Medical people: your thoughts?

[bostjan]

So, this incident was in the news the other day:



...and the way the news is reporting it doesn't sit right with me.

Obviously, I don't know all of the details here, but there is enough in the video that I think I get the gist of the situation.

This guy is in the ER because he had an anxiety attack. The ER doesn't treat anxiety attacks. Immediately there's an impasse. I think those things are easily falsifiable and really not open to much interpretation... so here's my opinion, maybe I'm way off base, though.

I think that the ER doc is probably someone who sees a lot of people coming in to get a fix. The opioid epidemic is still in full swing, and I am pretty sure that ER docs are trained to not give out narcotics unless someone really needs them.

I think that this guy earnestly wanted treatment for anxiety and simply didn't know that going to the ER for such, in 2018, was probably not going to be productive for him. But where I'm totally not sure is what he specifically expected.

I think that when you go to the emergency room for treatment, you should not expect a mint on your pillow, so to speak. People go to the ER because of severe trauma, like a car accident, shooting, stabbing, accidents with heavy equipment, etc. People go to the ER to not die when they are about to die, basically. If I go to the ER with an earache or something, maybe, for me, in that moment, I can't think of anything more productive, but again, I shouldn't expect the ER doc to stop treating the guy in the next hospital room over, who was just impaled by a fork truck, in order to come look at me with my non-life-threatening issues.

So, I'm not saying anyone in the video is acting in any way that deserves a medal, but I really think that the patient is in the wrong here. I think that the ER doc could have been a lot more polite, but this is an ER doc, not the head waiter at a french restaurant. I wouldn't be in a very good mood either after a sixteen hour shift of blood and guts.

Furthermore, if the wait to get treatment in the ER was 4 hours, as claimed in the video, then firing another critical person staffed there is only going to exacerbate the problem. Again, if my arm was mangled in a horrific car accident, I'd rather see the rude ER doc than have to wait eight hours to see a doctor with a pristine bedside manner.

I guess I'm wanting someone to change my mind about all of this, partially because, after reading people's comments and reading the reports on this incident, I feel like I missed the boat on why this doctor needs to be let go or even reprimanded for the incident.

 

[Mike]

I agree with you.

 

[bostjan]

I agree with you.

Ok, it seems like you're the first person I came across who felt that way, so now I feel a little less crazy, at least.

 

[Mike]

I mean maybe it's just because I'm a little tougher skinned and don't see her actions as abuse. Maybe a little unprofessional and unsympathetic to his plight, but not worthy of being fired and drawing the pitchfork reactions I see from people's comments all over the different uploads of that video.

I had anxiety, panic attack issues when I was younger and as shitty as they are, you're not going to die and they don't warrant a trip to the ER. As she said and as you alluded to, there's much sicker patients/people in actual need of emergency attention waiting and this guy is just a time waster, potentially someone just lookin for some narcos.

If he is having these episodes of anxiety since they mentioned it happened before, then he needs to see a psychiatrist or a family doctor that can treat him properly.

 

[KnightBrolaire]

1. If he's having an anxiety attack it'd be super apparent. He'd be hyperventilating, pulse would be through the roof, sweating profusely, probably show signs of nausea/dizziness as well. Those are the most common symptoms of an anxiety/panic attack. The patient is relatively calm, he's not hyper ventilating, he's not sweating profusely, or showing any of the common symptoms. That alone is a red flag imo. The combination of that with the fact that he's claiming he can't move from the bed (but he can apparently move his arms and head just fine) is also a red flag. People generally don't magically lose muscle function, especially from a panic attack. His claim about "not being able to inhale" is utter bullshit. His "O2 saturation is 100%" which means he's more than adequately oxygenated, and doesn't need to be on oxygen. To quote one of my old NCOs: "if they're talking, they're breathing, and if they're breathing they ain't dead."

2. We do triage all the time in the ER, which means that unless something is threatening life, limb or eyesight, patients like that guy in the video get seen after any higher priority patient. They put him on oxygen to help subside the hyperventilating/calm him down. The only kind of meds I'd be giving him are maybe a benzodiazapene or whichever generic anti-anxiety medication he's already prescribed. As far as the pain, he's never going to get anything stronger than maybe ibuprofen if I was treating him.

