# 9 patients, 2700 er visits in 6 years



## amberdt03 (Apr 2, 2009)

http://www.wfaa.com/sharedcontent/dws/wfaa/latestnews/stories/wfaa090401_mo_ervisits.92b88044.html



i wonder how they figured out who they were.


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## mycrofft (Apr 2, 2009)

*Either electronic medical records*

...or they just dumped the residue on them.
Entirely believable as to frequency of visits, but the money end is all paper. Billing a drug addict or psychiatrically ill person an aveage of $1,000 per visit is ludicrous when you will often look them over then write them a scrip for Vicodin to get rid of them, or similarly touch and go treatment.
Wonder how many ares still alive?


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## 8jimi8 (Apr 2, 2009)

its not like they just arbitrarily assign them $1000 bill.  They cannot be refused.  I know of several patients that go to that specific ER with "chest pain" when it gets cold.  Why? because they get hot nurses cleaning them up, a comfortable bed and food.  Oh yah... AND they don't have to freeze outside on the streets.  These people know how to work the system.  If you respond in your unit are you going to NOT take someone to the ER who has chest pain?


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## EMTinNEPA (Apr 2, 2009)

I've ranted and raved about the failures of socialized medicine and how much I hate system abuse plenty of times before.  No point in wasting my strength typing any more about it.


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## Hastings (Apr 2, 2009)

EMTinNEPA said:


> I've ranted and raved about the failures of socialized medicine and how much I hate system abuse plenty of times before.  No point in wasting my strength typing any more about it.



Actually, it's a problem that is provoked by a non-socialized system. 

If we had a system where people could get the medical assistance and social programs that they need, then these people wouldn't in theory be so badly off that they need to seek shelter in an emergency room.

Socialized medicine is more largely about prevention than treatment. If people are getting regular checkups and have access to social support programs, they aren't going to reach that level of having no where to go but the ER. Understand?


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## EMTinNEPA (Apr 3, 2009)

Hastings said:


> Actually, it's a problem that is provoked by a non-socialized system.
> 
> If we had a system where people could get the medical assistance and social programs that they need, then these people wouldn't in theory be so badly off that they need to seek shelter in an emergency room.
> 
> Socialized medicine is more largely about prevention than treatment. If people are getting regular checkups and have access to social support programs, they aren't going to reach that level of having no where to go but the ER. Understand?



Then you get people with a cold who have a doctors appointment in two days who call 911 just because they don't want to wait two days.


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## Hastings (Apr 3, 2009)

Yes, with the current system we have now.

I had more trouble getting into a doctor in America than I did in Australia.

Wait in America for a non-emergency appointment: 4 months.
Wait in Australia for a non-emergency appointment: The same day I called.


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## EMTinNEPA (Apr 3, 2009)

Hastings said:


> Yes, with the current system we have now.
> 
> I had more trouble getting into a doctor in America than I did in Australia.
> 
> ...



Wait in Canada for an MRI: 6 months.

I walked in to my doctor's office without calling when I was hypertensive and walked out with a prescription for lisinopril.


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## Hastings (Apr 3, 2009)

EMTinNEPA said:


> Wait in Canada for an MRI: 6 months.



Why does our hypothetical patient with the cold (the one abusing the system) need an MRI?


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## EMTinNEPA (Apr 3, 2009)

Hastings said:


> Why does our hypothetical patient with the cold (the one abusing the system) need an MRI?



You brought up wait times.  I gave an example.  I also gave an example where I just walked in to my AMERICAN doctor with no prior warning with a problem and walked out with a solution.  A doctor in PRIVATE practice.


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## reaper (Apr 3, 2009)

Hastings said:


> Yes, with the current system we have now.
> 
> I had more trouble getting into a doctor in America than I did in Australia.
> 
> ...



Dude, you need to find a new Dr.. I have never in my life had to wait more then a day or two to get into the Dr.! Most take me that day.


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## Hastings (Apr 3, 2009)

EMTinNEPA said:


> You brought up wait times.  I gave an example.  I also gave an example where I just walked in to my AMERICAN doctor with no prior warning with a problem and walked out with a solution.  A doctor in PRIVATE practice.



I'm glad you had success. Although telling them you're having trouble with your blood pressure is more likely to get you in quickly than a cold or a checkup. Afterall, they can give drugs for that. And drugs mean money.

Sadly though, here, all the family physicians are leaving. Doing other things. We have so few that the average wait for infections and the such is upwards of several months. Sick of dealing with the insurance agencies, I hear. And it's because of the system we have. If we had a socialized system, there would be doctors, and there would be healthy people. Doctors wouldn't have trouble getting paid, and patients could get in when they needed to.


