Life Under Rmoney's 'Emergency Department' Medical Plan

[AtomicKitten]

I just transcribed an admission note for a 27-year-old female who was picked up from her apartment via EMS and was admitted through the ER with altered mental status.

Her diagnoses?

1. Acute liver failure.
2. Metabolic encephalopathy.
3. Acute renal failure.
4. Hypernatremia.
5. Elevated liver function tests.
6. Lactic acidosis.
7. Leukocytosis.
8. Diabetes mellitus type 2.
9. Gallbladder dysfunction.
10. Elevated ammonia.
11. Respiratory failure.

She couldn't afford medical care and it's probably too late for her; she is not expected to live.

This is the real world in Rmoney's America.

[Liberal_in_LA]

1. that is so sad

[Mnemosyne]

2. No words. K&R

[belladonna]

3. Depressing, isn't it?

I type mostly admission history and physicals and ED notes and I see this sort of thing on a daily basis, multiple times a night. The diabetic who can't afford his insulin or to see a podiatrist for proper foot care and ends up with amputations or in intensive care from dka or horribly infected extremity wounds with a little necrosis thrown in there just to liven things up. The mother of 2 young children who had some weird symptoms of back pain and fatigue, etc that she just didn't get checked out because she didn't have insurance who finally shows up at the emergency department and is diagnosed with liver cancer with metastases. The sad part is that I could keep on typing for a good hour or two and wouldn't run out of examples. It's so frustrating and sad and it just made me furious when that asswipe made the statement about emergency rooms and that people didn't die from a lack of health care in this country.... BULLSHIT!!!!

Ah well, back to the typing grind.....

[AtomicKitten]

4. It's as depressing as it is maddening.

I'm working for a group of hospitals that are teaching institutions. They offer a higher level of care and so many people who present to the ED with such a devastating constellation of symptoms are transferred there. This is a perfect snapshot of the argument for preventive care and it is just heartbreaking.

You know better than anyone else EDs only stabilize medical conditions. For instance, if you present with a fracture, you will be assessed for a compartment syndrome. If negative, you will be discharged with a splint and a pain prescription. If you require orthopedic surgery, you're on your own.

Rmoney's assertion that people can get their care at EDs is as ignorant as it is heartless.

[belladonna]

8. That's exactly it

If people are able to get preventive care, you're rarely going to see a patient like you described presenting in the ER. Not only that, I see so many repeat patients who come back to the ED after they've been stabilized and told to follow up with a gastroenterologist, orthopedist, etc. because they weren't able to afford to see a primary care provider, much less a specialty doc. They come back to the ED because they don't have anywhere else to go and, in most cases, whatever they were diagnosed with has progressed to the point that they now need to be admitted to the hospital. Call any specialist and tell them you need to be seen, but don't have insurance. They'll see you, but they'll also tell you that just to get in the door is going to cost two or three hundred dollars. If you need surgery, you're truly out of luck.

[zingrr]

5. FL Gov already purging disabled now

FL Gov Rick Scott started implementing a plan to reduce the cost of Medicaid - get rid of the 100% disabled adults 18-64. They cost the most about $100,000 p/yr..

5000 purged x $100k = $500,000,000 in savings....

that's how the Republican governors are doing it right now we need to revolt against this tyranny

[Ms. Toad]

6. That could be my daughter.

If Obama is not re-elected.

Respiratory failure is the only thing on that list which is not a characteristic of the disease my daughter has.

Currently she is on my health insurance - but she is 22 and only covered because of the Affordable Care Act. If it is repealed, I will spend my last penny on care for her - but her (non-emergency) costs rund around $40,000 a year. And - it is likely she will need a liver trasnplant which costs around a half million, and will double her run-of-the mills every year after transplant for teh rest of her life.

[Uncle Joe]

7. Kicked and recommended.

Thanks for the thread, AtomicKitten.

[Barack_America]

9. Sounds like septic shock.

This is particularly tragic because I guarantee you this is something she suffered with for days before getting to this state.

Awful. This time last year I was an intern in the MICU accepting this patient. Want to talk about a crash course in reality.