Posts Tagged ‘Emergency Room’

Wrap it up, I’ll take it!

August 19, 2010

My wrist is healing nicely, just a little bit slower than I would like. I am not a patient person; I’m ready for this splint to be gone. I want to open a bottle without tucking it under my arm, and I especially want to be able to type with two hands again. I feel like I am letting my readers down!

Another thing that I do not like is that the Emergency Room bills are starting to trickle in. Don’t get me wrong – I do not mind paying the bills. The doctors, nurses and staff provided a service that I really needed, and their efforts were very much appreciated. But everyone bills me separately… why can’t I just get one bill to cover everything????

Short answer: That’s not the way it works.

Longer answer: Whenever you go to the doctor, you receive a sheet of paper that you are to take to the front desk and give to the receptionist, who then calculates your bill. Basically, this is an invoice – it lists every service they provide along with a code number. If you use Medicare/Medicaid, the US Government requires this sheet to be coded and submitted correctly before they pay the doctor. And since the Government is the biggest kid on the block, the insurance companies follow their lead.

So this sheet is the key to everything: If it is coded and submitted in the proper way, the doctor gets paid. This sheet is why the medical system is so…. interesting. Every medical professional uses these sheets: Doctors, hospitals, EKG labs, Radiologists, Oncologists, this-ologist, that-ologist… everybody! In an ER or a lab you may not see the sheets, but they are there. And everyone wants to be paid.

That’s fair – a workman is worthy of his hire, after all. But since there is little co-ordination, you’ll have bills coming from every direction. While in the ER in Houston I got X-rays. But hospital employees didn’t do the X-rays, so that wasn’t in the hospital bill. An independent service working in the hospital took the films – so I owe the hospital, and the X-ray service. And the lab that analyzed my blood work. And so on.

Why can’t all these guys get their act together and mail me one bill? Pay it and forget it?

That idea known as Bundled Payments, are being worked on in various parts of the country.  It would not have helped in my case – a bundled payment plan is aimed at chronic illness, where most of the patients follow a certain treatment plan. If most of the patients are getting the same services and/or the same drugs, it stands to reason that these people should be charged the same amount. Just check off the right boxes and the paperwork goes through – and the check is in the mail!

This seems a little too good to be true. The presence of the U.S. Government rarely simplifies anything! And while putting together one comprehensive bill would make things easier on the patient, what happens on the back end? When the Government or insurance company pays, what is the split? Who gets how much? I am certain there would be some entertaining discussions!

Maybe one day we’ll get the billing system more organized. But I wouldn’t be holding my breath.

In case of Emergency, Break Glass

May 18, 2010

Note: This is the entry I posted last night. It was active for about five minutes before I pulled it down to tell you about Gabriella’s heart transplant. (She’s awake and doing well, at last report!)

The day is going normally and suddenly you (or your Cardiac Kid) have a problem. And it’s not a stubbed toe or a skinned knee, it’s a We need to go to the hospital right now problem. What do you do?

Your first move should be to grab your Heart Book. What’s a Heart Book? Glad you asked!

One of the most frustrating things about Congenital Heart Defects (CHDs) is that they affect each one of us differently. My Atrial Septal Defect (ASD) is slightly bigger/smaller, it is in a different location in the Septum… whatever. The end result is that two people with the same defect rarely have the same symptoms.

And you need to assume that when trouble happens, you’re going to be quickly overwhelmed. You’re suddenly stressed out, you aren’t thinking clearly, and if you are the patient you could be in pain. No matter why, just assume that mentally you aren’t going to be much help.

So the first thing you should do (or do after calling 911) is to grab your heart book. Since CHDs affect everyone differently, your treatment plan is going to be different – and the information your doctor needs is in your heart book.

First, your book needs to contain all your important personal information: Copies of your driver’s licence, birth certificate, insurance policies, Organ Donor Card… what ever you need to prove that you are you, that goes in the front of your heart book. If you travel internationally it wouldn’t hurt to put a copy of your passport in there, also.

Next, you need a drug chart. CHDers medications are usually pretty involved; so I’ve included one as a .pdf file in the blogroll. (or you can CLICK HERE to download it) Save a copy to your computer (you’ll need another copy when the doctor changes your meds!) print out a blank copy and fill in your medications and dosages. Keep a current copy in your Heart Book.

Have a page outlining your heart defect, the name, address and phone number of your cardiologist, and general treatment options. Also be sure to note what shouldn’t be done. Saline? Ok, but I’m on a low sodium, controlled liquid diet, so I’ll probably need an extra dose of diuretics later. Keep pumping me full of saline and things might get ugly. MRI? No way Doc, I have a pacemaker! Echocardiogram or CAT scanner for me!

