As a physician-in-training, specializing in Emergency Medicine — I thought I’d chime in on the Patient Protection and Affordable Care Act (PPACA). First off, this “mandate” everyone is talking about basically says if you can afford insurance but do not get it, you will be charged a fee — or in other words, taxed.
For some healthcare organizations, physicians, and hospital departments, today’s ruling will have significant implications — hospital emergency departments will be greatly affected.
In the ED, we’ll most likely experience a little increase in reimbursements, as 20 percent of the patients are uninsured. Basically, uninsured individuals, who have been paying for healthcare services independently —- the lowest form of reimbursement for hospitals and EDs —- will have access to insurance through Medicaid and state exchanges.
Aside from that, the EDs will most likely see volumes increase for two reasons.
First, the mere fact that more individuals will be covered by insurance will bring more patients to the ED, especially since the uninsured population has healthcare needs on reserve.
Second, there is not a primary care practice excess in the country. The odds are that newly insured individuals will not be able to see primary care practitioners and instead will visit an emergency room — thus contributing to even more emergency department overcrowding!
We already have our emergency departments full — when I’m in the ED, I constantly see beds in the hall. With PPACA, it will only lead to even more ED crowding, poorer access to emergency care for the truly vulnerable, and more losses for hospitals. It’s not just about the money — if we’re turning patients away due to capacity constraints, we won’t be able to provide adequate emergency care.
Sometimes I really ponder over treatment problems. I really hate those cases where both options stink. For example, you have an elderly patient in afib.. something I see all the time!
- Choice A: Put them on Coumadin. They don’t embolise but they bleed like stink. Nosebleeds. Head bleeds. GI bleeds. Lacerations that bleed. Dental work that bleeds. I hate it — certainly not an option for those who are a great fall risk.
- Choice B: Don’t put them on Coumadin. Presto! No bleeding! But them they come in one day with a dead leg or a huge hemispheric stroke and end up an amputee or a vegetable.
I guess you just have to decide which bad thing is more likely to occur. I’m not sure what I’d choose if I were the patient — what would you do?
There are lots of ways to mark the passage of time, but none as unusual as seeing what common household objects find their way up a person’s innards.
That’s the discovery that forensic psychiatrist Marty A. Sindhian, M.D., made while researching “Stuck Up!” — a look at the strange objects that have found their way into the human body through the various orifices. The intentionally funny book includes more than 100 bizarre X-rays, and when you finish, you may never look at Barbie dolls or baby shoes the same way again.
Sindhian, who co-authored the book with fellow shrink Rich E. Dreben and emergency room physician Murdoc Knight, made this discovery while researching a case about a person who came into the emergency room a few years ago and a cassette tape showed up on the X-ray.