As far as the Doctor's attitude, this is relatively common in the ER. Having to regularly deal with tweakers, obnoxious helicopter moms and anti-vaxxers or other people who waste our time/resources makes it even more common. Granted, it wasn't the professional way to approach the situation, but I understand her feelings, having been in similar situations myself.
The patient needs to get the hell out of the ER so they can focus on helping people with real problems. That's at least part of why the doctor is so mad, since he's taking up valuable real estate/resources that can be used on actual emergencies.

 

[Dcm81]

I too, find that the Dr. is in the right. It's the damned EMERGENCY room, not the boo-boo room. And if people start getting repramanded or worse because of a lack of politeness and rightfully getting pissed by ignorance then I see a massive wave of unemployment in the near future.

So they go to the ER to refill his medication which......"ran out"? If you've got such a severe condition, why in the fuck would you not make absolutely sure, that you always have enough? Since when is the ER the go-to place for mental conditions?
"I can't sit up" but can yank his arm away when she tries to pull him up.
"I can't inhale" but he's talking perfectly normally.

Move along, nothing to see here. For a SJW on the other hand it's a goldmine.

 

[vilk]

For a SJW on the other hand it's a goldmine.

Sorry, I'm having some trouble figuring out what this scenario could have to do with social justice? Maybe you could clarify?

 

[narad]

+1 for the doctor.

 

[bostjan]

Sorry, I'm having some trouble figuring out what this scenario could have to do with social justice? Maybe you could clarify?

Lots of people are up in arms about the video I posted, citing patients' rights, health care being a basic human right, or even saying that this is a race issue. I don't think any of those are not issues worth discussing, but I think there is no evidence that any of those things can be used to argue that this health care employee committed some sort of cardinal sin. Patients should have rights, but the right to receive treatment from a hospital department that has nothing to do with your ailment is not a thing that exists. Health care should be affordable for everyone, but there's no basic human right to stay in a hospital bed and get prescription narcotics when you have been diagnosed to be in need of neither. And I don't see where this doctor brought race into this in any way - I would expect a person of any race behaving this way to potentially be treated exactly as these men were. Furthermore, I wasn't even aware of what race or culture with which these two men identified until the news articles pointed it out.

 

[vilk]

Lots of people are up in arms about the video I posted, citing patients' rights, health care being a basic human right, or even saying that this is a race issue. I don't think any of those are not issues worth discussing, but I think there is no evidence that any of those things can be used to argue that this health care employee committed some sort of cardinal sin. Patients should have rights, but the right to receive treatment from a hospital department that has nothing to do with your ailment is not a thing that exists. Health care should be affordable for everyone, but there's no basic human right to stay in a hospital bed and get prescription narcotics when you have been diagnosed to be in need of neither. And I don't see where this doctor brought race into this in any way - I would expect a person of any race behaving this way to potentially be treated exactly as these men were. Furthermore, I wasn't even aware of what race or culture with which these two men identified until the news articles pointed it out.

I was being a little bit sardonic in my comment, because as you have well described here, this scenario does not ostensibly have anything to do with social justice.

 

[MaxOfMetal]

About 1/10th of this country has no medical insurance and as many as 40% that do are "under covered". Throw into the mix that almost half of households in this country can't afford a unexpected expense of $400.

Emergency rooms are now a significant portion of this country's only option.

 

[Rawkmann]

This situation happened to my cousin once after he suffered his first panic attack at work one day. He wanted to be taken to the the ER because he was scared he was having something like a stroke or heart attack at the time. After he got there the staff did nothing more than treat him like a hardcore drug addict out to score a fix (he’s most definitely not that type btw). We are always told to seek out treatment at the first sign of medical emergency so it seemed troubling to me that he was met with the kind of cynicism and disdain he received that day. I don’t know the entire story of the gentleman in the video above but based on someone’s account whom I implicitly trust I don’t like what I’m seeing.

 

[vilk]

About 1/10th of this country has no medical insurance and as many as 40% that do are "under covered". Throw into the mix that almost half of households in this country can't afford a unexpected expense of $400.

Emergency rooms are now a significant portion of this country's only option.

Pardon my ignorance here but...

...aren't Emergency Rooms basically the most expensive way to see a doctor?

What happens? Do you just amass a huge debt and have your wages garnished? I guess I'm not sure why the ER is the only option. It seems like it ought to be the last option for someone who doesn't have health insurance on account of that it's the most expensive. I mean you could just go to a normal doctors office, take the fees without insurance, and ultimately the end result is the exact same? or will most doctors and clinics not even see someone unless they have insurance? <---that's gotta be it because otherwise this makes no sense.