Get your cardiologist to draw a diagram of your heart with all the surgical corrections. Speed may be critical when you have an emergency, so don’t make the Emergency Department doctors get an x-ray to figure out what is going on inside your chest.

You can also include EKG forms in your folder, that will be helpful. You’re going to have a strange beat pattern, so it will help if you have an EKG strip taken at a regular checkup, so they can see what your heartbeat normally looks like. Getting an EKG strip isn’t hard – the next time you have one done, just ask. Some will just run two strips and give you one, others will photocopy the original. You may have to sign a form that says you asked for it, in case there is every any question, but there shouldn’t be any problems getting your EKG. Be sure to update it occasionally and keep it current.

Now here’s the hard part – we’ve got to take this information and condense it. Remember, this is your secret weapon that you only use when there is an emergency, so we don’t want to present the doctors with a copy of War and Peace. You need to get the important information across clearly, concisely, and quickly. Ask your doctor. Better yet, catch an Emergency Department doctor when he isn’t on duty and ask him/her: If I came into your hospital with this information, would it help you do your job?

I hope this information will help you put together a terrific Heart Book that will be invaluable.

And I hope you never have to use it.

You need a buddy!

November 16, 2009

Here’s a good post by The Happy Hospitalist about the mental checklist a doctor goes through whenever a patient is examined. In this case, however, the doctor misread an important sign and decided to send the child home.  Happy describes what happened next:

Several hours later the child was complaining of a mild headache, was having a bout of diarrhea and was not interested in moving or eating or drinking.  He was still wheezing and he was still having fevers… When I heard about how the child was acting, how his oxygen saturations left no wiggle room for safety, how he was complaining of a headache (which could be a sign of low oxygen levels), how he sounded lethargic, how he had a history of asthma and SVT, and how the H1N1 virus was disproportionately affecting the young in adverse ways, Mrs Happy and I recommended that she ignore her physician’s advice for watchful waiting and take her child in for an emergency assessment and emergency medical care.

This is a situation in which a parent excels – watch your child closely when he/she is sick. No one knows them better than you do; often you are the first person to detect that something just isn’t right. You may not have the medical education, and you may be following a gut feeling, but if that alarm bell starts going off in your head, act on it. Many a CHDer was first diagnosed by “Dr. Mom”… who may have had no idea what was going on, but they realized that something was wrong.

As the mother, you have to do what you think is right.  That means if you think your child is in danger, you take them in for an emergency assessment and emergency medical care, regardless of what anyone else says, including the physician.

PalMD of the blog The White Coat Underground continues the theme as he discusses the best thing you can bring to the hospital with you: an advocate. Going in to the hospital doesn’t automatically make you an idiot, but it can be extremely difficult to keep your head in the game:

Even minor illnesses change the way we think, not just about mortality and finances, and other “big things”, but it changes our ability to think…Trying to parse through this complex information when in pain and stoned on Dilaudid is a challenge.

So plan to be out of it – and if you aren’t coherent, you need someone to look after you. Perhaps not 24/7 but as often as possible. A perfectly healthy friend of mine lost all the feeling in her right side and collapsed one Friday afternoon, and was rushed to the ER of a “Regional Hospital”. After some tests were run, the doctor came in, sat down, and announced that she has suffered a stroke… and that they would do an MRI first thing Monday morning to determine the damage and start treatment.

I was sitting on my couch 35 miles away; yet I clearly heard her husband scream “The hell you say!”

Take a friend to the hospital – or be a friend and go with someone you know.

Get the notes!

August 4, 2009

My main task yesterday was to get my information together and fax the Medical Records department at Johns Hopkins. I don’t know what happened to them or where they went, but I have misplaced some of the photocopies of my records that I had gotten from them.

It was rather surprising that I actually got them. I emailed them and asked if records from February of 1967 were still available.  Surprisingly, they said they would look for them! And now I have managed to misplace them! Ain’t life grand?

You really ought to have a copy of your medical records handy, just in case. The more complex of an illness you have, the more useful they will be. I have multiple copies – an 8×10 folder (Which I take with me when I travel and leave somewhere in my room that it will be easily seen), a 3×5 folder in my back pocket, and a copy stored on a USB stick clipped to my belt. If I get taken into an Emergency Department unable to speak, I ‘ve got what I need.

And you have to look through everything and decide what’s important and what is not. I edit mercilessly – that unexplained fever I had in the 5th grade probably isn’t a concern any more, so that report stays at home. This is what I have in my heath folder: my vital statistics, insurance information, who to contact, allergies, information about my defect, corrective surgeries, diagram of my heart, and the last EKG I had. The basic stuff.

