November 14, 2009

Friday evening tutorial

I'm hoping this weekend turns out better than last. Last Friday started well. My wife and I were enjoying the cool evening having a beer out on our patio.....until our son came out saying he cut himself with scissors. Well, he tends to be a bit overdramatic so I reluctantly went inside to take a look at his finger. As soon as he removed the paper towel, all that I saw was blood. Uh-oh. I applied pressure to staunch the blood for a couple of minutes and then took another look. Still lots of blood. Uh-oh. It's nearly ten o'clock on a Friday evening so the family doc is out of the question. We're in between insurance so I'm reluctant to take him to the ER because I have no idea what it'll cost. I break out my hiking first aid kit. Iodine, sutures, forceps.....where's my lidocaine. Ah crap. I look at it some more trying to convince myself I can just butterfly it with glue. Reason overrides that and justifiably so. So I grab my keys and wallet and off we go. We first stop at a privately run minor emergency center thinking maybe I can bargain with them or at least hope that they'll cut me a break out of professional charity since I'm training to be a doc. $350 just to get into the door. It's a slow night and the doc overhears my conversation with the clerk. He takes a quick look at over the counter. Well, according to the Brits who are always trying to save money, inscicions slightly smaller than his so long as they're not on a nerve or joint can be left open to heal so long as they're cleaned really well and packed with neosporin. Hmmm.......I seriously consider it until I realize the ramifications of trying to keep Huck Finn's finger clean from dirt for a week. Off to the Tomball ER we go. The front desk was really nice but they wouldn't give me an estimate. I cajoled some more and they finally said that it'd probably run ~$200-300 and they could work with me so long as I'd put $25 down that night. Deal. Fast forward about 4 hours and this is what we finally got. 4 stitches. He did a good job but I think I could've sewn even better. I've thrown so many suture loops on animals it's ridiculous. But I didn't have lidocaine and after watching the nerve block, I realized that though I could've probably hit the right spot (had I had lidocaine), I wasn't 100% sure. I also learned the important lesson that lidocaine for digit nerve blocks canNOT have epinephrine in it as it can cause some serious damage to the finger when it constricts everything down. So I learned about wound closure courtesty of my son's "stupidity" (his words, not mine). I wish I had someone to practice on now. I do need to get me some lidocaine for when we go hiking, though. And while not directly tied to my medical training (other than it ruining my Saturday morning studying as I didn't get to bed until 4am), this event has everything to do with being a doctor. It's got me thinking a lot about how medicine is paid for and all the problems associated with it. I don't want to get into the broad sweeping debate about the healthcare bill (monstrisity, I should say) but I think this event does illustrate some very deep problems inherent in our system. #1 - In what other situation in life would you go into a business transaction, and make no mistake about it, that's what this is, and have NO idea what something is going to cost. The only reason I was able to get an estimate was because I begged and cajoled. I was told by one clerk that they're "not supposed to give that information out." #2 - Anytime that one does not know the cost of something, the value will be lost. It's a sad fact of life but life ain't fair. Why does everyone demand the same level of healthcare? It doesn't happen anywhere else be it your car, your house, or your education. We can't all afford Harvard. Take cosmetic surgery for example. There are a whole range of options. One can get the top of the line impants so that they look real or go for something that looks good but not perfect. They both work, so to speak but cost has to be figured into it. #3 - Regarding plastic surgery, it's pretty telling that the costs of surgical procedures have come DOWN over time. Why? In a word, competition. It's about the only part of our healthcare that is subject to free market competition. I always laugh when people talk about socialized medicine as a boogey man. Take a look around. Our system is so far removed from a free market system it's laughable. Doctor supply is limited by training, insurance essentially has a monopoly, doctors are not allowed to negotiate with patients, etc, etc, etc.


Steve Parker, M.D. said...

Hospital service pricing is particularly byzantine. You cant' even compare hospital prices on the basis of a regular hospital room per day anymore.

The lack of transparency in healthcare pricing must be by design.

Isaac said...

You work at a hospital, right? What portion of your patients are medicare? Does medicare reimburse a hospital(ist) differently than a family doc for the same service?

I seem to recall that insurance will reimburse a cardiologist more than a GP for managing a patient's hypertension. That's where the patient needs to have control of the money. Just like I shop around for auto or house insurance, you can bet I'd start shopping around for docs based on money and quality if I was responsible for it.

Anonymous said...

Do you remember "Hilary Care"...prior to that MD's not MBA's called the shots!