Dear (Insert CT lawmaker name here),
I am a resident physician in the Yale-New Haven Hospital emergency department. I'm writing to tell you a little bit about ER conditions so that you will have a sense of how emergency care is an important issue that should be included in the currently debated health plan. A health care plan in our country cannot be comprehensive if it does not address emergency care.
When I show up for my 12 hour shift at Yale's level one trauma center, I am immediately inundated with an atmosphere that to an outsider could be perceived as chaos. The scene is far from the clean depictions on your television set, and believe me, there is not time for the intrigue that home viewers expect from “Grey's Anatomy.” Every night at many of the top hospitals in this country, patients sit in emergency room hallways for lack of private rooms. It is not unusual for these folks to receive all of their care in the hallway. I will personally wheel patients in and out of rooms so that they may have the dignity of a private exam. It breaks my heart to tell these folks, “We'll only be in here for 10 minutes before I take you back out into the hallway.” Can you imagine your doctor saying, “You have appendicitis and will need surgery, but until then try to make yourself comfortable on this hallway stretcher,” like I have? When you are having the worst pain of your life, you can't understand there is someone sicker than you.
This brings me to the health plan. There are always really sick patients. President Obama has been championing primary care as the centerpiece of his plan; and rightly so: prevention and a steady relationship with one doctor will go far to reduce health care costs. But increasing resources to primary care will not alleviate the overcrowding problems we face in delivering emergency care. For example, with 97% of the population in nearby Massachusetts insured, ER use has increased by nearly 10%. A refrain we physicians wish to emphasize is: coverage does not equal access. Where do people go when they get sick after hours?
I am familiar with and applaud sections 214 and 215 of the current Senate bill (“Systems for Emergency Care...” and “Trauma Centers...” in “Quality, Affordable Health Care for all Americans” submitted by Sen. Reid), and hope you will support these provisions. The grants and mandates are based on recommendations a 2006 Institute of Medicine report and will go far to improve care through one of the most frequent access points for people in need. In the interim, I'll do my part to see as many patients as I can safely handle so that our ER's hallways are used for walking, not patient care.
Sincerely,
Thomas Robey, M.D., Ph.D.
Need a hint? My wife is an awesome packer. I am not.
Rather than release lead and mercury into whatever space I'd be weilding a sledgehammer, I've turned two old TVs into fish tanks...There comes a time when all that's left to be said is, "Goodbye old friend." This week I used that phrase twice. Once to the Harborview emergency department and later in the same day to my clinic shoes. Over the past 2 years I've used a dedicated pair of shoes during ED shifts and overnight call. The day I stepped out of the Harborview ED was the same day I said goodbye to these old friends. The left toe bears the badge of ortho (plaster). The right foot has a spatter from irrigating my last wound in Seattle. Both bear marks from my away rotation at San Francisco General, as the heels and laces retained a tinge of the scrubs' cranberry pink dye. The real reason for discarding this pair was the torn apart left heel and loss of sole traction. Otherwise, with a splash of bleach they'd be ready for another shift!
An expanded version of this article was published at Medscape's student blog, The Differential.
The entries each indicate transport to the hospital where I was on call. My willing compliance with HIPAA and patient confidentiality rules prevents me from saying any more about the specifics of the cases, but I will comment briefly on a facet of patient care that could use improvement. Information is often lost in the transition from witnesses to emergency response personel to emergency physicians to their hospital consultants. (I was a student on the orthopedics team at the time.) We hope that the important information is maintained, but invariably, there is something that we wish we had known at the time.
It wouldn't have changed how we treated these patients to know the specifics documented in the blog entries; the primary determinants of treatment are derived from the physical exam and what the x-rays and CT scans reveal. But one wonders if speedy documentation of accidents and injuries in the field could ever be incorporated into the electronic medical record. iPhone medicine is already being practiced in many emergency departments. The fellow on our service used his Blackberry to photograph one of our patients' wounds. He only partially joked with the radiology tech that he needed it to plan for a surgery. The image was later used to communicate with the attending surgeon and was reshown the next morning during a sign-out conference.
I've not embedded the clip because YouTube has restricted it and because if you are visiting my front page, you still get to hear the "Imperial March" in the background. Wondering why? Read this. Then watch Susan Boyle live a dream.
It's no 9a as in Seattle, but 6b is better than Chicago's 5a or Pittsburgh's 5b - two places I've gardened in the past. It's looking good that we will have a yard (0.09 acres minus the house's footprint), so if we have any time after (1) being residents and (2) minor remodeling projects, the yard will offer us an urban oasis. And vegetables. This year even!
If the cuts are approved, there will be financial capacity for only about half of the flights now made. The governor's office cites that this program is run from a private hospital as a reason to be included in the cuts. The problem with this reasoning is that there is no other service in the state making this kind of transport. According to the article, legislators on an appropriations subcommittee recently recommended restoring the entire $1.4 million that was cut. Even so, I think it's reasonable to engage in discussions about the cost of emergency transport. It seems to me the $9000 per flight cost is worth saving a life.