 

[MaxOfMetal]

Pardon my ignorance here but...

...aren't Emergency Rooms basically the most expensive to see a doctor?

What happens? Do you just amass a huge debt and have your wages garnished? I guess I'm not sure why the ER is the only option. It seems like it ought to be the last option for someone who doesn't have health insurance on account of that it's the most expensive. I mean you could just go to a normal doctors office, take the fees without insurance, and ultimately the end result is the exact same? or will most doctors and clinics not even see someone unless they have insurance? <---that's gotta be it because otherwise this makes no sense.

Most private doctor's offices will not see you unless you provide proof that you'll actually pay them.

Emergency rooms will take anyone*.

You're correct, the emergency room isn't cheap. Which is why "medical debt" accounts for over 60% of personal bankruptcies in the United States.

 

[bostjan]

That's the problem with treating medical treatment as a basic human right within a socioeconomic system based on free enterprise, economic liberty, and capitalism. The ideas simply don't jive with each other.

In a free enterprise economy, if I need a service from someone, the first question is how much does it cost. If I go to the ER and ask them how much it'd cost to fix my medical problem, they aren't even going to begin to know the answer to that.

So, if you are going to have free enterprise, then, no services are free unless the service provider wants to make them such. But...medical supplies are very expensive, medical insurance is expensive (for providers), medical school is expensive...so who foots the bill for all of that. The entire idea has to be fully baked or else it isn't going to work, long term. Single payer options where the public foots the bill is just going to make taxes unaffordable as everyone crowds the ER for their sinus infection every year.

This situation happened to my cousin once after he suffered his first panic attack at work one day. He wanted to be taken to the the ER because he was scared he was having something like a stroke or heart attack at the time. After he got there the staff did nothing more than treat him like a hardcore drug addict out to score a fix (he’s most definitely not that type btw). We are always told to seek out treatment at the first sign of medical emergency so it seemed troubling to me that he was met with the kind of cynicism and disdain he received that day. I don’t know the entire story of the gentleman in the video above but based on someone’s account whom I implicitly trust I don’t like what I’m seeing.

I've heard it before as well. Like I said, there is an opioid epidemic. I can't say what % of people going into the ER are looking for a score, but I guarantee it's enough that ER staff are often trained by hospitals to be conservative in judging who needs pain meds and who doesn't.

I'm not a fan of pain, but, frankly, pain meds don't help a person, in most cases. During surgery, sure, but other than that, it's doubtful. Pain doesn't kill people. In fact, not being able to feel pain is very dangerous. But anyway...

You go to the ER describing chest pains or whatever, I guarantee they are going to check your heart. The EKG costs them a lot of money to keep on their campus, and they need to use it in order to justify having it, and also they charge you a lot of money if they use it on you, so I'd be shocked if they didn't check your cousin's heart. But, really, once they check your heart and maybe a dozen or two other things, and rule out anything they can treat, what are they supposed to do?

I realize no one who feels off wants to hear "go home, you are fine." Obviously if you thought you were fine, you would not be in the ER, but once you are in the ER, you have to trust that, when the ER staff says that they cannot treat you, it's time to leave the ER. Assuming that they know what they are doing, you should take their advice, and assuming that they don't know what they are doing, you should go somewhere else. Even if there is no place else to go for treatment, staying in the ER when the ER staff tells you that they cannot treat you is not going to be productive.

Your cousin isn't the type to try to score a drug fix by going to the ER, but does the ER staff know that? Was he asking for a pill to fix his anxiety? I mean, I'm sounding like a broken record, but the ER is not the PCP, it's the ER. Their job is to determine how to deal with medical emergencies, and a huge part of that is determining what constitutes a medical emergency. If druggies are coming to the ER to get drugs, and you go to the ER for something that the ER doesn't and can't treat, then what should happen? How is this handled best?

We seem to be completely unable, as a culture, to solve problems. There is a simple method to problem solving at a high level that we Americans have no grasp upon whatsoever:

1. Define the problem.
2. Define the current situation.
3. Define the desired situation.
4. Brainstorm steps to go from the current situation to the desired situation within the framework of the problem definition.
5. Evaluate the ideas from step 4 and perform trial and error, starting with the most obvious and cost effective solutions first.
6. Repeat until the desired situation is attained.

