>> Tuesday, October 13, 2009
ya know some things have become so cliche'. a non health care related example-how many times have you heard about the person in front of someone at the grocery store who pays with food stamps and has nothing but junk food, or they buy groceries with the food stamps and seperately pay cash for beer, or my all time favorite...the food stamp offender *always* leaves the store and loads their stuff into a fancy, expensive vehicle (usually it's an escalade or something)?! now in all of my trips to the grocery store, i have never witnessed these things and especially not the escalade part. maybe i'm not paying attention. i'm not saying these things never happen but really is it possible that it has become just a bit of a cliche'? the scary thing is that these types of things become "facts" to people.
there is a misconception i hear about health care all.the.time. so much so that it's rather cliche'. but i have to tell you that the following is not exactly true! now i have no source to quote and can only use my experience as an RN who worked in utilization review and case management as well as my experience as a cancer patient. with that i think i have a pretty good grasp on things.
uninsured people (often times with some descriptive term like lazy) can go to any ER in america and get their care for free! the ER has an obligation! and of course the rest of us (descriptive term hard-working) get to foot the bill! yes this is true! the ER is a catch all. ever wonder why the staff is grumpy? well because they've become hardened as they see way too many non-emergencies walk through their doors. people who are walking through the parking lot just fine, maybe laughing and the moment they enter through the ER doors they are doubled over, can't walk, groaning. people who come to the ER for a pregnancy test instead of just buying one at the pharmacy (heck you can even get them at the dollar store and they are about the most sensitive and reliable out there). or they come in with some ailment that could and should be treated at a doctor's office like a urinary tract infection. the person suffering some affliction for three weeks and suddenly decides to pop on in to get it checked out. throw in some drug seekers and those that arrive at the end of a rousing weekend seeking a doctor's note to miss work on monday. now i have to add on a personal note that the staff should not be grumpy, it's unprofessional-but these are good causes. and yes this is all pretty cliche'.
now on to the misconception and why i feel the need to speak up. the ER is a catch all but it is not a cure all. and for those who go uninsured because they feel that they will always have a back up plan-think again. your life may depend on it. i will share a true story of a patient that was well known at our hospital. no names or extremely personal info to respect HIPAA. and if you think you know this person-you don't.
this 20 something year old man was sick and unable to work. his wife's employer family insurance policy and those available privately were more than they could afford on only one income. however, she made too much money to qualify for medicaid.
he came to our ER with a "symptom" and that "symptom" was our obligation to treat. he had an infection, was admitted to the hospital and received IV antibiotics. the infection was cleared and he was sent home. again he came to our ER with a "symptom" this time being intractable pain. he was admitted, his pain was managed and brought to a controlled level and then he was sent home.
the important thing to note is what caused the "symptoms". it was cancer. this was also why he was unable to work. and this is where the cliche' or misconception comes into play. the ER/hospital was obligated to treat the "symptom" that brought him in. however, the hospital is NOT obligated to treat the underlying cause if there is one. in this man's case the underlying cause was cancer which nobody treated because there was no obligation. see why the catch all ER is not the cure all?
the admitting doctor wrote orders for this man's hospital care which included oncology consults. being a rural hospital with only two oncologists on staff who were partners of the same practice, the choices were limited. the oncologists had an obligation to assess the patient, which they did. and upon knowledge of his lack of payer source they refused, yes refused(!)to take him on as a patient. and that is completely ok and apparently legal. at some point as a nurse, case manager and human being-i would think that someone should have felt some sort of obligation to treat this young man, husband and father. if not for any reason other than an act of kindness and because it was simply the right thing to do. even as a charity case. we all went round and round. the admitting doctor ended up in a tear filled yelling match with the oncologists. we the nurses of case management called every single, possible agency for some sort of help for this man which failed and we were tear filled as well. truly words can not describe the weight of our failure for this very sick and kind man.
in the end, he received symptomatic care only. never one drop of chemotherapy or any other cancer killing agent. and as you have likely guessed this man died.
by sharing this story i don't know what i'm trying to accomplish. maybe to dispel a misconception? make it less of a cliche'? encourage those who can obtain health insurance but choose against it to change their minds? encourage everyone to believe in and speak up for health coverage that is obtainable for everyone? or maybe even save a life? that one life lost was one too many. but i am fairly certain that there are many, many others out there who have faced or are facing similar circumstances.