What you can also have that is invaluable is your surgical report. Whenever an operation is performed, a careful record is kept of the procedure. Here’s an example: Alfred Blalock’s surgical report of the first Blalock-Taussig shunt. (Page 1; Page 2) Having them is almost like letting that doctor travel back in time and see the original operation – he might have to call for a surgical consult to help him interpret them, but he’ll know exactly what was done during your operation.

Getting your surgical records might be difficult. The older you are, the better the chance they have been stored, filed and lost, and perhaps even disposed of. If you are the parent of a young child, be sure to ask for the surgical notes. The doctor may say, “Sure, no problem!”, or he may have to ask you to sign a form to show that they were transferred legally. You might have to jump through the hoops that the HIPPA law places in your way, but if they can be obtained, get them. Hopefully you’ll never need them, but if you do, they could save your life!

Free does NOT equal more!

April 9, 2009

I had finished my shopping a few days ago and was sitting in the store’s entrance foyer talking on my cell phone. A few feet from me was a table of free samples: packs of Advil, Tylenol, and some of the other painkillers that are handy to have around. As I talked, I watched this woman walk up and take ALL of the Tylenol samples: the stack of two pill packs she stuffed into her pocketbook must have been an inch thick. As the blogger Happy Hospitalist (One of the best medical bloggers I’ve seen, he’s worth your time!) would say, in her world, FREE = MORE.

I’m sorry, ma’am, but FREE does not equal MORE. Here’s a good example: In a six year period, nine patients accounted for 2,678 Emergency Department visits, for a total cost of  over three million dollars. Anyone want to guess who paid that three million? Probably not those nine people.

Emergency Departments are becoming more and more overworked. EMTLA (The Emergency Medical Treatment and Active Labor Act) laws state that if you present with an emergency condition you have to be treated, with no thought to your ability to pay (There are provisions and exceptions, but that is the general meaning of the law.) Show up at the door marked EMERGENCY! and the doctor will see you, no questions. Come one, come all, because FREE=MORE.

It’s so bad that Emergency Departments are trying to figure ways to cut “Preventable Visits” – Emergency Department visits that could be treated just as well somewhere else – a clinic or a “regular” doctor’s office.

One thing that an Emergency Department can do is to shut down and convert the space into an Urgent Care Center. An Urgent Care Center may be big enough to handle the cases that an ED can, but they don’t have to: EMTLA does not apply to Urgent Care Centers. So they can question you on your ability to pay, and they can (and do) refuse treatment. And thanks to FREE=MORE, a community loses its first line of defense against trauma and sudden onset illness.

This is why we can’t have nice things.

Two Boys

March 8, 2009

I was a the University of Alabama at Birmingham (UAB) for my second heart operation in 1977. I had only been there for a day or so when two boys about my age (11) were brought into the ICU. These two young men had been riding a go-cart – one in the seat, the other sitting on the engine cover and hanging on – when they collided head on with the local mailman. The only reason they weren’t killed right then and there was that the mailman was driving a vehicle that was higher off the ground than most.

Daddy was in the elevator lobby using the pay phone when the families came boiling out of the elevator. Standing with the phone to his ear, he could see the group standing together as they waited for the doctor’s report. Although he didn’t know any of them, it wasn’t hard to identify the two mothers by the looks on their faces.

It isn’t hard to miss that look: I’ve seen Heart Moms wear it too. Their tears are gone; they have sobbed but now the shock has worn off. Now their jaw is straight and their eyes are focused. I’m OK, doc, they seem to be thinking. Now tell me what we’re up against. What do we have to do to to save my child?

One of the boys was stabilized and transferred out of Intensive Care, but he was still a mess. Lying in his bed with scars on his chest, his right arm and his left leg both still in slings. My parents and his folks became friends and we visited together a couple of times. I even took a turn sitting with him while his parents took an hour or so away one afternoon; he seemed to be a nice enough guy. My folks became friends with the other family also – a shared crisis will do that – but I never saw the other boy. Apparently he had gotten the worst of it and was in the ICU a lot longer. Both of them were still patients when I was discharged.

Both of them survived and were discharged later… two more yanked back from the brink of death. An ER doctor once told me that kids were tough, it seemed that we got wimpy as we grow older, and these two seemed to prove him right. My friend in the slings did well, but about ten years later he contracted Meningitis. Came home feeling terrible, went to bed, and never woke up.

The other young man is now a trooper with the Alabama Highway Patrol. The only souvenir he has of his go-cart days is a scar on his chin.