We're hung up on step one, when people skip to step three right away shouting "Free health care for everybody!!!!"

The problem here is that health care is unaffordable, not that it isn't free. It's unaffordable because, in our current situation, insurance rates are killing the industry. Providers are paying an average of over $100k USD per year in insurance! That means that if your doctor is making $200k USD/year, half of what he or she is earning goes right to the insurance company. Customers are paying over $10k/year on insurance premiums. Health care in the USA is more than twice as costly as it is in the next most expensive country! How is this not the main problem?! It seems we ignore the statistics and go straight for the "I can't afford health care" -> "health care should be free for everyone," for some inexplicable reason, instead of trying to find the root cause.

I know it's come up here before, and a few people will vehemently disagree with my assessment being on insurance companies, but the USA pays $3.2 trillion USD in health care per year. The average medical insurance company makes between $6 billion USD and $13 billion USD in net profit per year, and those profits are on track to continue increasing up to 30% per year. Hospitals, in total are making about $20 billion USD. So 2-3 health insurers make the same profit as the sum of all hospitals in the US. Does that seem right? I don't think it does.

 

[vilk]

Is everyone really shouting "free healthcare"? I mean, even in places that are presently functioning well under a single-payer system, obviously everyone understands that it's taken from taxes; it isn't "free". We just assume that the amount that we would be taxed is significantly less than the amount that we are paying presently for health insurance.

Really I think most people would be perfectly fine with just having a public option which would almost automatically be less expensive than private insurance company rates, but not only this it would also force private insurance companies to become more competitive with their pricing.

I'm curious to ask you @bostjan because I think of you as a smart guy, if you're awfully opposed to single-payer "free healthcare"... how do you feel about just introducing a public option?

 

[ElRay]

This is a prime example of how you can be 100% correct and yet wrong at the same time.

From a triage perspective, the MD was spot on. With the info we have, patient care was inappropriate.

Now, if reality was that the Px and parent were demanding a-holes and expected care that wasn’t warranted based on Px load, quality of care becomes debatable. The MD & staff could have been inept in explaining triage and what the Pxs signs & symptoms indicate. The Px & parent could have been entitled/demanding a-holes and no level of quality care would have gotten through their skulls.

Personally, unless they were disrupting patient care, I’m hard pressed to justify the rant. That’s why I start with correct vs. right. All we have is the end result video. Not how they all got to that point.

 

[KnightBrolaire]

So i read the article related to this video (https://www.mercurynews.com/2018/06...-video-that-led-to-her-removal-from-hospital/ )
The pt was on klonopin and went off his klonopin for 2 days due to being unable to get a refill. He was playing basketball/ started having some trouble, took a break, played more bball, went and lifted weights for a while, and then fell down/was unable to get back up. They don't really go into details about that part but I'm guessing it was most likely exercise induced overexertion/vasovagal syncope(fancy way of saying he fainted), which the patient was at higher risk for since he's quite tall. The only other logical choice would be heat exhaustion imo.
Either way, neither of them are in any way related to a panic attack, so the doctor was even more justified in trying to kick them out of the ER once they'd been treated for those problems (which the EMS crews should have been able to handle en route to the hospital).

 

[Steinmetzify]

The internet pisses me off sometimes. I should really stay out of these threads.

Dude with an medically unquantifiable current condition takes a ride in an ambulance to a qualified physician (never mind the fact that he goes to a part of the hospital that DOESN'T EVEN TREAT WHAT HE'S SAYING HE HAS) and doesn't want to listen to what she has to say because what she's saying is the word 'No' and the end result is that because someone got offended about the way she said it she's fired.

Complete and utter bullshit.

 

[MaxOfMetal]

Single payer options where the public foots the bill is just going to make taxes unaffordable as everyone crowds the ER for their sinus infection every year.

*Citation Needed*

 

[iamaom]

Single payer options where the public foots the bill is just going to make taxes unaffordable as everyone crowds the ER for their sinus infection every year.

But this already happens, if you don't have insurance and you can't pay the bill then the public pays for it anyways. Medical bills are one of the most common sources of individual bankruptcy. If we had single payer people wouldn't NEED to go to the emergency room because they'd be able to actually see the proper doctor. This is like claiming that if the government gave out free food (WIC, SNAP) then no one would ever go to restaurants.