The hospital emergency room.

[i_got_a_mohawk]

True, though that's part of the issue. Dr's need to take a harder line at times, just say no, it's not going to help, you don't need them.

I'm not familiar enough with the other medical systems, but I'm sure it'll be possible in some countries.

Me too!

 

[spade2you]

I find most flu respond well to acetaminophen. I bought a jug for next to nothing years ago and it still works.

Pain is part of life. To get a handle check out the US consumption of oxycodone. The API in many popular pain meds.

Of course, getting the vaccine would be better, but this is the point where people try to learn me about toxicology.

 

[spade2you]

Health care is 20% of our economy. The health care system has twice as much money to play with, per capita, than any other civilized country. What we pay on top of what it should cost is like a 10% tax on the entire economy. Somebody is gouging us. Who?

Are there disparities? Sure. Is the industry good at grabbing the profits and leaving the costs to somebody else? Sure.

I don't believe that simple measures such as reimbursements are good for assessing the financial picture of the health care business. Everybody has 20 different ways to make money. The complexity and opacity of financial relationships in the business make it impossible to figure out how much anything costs, or where the money is going. This is by design, because a hard nosed cost accounting would probably drive the rentiers out of business.

Whilest I suspect you'd like to blame the wealthy yacht club CEOs and 1% on the state of healthcare, it doesn't help that people are in deplorable shape. Ya can't blame the mechanic if your car is beat to hell.

 

[fdeck]

Whilest I suspect you'd like to blame the wealthy yacht club CEOs and 1% on the state of healthcare, it doesn't help that people are in deplorable shape. Ya can't blame the mechanic if your car is beat to hell.

Ad Hominem much?

Read your Deming. Don't blame people, blame processes. I've been in business and industry for 20 years, typically in positions where I have a major influence on cost and profitability. If you understand how a system works, you can make it work better, and cheaper. I guarantee it.

If a process is costing money without delivering productivity, you can blame people, or you can improve your processes and eliminate the waste. This is accepted by economists and business people on both sides of the political fence.

 

[DwaynieAD]

Caffergot PB. And she shouldn't be going to an ER for a chronic illness. That's not an emergency.

There doctors that specialize in that. If she's not going there there's a reason the ER is suspicious.

she sees a family doctor, neurologist, physical therapist, pain management specialist, surgeon, and has previously seen another surgeon, another therapist, and a chiropractor. when she can't get a refill on her meds for 3 more days, is severely dehydrated from constant vomiting, and has been like this for 3 days what would you suggest she do? I'm deferring to your obviously superior knowledge on this subject.

 

[Selta]

If a process is costing money without delivering productivity, you can blame people, or you can improve your processes and eliminate the waste. This is accepted by economists and business people on both sides of the political fence.

You can't just completly ignore the people's personal responsibility at all though, either, especially in healthcare. Process can only do so much when the uncontrolable other half is doing so much to essentially sabatoge things.

 

[Selta]

she sees a family doctor, neurologist, physical therapist, pain management specialist, surgeon, and has previously seen another surgeon, another therapist, and a chiropractor. when she can't get a refill on her meds for 3 more days, is severely dehydrated from constant vomiting, and has been like this for 3 days what would you suggest she do? I'm deferring to your obviously superior knowledge on this subject.

Where is the hang up when her Rx runs out? What is her process for a week before - does she call her PCP and let them know? Most doctor's offices are on electronic prescriptions now, so a call in should have you an Rx within a couple of hours. Not trying to blame her, just curious why she needs to go to ER to get an Rx that her PCP should handle easily.

 

[spade2you]

If you understand how a system works, you can make it work better, and cheaper. I guarantee it.

I'm all ears if you can inform us about a solution to ER, the general poor health of the nation, non-payers, etc.

 

[Nev375]

You can't just completly ignore the people's personal responsibility at all though, either, especially in healthcare. Process can only do so much when the uncontrolable other half is doing so much to essentially sabatoge things.

People arent going to the ER with the intent to sabotage the healthcare system. They are going because they have an ailment and the system allows them to get treatment there. In many cases it is their only option.

 

[Selta]

People arent going to the ER with the intent to sabotage the healthcare system. They are going because they have an ailment and the system allows them to get treatment there. In many cases it is their only option.

Not what I was trying to convey... I mean the general state of health of Americans. We as a whole do a terrible job taking care of ourselves. Fast food diets and sedentary life styles. That is something that no "process" in healthcare can fix. People need to eat better, take better care of themselves, and be more active, rather than sit down at home on their computer and in front of their TVs constantly. That is the kind of sabatoge I mean.

 

[Nev375]

Ah. Well I believe that problem is a symptom of a much larger problem. I don't believe that people are inherently lazy. That tends to be the opinion of those who work hard for a living and would want nothing more than a day off. People who are unemployed or stay-at-home do not really enjoy their sedentary lifestyles. Most of them would give nearly anything to be working or out being more active. But the depression that sets in on these shut ins keeps them in a cycle of feeling encumbered by life and preventing the feeling of enjoyment.

