Dear Mr. Obama
I had heard on a newscast that president elect Obama was looking for suggestions on how to reduce costs in the health care system. I have, what I think, is a great one. ( But of course I would think it was great....you tell me what you think).
Little 78 year old Mr Johnson is admitted to the hospital with CHF, or congestive heart failure. He has no insurance other than medicare, which reimburses hospitals per diagnosis, a fixed amount. No more, no less. Mr Johnson also has diabetes, COPD, has had strokes in the past, high blood pressure and kidney insufficiency or outright failure. He worked most of his life at jobs that you and I would cringe at the thought of having to do, to put food on the table and clothes on his kids backs. He never had health insurance, picking cotton from the third grade on, or harvesting peanuts, he sent his children to school so they would not have to do what he did. He stays in the hospital for many days past what medicare pays for, but he only calls the nurses when he really needs help, thanks them for the help he gets, and treats his caregivers with utmost respect. He follows instructions, cooperates with his medical team and often has to be encouraged to take medication that will relieve him of his pain. His family members take turns staying with him to help in his care and make sure he is safe when the nurses can't be in the room with him. He comes in and out of the hospital several times a year, often because he ran out of his medicines and couldn't afford to get more, and his condition deteriorated to a life threatening level. We bring him back to his health baseline, and send him out the door again, hugging him and telling him to take care of himself, that we hope we don't have to see him for awhile. Knowing all the while, it is only a matter of time.
Now, here comes Mr. Smith. You cringed when you heard his name and that he was coming to your floor. You apologize to the nurse he is assigned to when you tell them they will be admitting him and they say "THANKS ALOT!!". ER personnel give you report, naming him a "frequent flyer", and while that term applies to Mr. Johnson as well, it would be said in a completely different tone of voice. Mr. Smith is being admitted for a chief complaint of chest pain, has a heart history several pages long at the age of 46, so can't be ignored for fear of a lawsuit. His EKG is , so far, normal, his enzymes that determine cardiac injury are , so far, normal. But he is having "unrelieved" chest pain. He has refused a nitro drip in the ER, has listed his allergies as Toradol, Stadol, Darvocet, Ultram, and Tylenol. He is positive for cocaine, marijuana, benzodiazapines and ETOH on his drug screen. He got Dilaudid an hour ago for his chest pain, and he reported that it brought him from a "10" pain level to a "7", and the ER doc wouldn't give him any more. He had been to hospital X yesterday, and was sent home with minimal treatment, and was just discharged from our hospital 4 days ago when his heart attack was again ruled out for the sixth or seventh time in the last six months. BUT, seven months ago, he'd had a cardiac cath and had required a stent to open a blockage. He has been receiving disability checks since he was 30 for a back injury received while on the job, and hasn't worked a day since. He smokes, and has been out "AMA", or "against medical advice" to smoke twice while he was waiting for his ER evaluation and a bed assignment.
He arrives on the floor on a hospital stretcher, and before you can even get to the room, he has pulled off his heart monitor, is stuffing it in a drawer, and heading down the hall to go smoke. You stop him, ask him to return to the room so he can be admitted, and he becomes hostile and belligerent. You quickly get him to sign the "AMA to smoke " form, supposedly absolving you of responsibility, should he "code" while out to smoke, and let him go. You know this guy and his game, and you don't want to play. When he comes back, his first request is for something for chest pain, which he reports is again at a level "10" out of 10, and when you try to give him a nitro first, as is protocol, he calls you a name you wouldn't repeat, says "that sh-- doesn't work", and demands the Dilaudid. You tell him it isn't time for the Dilaudid yet and he becomes more hostile and belligerent. He knows he has about 24 hours before his free high expires, tho, so he settles down. He then asks you when he CAN have it, and sets his watch alarm for that time.
So it goes. He's nasty to everyone who cares for him, noncompliant with all instructions, demands cookies, sodas, ice cream, extra food from the cafeteria, and smokes in the room because it's cold outside, then denies that he's done it. When the tests prove he has not, in fact, had an MI, the MD's discontinue all his narcotics. The next time he asks for them and is told they have been discontinued, he yells, curses all the staff, pulls his heart monitor off and walks out of the hospital AMA.
OK, Mr. Obama, here's my suggestion......set up a database shared by local networks of hospitals. When the frequent flyer comes through the door, and you find he has walked out AMA for the same diagnosis 3 times, make a law that you can refuse care without fear of legal repercussions. The little boy cried wolf, 3 strikes you're out, too bad ,so sad!! Billions would be saved in NO TIME AT ALL!!, AND we would have time to care more diligently for Mr. Johnson, who worked hard all his life, likely fought for his country, and raised his children to do the same.
