Physician's ER Experience Changes His Mind On Health Care

Jack Coulehan is a professor of preventive medicine at Stony Brook College in New York. He always shrugged off ER horror stories, arguing that, as a skilled and knowledgeable physician, he'd never fall in the black hole of endless and expensive tests.

After a sharp pain in his eye persisted, however, he and his wife went to the emergency room, assuming he had shingles. Though Coulehan and the original ER doctor agreed on the diagnosis and ordered some Vicodin, what followed was a full-day ordeal, complete with opthamologists, neurologists, CT scans, and other unnecessary treatments that ended up billing $9,000 to his insurance company.

Coulehan's opinion about the "trap" in the medical industry has changed, and his essay in Health Affairs and The Washington Post describes how we can all fall into this hole, driven by fear and anxiety.

How can we make stories like mine less common?

The only way is an approach to health-care reform that encourages well-coordinated, standard-of-care practice and simultaneously discourages the irrational, shotgun approach to medicine.

One thing's for sure: I've lost the smugness and condescension I often felt when listening to others' stories about being trapped by the system and manipulated into excessively complex and specialized medical situations. Unlike most of my patients, I actually knew what my diagnosis was and what to do about it, but I learned how difficult it is to remain objective when you're feeling very sick.

This irrational, shotgun approach to medicine adds on thousands of dollars to medical bills every day. This costs the insurance companies more, and inevitably, the consumer.

Leave us a comment or tell us your own ER horror stories. Did fear of an illness drive you to agree to thousands of dollars worth of unnecessary tests? Make your Impact known.

Comments

[karlak]

Spell check, please. Ophthalmologists is spelled wrong. Feel free to delete this portion of my comment, once you fix the spelling mistake.

I agree with Dr. Coulehan and avoid the ER at all costs. A couple of years ago, I had an accident in the kitchen which partially severed my thumb. With two small kids, spending the next seven hours in the ER was not a viable option. So, my husband sutured my thumb himself. (He's a physician.) No anesthesia... horribly painful.. but not as bad as waiting forever in the ER only to have an Intern attempt to sew it up and mess it up. (It was early August... not a good time to go to the E.R.) It took him about 15 minutes, and the thumb healed well. He emailed a hand surgeon friend of his pictures--to check and make sure there was nothing else needed. Saved myself many hours, and my insurance company a few thousand.

Unfortunately, that option does not exist for everybody. We need universal, single-payer health care in this country. We need nationwide tort reform--which is not in the new House bill that was just signed--quite the reverse, trial lawyers get a big payday.

[2lib4oh]

This is what happens when "vested interests" of those who profit from the health care industry rule over the actual needs of the patient.The patient needs good comprehensive care in the ER setting from an experienced well-trained physician whose major focus is helping his/her patient to recover.Such a professional should be well-compensated but not pressured to do more tests than needed or judgment demands.Everyone knows there are risks involved in doing or not doing a procedure.We have medical boards staffed with health professionals who should decide if the extreme measures were taken.We don't need insurance companies in the room trying to practice medicine at the patients expense and the doctor's credibility.

[GeneralRobert]

Getting a handle on ER costs is important, but a difficult target. Currently the insurance and government tactic is denial of claims, sticking the hospital with the costs of procedures deemed unnecessary, a cost that must be borne by other paying patients. If a physician orders a study or procedure, the hospital is not in a position to deny its performance. Any attempt to control costs by denial of claims after the procedure is performed will not cut costs as these procedures represent money already spent by the providing hospital. The only effective way to reduce these costs is by reducing the ordering of unnecessary procedures or studies.

[daytondoc]

This example shows how flawed the idea that patients can "decide and shop around" and "be more responsible with their health care expenses", the basic principle behind "health savings accounts". Even with the background of a well seasoned physician, this patient or doctor himself was powerless and helpless in the decision making process of what treatment, tests were ordered, especially in an emergency situation. HSA's are merely an investment scheme for the richer who can afford maximizing the contributions, compared to the middle and lower classes, and are usually part of another scheme, which is high out of pocket deductible plans. I call these consumer-directed or cost-shifting-to-consumer plans "insurance without insurance" and they represent the latest biggest scheme to make more money for the insurance companies. The other elephant in the room is the broken health care delivery system that some have already pointed out, which is contributing to a great extent to the costs of health care. To summarize and at the risk of oversimplification, doctors order tests or procedures, which may or may not be indicated, doctors make money, hospitals make money, radiologists make money, insurance companies pay up but try their darnest to keep the "benefit ratio" for each patient to be as high as possible (pay out as little as possible but keep collecting premiums), and jacks up premiums when they want to keep the stock holders on Wall Street satisfied. What a great system, only in America! And the patient...?

[tlgeiger62]

Amazing story .. .hope more people read it, Digg it and pass it on. I think it's an important story that needs to get some notoriety.