, shifted to eye rolls but acceptance, will soon turn into outright hostility from physicians.

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