Little 78 year old Mr Johnson is admitted to the hospital with CHF, or congestive heart failure. He has no insurance other than medicare, which reimburses hospitals per diagnosis, a fixed amount. No more, no less. Mr Johnson also has diabetes, COPD, has had strokes in the past, high blood pressure and kidney insufficiency or outright failure. He worked most of his life at jobs that you and I would cringe at the thought of having to do, to put food on the table and clothes on his kids backs. He never had health insurance, picking cotton from the third grade on, or harvesting peanuts, he sent his children to school so they would not have to do what he did. He stays in the hospital for many days past what medicare pays for, but he only calls the nurses when he really needs help, thanks them for the help he gets, and treats his caregivers with utmost respect. He follows instructions, cooperates with his medical team and often has to be encouraged to take medication that will relieve him of his pain. His family members take turns staying with him to help in his care and make sure he is safe when the nurses can't be in the room with him. He comes in and out of the hospital several times a year, often because he ran out of his medicines and couldn't afford to get more, and his condition deteriorated to a life threatening level. We bring him back to his health baseline, and send him out the door again, hugging him and telling him to take care of himself, that we hope we don't have to see him for awhile. Knowing all the while, it is only a matter of time.
Now, here comes Mr. Smith. You cringed when you heard his name and that he was coming to your floor. You apologize to the nurse he is assigned to when you tell them they will be admitting him and they say "THANKS ALOT!!". ER personnel give you report, naming him a "frequent flyer", and while that term applies to Mr. Johnson as well, it would be said in a completely different tone of voice. Mr. Smith is being admitted for a chief complaint of chest pain, has a heart history several pages long at the age of 46, so can't be ignored for fear of a lawsuit. His EKG is , so far, normal, his enzymes that determine cardiac injury are , so far, normal. But he is having "unrelieved" chest pain. He has refused a nitro drip in the ER, has listed his allergies as Toradol, Stadol, Darvocet, Ultram, and Tylenol. He is positive for cocaine, marijuana, benzodiazapines and ETOH on his drug screen. He got Dilaudid an hour ago for his chest pain, and he reported that it brought him from a "10" pain level to a "7", and the ER doc wouldn't give him any more. He had been to hospital X yesterday, and was sent home with minimal treatment, and was just discharged from our hospital 4 days ago when his heart attack was again ruled out for the sixth or seventh time in the last six months. BUT, seven months ago, he'd had a cardiac cath and had required a stent to open a blockage. He has been receiving disability checks since he was 30 for a back injury received while on the job, and hasn't worked a day since. He smokes, and has been out "AMA", or "against medical advice" to smoke twice while he was waiting for his ER evaluation and a bed assignment.
He arrives on the floor on a hospital stretcher, and before you can even get to the room, he has pulled off his heart monitor, is stuffing it in a drawer, and heading down the hall to go smoke. You stop him, ask him to return to the room so he can be admitted, and he becomes hostile and belligerent. You quickly get him to sign the "AMA to smoke " form, supposedly absolving you of responsibility, should he "code" while out to smoke, and let him go. You know this guy and his game, and you don't want to play. When he comes back, his first request is for something for chest pain, which he reports is again at a level "10" out of 10, and when you try to give him a nitro first, as is protocol, he calls you a name you wouldn't repeat, says "that sh-- doesn't work", and demands the Dilaudid. You tell him it isn't time for the Dilaudid yet and he becomes more hostile and belligerent. He knows he has about 24 hours before his free high expires, tho, so he settles down. He then asks you when he CAN have it, and sets his watch alarm for that time.
So it goes. He's nasty to everyone who cares for him, noncompliant with all instructions, demands cookies, sodas, ice cream, extra food from the cafeteria, and smokes in the room because it's cold outside, then denies that he's done it. When the tests prove he has not, in fact, had an MI, the MD's discontinue all his narcotics. The next time he asks for them and is told they have been discontinued, he yells, curses all the staff, pulls his heart monitor off and walks out of the hospital AMA.
OK, Mr. Obama, here's my suggestion......set up a database shared by local networks of hospitals. When the frequent flyer comes through the door, and you find he has walked out AMA for the same diagnosis 3 times, make a law that you can refuse care without fear of legal repercussions. The little boy cried wolf, 3 strikes you're out, too bad ,so sad!! Billions would be saved in NO TIME AT ALL!!, AND we would have time to care more diligently for Mr. Johnson, who worked hard all his life, likely fought for his country, and raised his children to do the same.
posted by Mommanurse at 5:37 AM
2 Comments:
Came on over from Greybeard's site and I'm glad I did.
That's a great story and highlights the sorry state of our medical system in this country.
I wish you much luck on getting someone to pay attention to your suggestion. It would help.
cjh
You go, girl! Or suggest that if a lawyer gets admitted, he must pay all medical bills for the patients currently in the hospital.
If a journalist is admitted, he must retract every published piece he has ever written before care is given.
If a nurse, teacher, fireman, EMT, soldier, sailor, marine, airman, policeman, is admitted, take them directly to a private suite AEP (all expenses paid)
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