tag:blogger.com,1999:blog-7323692122514281455.post1213387788533385372..comments2024-03-22T17:05:55.267-04:00Comments on MD Whistleblower: Emergency Room: Revolving Door or Backstop?Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-7323692122514281455.post-46964523461624795102011-07-06T14:15:35.969-04:002011-07-06T14:15:35.969-04:00It's so frustrating to read again and again ab...It's so frustrating to read again and again about the pressure docs feel to fill beds and are fearful of being sued if they don't over-prescribe. May be tough to do in an ER setting, but we patients need to play an active part in the care of our health. Ask a lot of questions. Even questions about how much treatments and drugs cost, because it matters. I found this helpful in shaping questions: http://tinyurl.com/4odprtzUnknownhttps://www.blogger.com/profile/07071949649094626779noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-77156256838536675692011-06-29T19:22:10.556-04:002011-06-29T19:22:10.556-04:00Dr. Michael, I'm taking a wild guess here that...Dr. Michael, I'm taking a wild guess here that you have never been on the other side of the gurney in the E.R. as a patient in mid-heart attack - as I have been. Textbook symptoms: crushing chest pain, nausea, sweating, pain radiating down my left arm. But when all cardiac tests (EKG, cardiac enzymes, treadmill stress test) came back "normal"(as they tend to do far more frequently with female cardiac patients), I was unceremoniously booted out the E.R. door within 5 hours misdiagnosed with GERD, feeling very, very embarrassed because I had just "made a big fuss over nothing". <br /><br />Had I been a MALE patient, however - same age, same symptoms - current guidelines dictate 'keep overnight for observation'. Research published in the New England Journal of Medicine, in fact, suggests that women under the age of 55 are SEVEN TIMES more likely to be misdiagnosed in mid-heart attack and sent home from the E.R. than men in the same boat are.<br /><br />I too felt that your last sentence warning us that we need to "think again" if we believe hospitalization is "safer" is not only "melodramatic", as A.Bailey wisely described it, but an affront to those of whose lives are quite literally put in peril by being sent home.Carolyn Thomashttp://www.myheartsisters.orgnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-71341635684611363412011-06-21T08:09:04.286-04:002011-06-21T08:09:04.286-04:00Thanks TB for kind comments. Last post I wrote ab...Thanks TB for kind comments. Last post I wrote about ER docs didn't generate much support from ER world. I was wearing Kevlar for a few days!<br />http://mdwhistleblower.blogspot.com/2009/08/emergency-room-medicine-model-for.htmlMichael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-38342152843398439352011-06-21T01:01:27.715-04:002011-06-21T01:01:27.715-04:00Great post and I am hard pressed to find any "...Great post and I am hard pressed to find any "reasons" for admission that you left out. I have worked as an ER doc (back in the day) so I know what it is like to be pressured to make hasty decisions and to CYA by being very conservative. But the most important deterrent to knee-jerk admission is knowing the patient can be seen and followed up by a good clinician. If that follow up is there, the ER doctor can feel more assured about sending a patient out.<br /><br />I love it when the ER calls about a patient. We are losing good Dr. to Dr.communication and we need to get back to talking about patients and planning care together.Toni Brayer, MDhttps://www.blogger.com/profile/15258759363309666629noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-58938727194172728762011-06-20T09:56:32.584-04:002011-06-20T09:56:32.584-04:00Agree that ER physicians are often in a tough spot...Agree that ER physicians are often in a tough spot. However, there are invisible agendas at play that patients are unaware of. This phenomenon is not restricted to the emergency room.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-70992147335281844682011-06-19T13:20:09.943-04:002011-06-19T13:20:09.943-04:00Over 40 and chest pain is an automatic overnight s...Over 40 and chest pain is an automatic overnight stay. Over 50 and rectal bleeding usually is an overnight stay. Show up with headache, numbness, arm or leg feeling "funny" results in an overnight stay. <br />I would not want to be an ER doc, as a lot of the care is simple self pay/no pay, medicaid, noncompliant patients, drug seekers, etc in my area. The ER waiting room scares most privately insured patients.<br />Thankfully I have some say in who gets to be seen in my office. The ER is forced to see anyone who walks in the door for whatever the presenting concern is. The ER really is a community clinic that often functions at a loss but makes up for this with the Medicare and private insurance admissions.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-1238986318895840912011-06-19T11:40:22.715-04:002011-06-19T11:40:22.715-04:00As the realtors say, it's all about the locati...As the realtors say, it's all about the location. <br /><br />Here in Louisville, the ER docs at Baptist Hopital East do an excellent job of notifying the doctor of record about these kinds of situations. When they call me, if I can see the patient in a timely fashion, they will discharge the patient to home. <br /><br />I don't envy their job. In my younger overworked and sleep deprived years I would make house-officer level protestations that only made their job harder. I regret having ever done that. <br /><br />Now I never second-guess them, especially as they are laying eyes upon the patient and I'm at home watching TV or something. <br /><br />I don't blame them a bit for erring on the side of caution, given the number of personal injury lawyers who aggressively advertize in our area. <br /><br />I don't worry too much about a patient staying overnight. I guess it just depends on how good you think your hospital is (yes, that was a bit snarky, but I think your last paragraph is a bit meolodramatic for my tastes).A. Baileynoreply@blogger.com