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## EMTinNEPA (Apr 3, 2009)

Hastings said:


> Doctors wouldn't have trouble getting paid, and patients could get in when they needed to.



First off, do you know how much all that crap would cost?  Most Americans would be bankrupted trying to pay for that Charlie Foxtrot of a healthcare system.

And patients getting in when they needed to?

Imagine if you will a lemonade stand.  This lemonade stand is run by the strictest 8 year old on the face of the planet.  She will give ANYBODY lemonade, but she won't let them cut in line based on severity.  First come, first served.  And she can do this because she is the ONLY lemonade provider in the country and has the authority of a socialist state behind her.  A man comes out of the desert.  He hasn't had anything to drink in days and he sees the lemonade stand.  He gets in line.  And he waits.  And waits.  And waits.  Meanwhile, the mildly parched patrons in front of him consume the precious substance he needs to live.  Now, I see three possible outcomes.  First, the guy _could_ get his lemonade, if he's lucky.  Second, there might not be any lemonade left when he gets to the front and he dies.  Third, he dies waiting for lemonade.

Now, let's take out the metaphors.  The lemonade stand is healthcare.  The lemonade is treatment, or a necessary test, or a consultation with a specialist.  The man coming out of the desert is a sick person.  The parched patrons are hypochrondriacs or parents who pitch a fit every time their child has the sniffles.

Scary, isn't it?


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## Sasha (Apr 3, 2009)

> Imagine if you will a lemonade stand. This lemonade stand is run by the strictest 8 year old on the face of the planet. She will give ANYBODY lemonade, but she won't let them cut in line based on severity. First come, first served.





> Now, let's take out the metaphors. The lemonade stand is healthcare. The lemonade is treatment, or a necessary test, or a consultation with a specialist. The man coming out of the desert is a sick person. The parched patrons are hypochrondriacs or parents who pitch a fit every time their child has the sniffles.



That's why we have this lovely little thing called "Triage". It means "To Sort" and sorts people based on their severity.

And here's a neat little fact, people who can get preventive care generally live longer, healthier, more productive lives and pay into the system longer, needing LESS emergency doctor visits and hospital visits. People who can take care of themselves are better for society.


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## Veneficus (Apr 3, 2009)

EMTinNEPA said:


> Wait in Canada for an MRI: 6 months.
> 
> I walked in to my doctor's office without calling when I was hypertensive and walked out with a prescription for lisinopril.



I always like to hear about waits for medical imaging. 

Medical imaging is a tool, in the US it is often used as a shortcut. The idea that something can't be wrong unless it looks wrong, or the idea that if it doesn't look wrong it must be ok. If it were so simple that we could have a tech take a picture, make a dx off of that and start a protocol treatment, we would have no need for physicians.

Even prehospital paramedics seem to think there is some magical nature to medical images and lab values. 

The ability to see a doctor the day you need help will always be more important than when you can get a scan. You can stare at all the ct images of a head bleed you like, without a neurosurgeon it won't matter what you see. The same for oncology, and a myriad of other specialists.   

In the US we often use medical imaging to satisfy a lawyer or an insurance claim adjuster. Medicare/medicade pays more for a CT scan than the knowledge of a physician and we wonder why there is no primary care?  

Truly, if you could get an MRI in 5 minutes but couldn't see a doctor for 4 months and you think that is good medicine; you seriously need some better education. 

In many areas I have worked in the US, only the people with money or incredibly expensive insurance could walk into a same day doc appointment. MY wife was once told that she could be seen for a UTI in 2 months unless there was a cancellation at the hospital I worked for and had an insurance plan anyone in the world would be envious of. (So naturally we went to the ED, which cost that insurance company way more than a PCP, urine dipstick, and antibiotic script would have cost.) 

Spare me the ethnocentrism, the US is 37th in healthcare in western nations. Not even in the top 30, much less the top 10 or 5. If our sstem is so good, why isn't it working? Do we not spend enough on healthcare? In that category we are #1. By a long shot.


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## reaper (Apr 3, 2009)

You tell that to all the pt's that have to come here for testing and TREATMENT, because of the wait times in their home country. Sorry, I will continue to pay for my health insurance and get treatment when I need it. I am not going to get into a polictal debate on this subject, That is all I will add!


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## Veneficus (Apr 3, 2009)

reaper said:


> You tell that to all the pt's that have to come here for testing and TREATMENT, because of the wait times in their home country. Sorry, I will continue to pay for my health insurance and get treatment when I need it. I am not going to get into a polictal debate on this subject, That is all I will add!



