A recent excellent piece by Dr. Karen Sibert, an experienced anesthesiologist at my institution, raised some critical issues regarding how physicians are thought of by non-physicians, and how misguided that thought process is. Indeed, our stress levels associated with the moves we make and the decisions we contemplate, some of which are made and done in milliseconds, do not come with a price tag, but do take a pricey toll. Every physician, from cardiac surgeons to breast radiologists to pathologists and pediatricians, recognizes the magnitude of cutting through bone, deeming something cancerous or benign, or sending a sick child home as opposed to the emergency room.
The Washington Post article to which Dr. Sibert refers berates and blames doctors as the source of ridiculously high medical costs, not the multi-million dollar salaried CEO’s who, while leading stressful lives, do not have the daily pressure of keeping extremely premature neonates alive, or getting a 70-something-year-old with advanced peripheral vascular disease off the OR table safely after a four-hour general anesthetic.
Not too long ago, The New York Times published an equally digging rant on medical finances. The author, Elisabeth Rosenthal, also happens to be a physician, one who no longer practices. Evidently, sometimes leaving medicine can enable one to completely lose touch with the reality of practicing medicine, especially emergency medicine.
In her article, Dr. Rosenthal teased apart seemingly fraudulent (yes, the word fraudulent was used) medical bills delineated by her husband’s experience following a bicycle accident. Indeed, much of the costs seem absurd: billing for physical therapy when said physical therapy never actually happened, getting charged attending surgeon fees when a trainee performs an emergency procedure, and the trimming a plastic cast later billed as a surgical procedure in and of itself.
But as a surgical specialist at a tertiary care medical center, I wholeheartedly disagree when it comes to some of her statements. I would hardly call a stabilizing cervical spine collar “medical swag,” as it if were an unnecessary item purchased on Rodeo Drive. Granted, her husband did not need it for long (lucky him), but not utilizing such “swag” can put a trauma patient’s entire peripheral nervous system at peril. Certainly worth the discounted $319 for one’s spinal cord integrity. Ask any attorney, and they will tell you — not using such a collar is below standard of care, and they will charge you $500 or more per hour just to tell you that.
Yes, ERs are settings for emergencies, but there is a drastic contrast between an emergency patient with a sprained ankle and one who gets taken to the trauma bay after a major bike accident, whereby ER personnel prioritize care, call in other specialists such as trauma surgeons, radiologists, anesthesiologists, neurosurgeons, and orthopedists, to name a few. This is costly, both from a human resource standpoint as well as from the standpoint of prime ER real estate. Trauma bays are not just regular ER rooms. While all of these specialists are on-call for such traumas, they are actually working with other patients during these events. They may leave office patients, delay elective surgeries, or get called in from home in the middle of the night for such traumas.
Yes, the purpose is for the ER to be “ready,” as states Dr. Rosenthal, but there are levels of readiness that require differing levels of care. Pulling out all the stops for a trauma patient is hardly fraud.
Nina Shapiro is a pediatric otolaryngologist and a professor, department of head and neck surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. She is the author of Hype: A Doctor’s Guide to Medical Myths, Exaggerated Claims, and Bad Advice – How to Tell What’s Real and What’s Not and can be reached on her self-titled site, Dr. Nina Shapiro, and can be reached on Twitter @drninashapiro.
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