The problem is one of economics and societal environment. It takes two people working full time anymore to afford the amenities of life that the average family owns. That used to be accomplished with only one working adult and less than half the debt load of a family today. So with so little time left and so little money fast food and junk food are more practical than quality dishes that are more expensive and time consuming to prepare.

If things could be changed to where people had the time and money to both work and enjoy their lives they would be healthier, get out more, and choose better foods.

Tldr version... america is unhealthy because we live in an unhealthy environment.

 

[spade2you]

People arent going to the ER with the intent to sabotage the healthcare system. They are going because they have an ailment and the system allows them to get treatment there. In many cases it is their only option.

It would be the only option if there weren't clinics. Sure, they'd have to make an appointment during normal business hours.

 

[Nev375]

It would be the only option if there weren't clinics. Sure, they'd have to make an appointment during normal business hours.

... and have a minimum of $200 cash in hand upon check in to cover the dr. Fee and the almost certain lab fee.... and or be willing to write a post dated check for any additional fees. God help you if you are unemployed. Those bounced check fees are a pain in the hole too.

 

[blue4]

It would be the only option if there weren't clinics. Sure, they'd have to make an appointment during normal business hours.

I don't think clinics can be forced to take an uninsured patient like ERs have to, but I may be mistaken. Most of them around here are not 24hrs either.

2/3rds of the patients my wife sees in her ER every night are there because they have no insurance. It's a poor neighborhood, but still a valid point I think.

 

[spade2you]

... and have a minimum of $200 cash in hand upon check in to cover the dr. Fee and the almost certain lab fee.... and or be willing to write a post dated check for any additional fees. God help you if you are unemployed. Those bounced check fees are a pain in the hole too.

Good thing the ER visit will cost 3-4x that.

There are outreach clinics out there. You seem to act as if the ER is the only solution. That's the sort of mentality that's getting us into trouble.

Some of the stuff is so piddly that a Walgreen's pharmacist could recommend some cheap OTC to help with symptons. Suddenly the $800 ER bill or $200 office visit could potentially be solved with an OTC less than $10.

 

[spade2you]

I don't think clinics can be forced to take an uninsured patient like ERs have to, but I may be mistaken. Most of them around here are not 24hrs either.

2/3rds of the patients my wife sees in her ER every night are there because they have no insurance. It's a poor neighborhood, but still a valid point I think.

Again, there are outreach programs and clinics. If my town has them, most probably would. Waiting until Friday at 11pm doesn't help.

I'm well aware that problems can happen after hours. I once had an urgent plumbing issue after hours and paid the price.

 

[DwaynieAD]

Where is the hang up when her Rx runs out? What is her process for a week before - does she call her PCP and let them know? Most doctor's offices are on electronic prescriptions now, so a call in should have you an Rx within a couple of hours. Not trying to blame her, just curious why she needs to go to ER to get an Rx that her PCP should handle easily.

hang up is in the drug constantly being on back order. furthermore sumatriptan is only affective if taken during the onset of a migraine. her refill is for twelve shots, the pharmacy will often only give her 6. and it's getting worse. it's obviously not easily handled by a pcp because its not being handled by the pcp.

 

[spade2you]

hang up is in the drug constantly being on back order. furthermore sumatriptan is only affective if taken during the onset of a migraine. her refill is for twelve shots, the pharmacy will often only give her 6. and it's getting worse. it's obviously not easily handled by a pcp because its not being handled by the pcp.

Your PCP and pharmacy should be motivated to try a little harder since the lack of supply is resulting in ER visits. Imitrex isn't cheap, but plenty cheaper than an ER visit.

 

[MJ5150]

it's obviously not easily handled by a pcp because its not being handled by the pcp.

Perhaps finding a different PCP would help? Putting ER providers in a position to manage chronic illness may not be the best option for anyone. Many people assume all PCP's are equal, but I have found this to be not true.

My wife struggles with those debilitating migraines as well. I hope your wife can find a successful treatment plan. Kudo's to you for being there to support her. I don't have them, so I can't relate to my wife's pain, but I do what I can to help her feel better.

-Mike

 

[DwaynieAD]

Perhaps finding a different PCP would help? Putting ER providers in a position to manage chronic illness may not be the best option for anyone. Many people assume all PCP's are equal, but I have found this to be not true.

My wife struggles with those debilitating migraines as well. I hope your wife can find a successful treatment plan. Kudo's to you for being there to support her. I don't have them, so I can't relate to my wife's pain, but I do what I can to help her feel better.

-Mike

switched 3 pcp's and on our 2nd neurologist, who is the one actually prescribing the imitrex. which makes it that much more difficult. the ER is a last resort and we have insurance.

has your wife tried doing a valium regiment? my wife did one for a month and was great. she's finally found a physical therapist that wanted to do CT's and Xrays before they started wrenching on her. We finally (after 5+ years) seem to be making some headway in that her migraines may be muscle related.