One reason I won’t vote for McCain

Is his healthcare advisor’s attitude toward’s Emergency Departments:

 In the Los Angeles Times‘s (8/28) Booster Shots Blog, Shari Roan wrote that this week, “John McCain campaign advisor” John Goodman “said, in effect, that as long as there are emergency [departments], no one in America is really uninsured.”


Op-ed columnist Paul Krugman writes in the New York Times (8/29, A21) that according to Goodman, in America, “there’s no such thing as being uninsured. After all, you can always get treatment at an emergency [department].” Furthermore, Goodman “the president of the National Center for Policy Analysis, an important conservative think tank…wants the next president to issue an executive order prohibiting the Census Bureau from classifying anyone as uninsured.”

Understand that there are a few issues here:

1)  An unfunded government mandate that requires that anyone presenting to an ER requesting medical evaluation, or someone requests a medical evaluation on their behalf, must receive screening for an emergency medical condition regardless of ability to pay.

I have no issues with screening people for medical problems…but the government provides no compensation or liability coverage for hospitals or physicians following this mandate.

Why should this concern you?  When the ER is full of uninsured people demanding an evaluation for their chronic pain or made up medical conditions, or just because they are bored and it’s your hospital’s turn for their daily/weekly/monthly ER visit (yes, it happens…over and over and over again)…YOU or your LOVED ones, who are responsible users of the system will be a) waiting for an ambulance to return to service after transporting the “sprained ankle” who didn’t have money to call a cab or b) waiting in the waiting room because all rooms are full…

Problem #2

Going to the ER to be screened for an emergency medical condition is no substitute for primary preventative care.  People come to the ER only AFTER they are ill, or well advanced into a serious medical condition for which the might have sought treatment had they had insurance.  In addition, the ER is only required to screen for an emergency medical condition and provide stabilizing treatment.  In other words, if the patient does have a medical condition, but it is not an emergency (long term treatment of hypertension, for example), the ER is a horribly inadequate place to be seen and evaluated.

A patient like that will fall through the cracks, not follow up, not be treated for his ongoing medical problem until he shows up in an ER years later (if he can get in) with a heart attack, stroke or flash pulmonary edema.

The stance of the McCain advisors is flat out abuse of the existing Emergency Medical System, which will ultimately hinder your ability to receive appropriate and timely emergency medical care when you or your family needs it most.

The Tale of the Drunken Cowboy

The Tale of the Drunken Cowboy

The drunken cowboy paced in and out of his room, looking for something.  Looking to make sure no one was watching.  Holding his left arm at his side with his forearm across his chest, he paced out into the hallway once more.  Looking left then right, he turned towards the exit and began walking.  Even his casual cowboy gait looked suspicious.

He stopped at admissions and asked one of our petite, 97 pound receptionists, “Are you guys gonna show me how to put this on or what?” he asked, holding out a foil covered fiberglass split, still in it’s package unopened.

The receptionist coolly guided him back to his room in the ER to await my evaluation.

As I introduced myself, I wrestled the fiberglass package out from under the (obviously) broken arm and sat him down on the bed.  “You’re in the ER now, and you have to follow our rules, OK?”  As he sat down, the bulge in the back of his pink cowboy shirt revealed the corner of yet another foil wrapped splint.  I reached inside the torn seam of his shirt and wrestled this one out too.  By this time I was lauhging inside…the drunk cowboy trying to hide 10″ x 10″ and 3″ thick silver packages under his shirt and under his arm as if no one would notice.

The cowboy was in a hurry to go back to work, angry that his arm was betraying him with pain.

When he tried to steal a split for the fourth time, I somewhat hastily pushed his shoulders back onto the bed, and had a stern talk with him.

“This is stealing,” I said.  “You wouldn’t want us to come into your stable and start taking tack off the wall, now, would you?  When you are in our house, you need to play by our rules.”

As he finally laid down on the bed and put his muddy spurs up on the white sheets, I noticed a small knife strapped to his belt.

“You’re not going to take that knife out and stab me, are you?”

In a southern, drunk, Jack Daniel’s Drawl, he said, “Naw…you already kicked my ass…”

Finally after viewing the x-ray, two of us placed the split which he so desparately wanted, and he whined, “A pint of whiskey sure would make this feel better.”  It was a perfect opening for me, as up to this point, I had not confronted him about the drinking, nor did I really care…but I was curious…

“Did you have any whiskey before you came over here today?”

“Yeah, a little bit”

“How much is a little bit?”

“Oh, half a bottle or so…not much…”

We convinced the cowboy to leave his splint on at least until he was sober before he decided if he could work without it on.  Finally he smiled at us….which made me suspicious again.

“What are you smiling about?”

“Well…you’re the first doctor who’s ever been nice to me.”

Stay tuned for Part 2, “The tale of the drunken lady”

If You’re Not a Cowboy…

I see a lot of Horse injuries up here in the rocky mountains.  Mostly tourist stables and stuff, but when there are horse shows in town, we seem to get a lot of hunter-jumper injuries…girls getting thrown headfirst from their horse.

Which is wierd, because during the rodeo, when guys are deliberately riding horses & bulls getting thrown off, we never see them in the ER.  Those cowboys are tough and refuse to go to the hospital, even if they can’t breath or walk.

So my new motto is, “If you’re not a Cowboy, don’t get on a horse.”