Wednesday, August 18, 2010

American medical care

Two months ago I saw a woman who was employed and has insurance, both medical and disability through her employer. I am not implying I never see patients like this any more but this woman was not really ill enough to be in the hospital. She and her husband moved to a community south of the Metropolis 6 months ago from another state. For reasons I will not go into her that community does not have women's services at their hospital.

She woke up on a Saturday morning with some mild pain which increased over the day. Having no physician to call, she went to the local emergency room. With no gynecologist to refer to, the ER physician got out his protocol book and began ordering tests. Pregnancy test was negative, white blood count was normal, ag. ain she really was not sick, but the next step was a sonogram.

When the sonogram was done by the technician, who was called in from home, she informed the ER physician that the radiologist would read it on Monday. The sonogram did, however, show something abnormal in the region of the right ovary. Hearing this the ER physician called the ER physician at my hospital. The result was the transfer of this woman, by ambulance, 45 miles to the hospital where I was on-call. No one told me about the patient until she arrived in the emergency room at my hospital 5 hours later. By this time it is 1 AM on Sunday morning.

Seeing the patient, reviewing her laboratory values and her sonogram, I explained to her that she had a hemorrhagic corpus luteum cyst or a blood clot on her ovary from ovulation, which had grown slightly larger than normal, probably causing the pain she had the day before but had now resolved. Her blood counts had been repeated by the ER doctor at my hospital. He needed to have something to do and bill for, right. These tests were all stable and now she was pain free.

Her husband was there. He had followed the ambulance to be with her. Following my exam and review of all that had been done, both were relieved to find out it was nothing serious. They packed up and went home. I gave her a follow up appointment in my post op clinic the next week to make sure she was feeling OK along with the names of several gynecologist who have practices in the area.

When I saw this woman 4 days later, she was doing great. She had an appointment in a couple of weeks with her new gynecologist AND she had four or five pages of paper work for me to fill out to get the ER visits and the ambulance ride paid for. I did my best.

And why am I bringing this story up now. Well, at the time I thought about how pointless all this was. Her pain resolved with a little bit of time and not much else but she got several thousand dollars worth of tests. I am now really irritated because I am still filling out paper work for the expensive items: sonogram and ambulance ride while I have little hope of being paid for my part in her care.
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