What country are they coming from?


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## EMTinNEPA (Apr 4, 2009)

Veneficus said:


> In many areas I have worked in the US, only the people with money or incredibly expensive insurance could walk into a same day doc appointment.



Really?  Because I make less than $20,000 a year and at the time had no health insurance, but I still got into the doctor's office the same day just by walking in.

Show me a country where you have to wait four months to see a doctor, and I'll show you a country with socialized medicine.

Just like reaper, I will continue to have money taken out of my paycheck for medical, dental, and vision benefits every two weeks, because when I need to see my doctor or see a specialist, I know I'll get to do so in a timely manner.

I've gone over this before, no point going over it again.  Down with socialism.  Privatize EVERYTHING.


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## Hastings (Apr 4, 2009)

EMTinNEPA said:


> Privatize EVERYTHING.



Because that's worked so well so far. 

How can someone witnessing the country falling apart still suggest that? It blows me mind. 

Consider what would have happened had Bush succeeded in privatizing social security when he wanted to. This economic crash we experienced would have taken every single American's retirement and left them with nothing.

You're not thinking this through.


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## Veneficus (Apr 4, 2009)

EMTinNEPA said:


> I've gone over this before, no point going over it again.  Down with socialism.  Privatize EVERYTHING.



If there was a workaboe answer other than socialized medicine I'd be all for it, why does it always have to be an extreme of socialism or completely private? WHy not a happy medium.

I think privatizing everything is a great idea, when you see how bad it actually works, you will have it out of your system.

We know from central and eastern europe that total socialism doesn't work. Neither does what we have been doing.

Take the middle path


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## EMTinNEPA (Apr 4, 2009)

Hastings said:


> Because that's worked so well so far.
> 
> How can someone witnessing the country falling apart still suggest that? It blows me mind.
> 
> ...



The country is falling apart because the government took it upon themselves to "bail out" all the companies who were finally being crushed under the weight of their own unscrupulous business practices.  In a truly free market, these companies would have been allowed to die.  But Bush had to come along and say "i was against socialism before I was for it" and institute a multi-billion dollar bailout, then Obama came along and pulled off a few more of them.  Where's this money coming from?  Your guess is as good as mine.  It will probably be coming out of our pockets, so in a sense WE are paying to keep these companies afloat.  This is an example of the epic failure that occurs when government becomes TOO involved... throw the working man's money at a problem until it's fixed.  So here we are, with the government dipping their hand in every pot they can, and this is supposed to be an example of privatized society going awry?  Don't be so blind.


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## Ridryder911 (Apr 4, 2009)

I am surprised that everyone is was surprised about the costs these abusers ran up. This is not new or rarity. 

I know of one patient in a rural ER I managed that had over 376 visits in one year. Of course he worked the system. 

I don't know how everyone else can get into their physicians so easily. Even knowing them personally, I recently attempted to see anyone of them, the earliest appointment with my glucose >500 mg/dl and it would take at least 3 months (this is even with insurance and having been a previous patient).  Luckily, I have a friend that's a P.A. that took care of me. 
I could only imagine if the government was involved. 

I have worked in the public health of the government, I know how the wheels turn slowly and become delusioned.


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## mycrofft (Apr 6, 2009)

*My doctor is with a large hospital's outlying medical groups..*

Little wait, they even have an evening walk in clinic and littlem sdatelite clinics staffed by Nurse Practitioners in a local brand of pharmacy.
I case managed medically indigent patients for two years' hiatus from the jails. Delay is most often due to not enough porviders willing to see patients for the ludicrously insultingly low repayment rates offered by government. A small number will, and a similar number VOLUNTEER and work for free at county clinics etc. 

A single payor system does not mean every doctor is socialized, if a MD wants to try to stay afloat without government money he/she can. I think though that to work in a county the medial officer should absolutely require that each and every MD must do so many cases of pro bono work, and the pts are handed out by specialty, order of request  and severity, not cherry-picked. You want to make millions in our County, then show a little social responsibility.

PS: Do those incredible wait times take place in all socialized medical contries, and can it be proven? AMA and others are flooding media and internet with propaganda abot this.


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## Veneficus (Apr 6, 2009)

In all the countries I have visited or been a part of in Europe, in any one of them, includng GB, you could walk into any doctors office and be seen within 2 hours. They even have CTs in the ED. 

Even in Canada most of the horror stories I have heard were isolated incidents. 

If anyone has a way to offer everyone reasonable medical coverage at an affordable rate I am waiting to hear it.


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