American healthcare is so royally fucked up, I just can't even begin to tell you.
6:30AM I got a phone call from a patient who has a bad cancer. Her abdomen was filling up with fluid and she wanted to go to the emergency room. Now, 20+ years of experience have taught me that if she goes to the emergency room she will spend six hours there, get a whole lot of tests, nothing of substance will happen, and she will be admitted to the hospital. Eventually, the doctors who take care of hospitalized patients will get around to seeing her and maybe tomorrow she will get the fluid drained and then she will feel better. This will cost at least $10,000. On the other hand, she can see our NP in the office around 8:30, get the fluid drainage done this morning as an outpatient and maybe be home for lunch, feeling much better and saving the cost of the ER visit and the night in the hospital. At a guess, it will cost less than $1,000. I tell her this and talk to my partner who takes care of her. He agrees and calls her to reinforce this, but she does not have anybody to drive her to the office so she ends up calling 911 and goes to the ER. That's right, lack of cab fare or a friend to drive her is going to cost you, the tax payer, almost as much as it would cost to keep a family above the poverty line for the whole year.
Around 3PM, my partner is at the hospital and wonders why the ER hasn't called about her so he stops in. She is sitting there and predictably, nothing has really happened. She has had a CT scan which shows a whole bunch of fluid in the abdomen - something I figured out from a telephone call - and they plan to put her in the hospital because...what else could you possibly do? He talks to the ER doc (who I can tell you from numerous conversations doesn't know her ass from a hole in the ground) and says "how about we get her belly tapped?" She says that's an inpatient problem and she does not know how to order it. Are you fucking kidding me? You pick up the god damn phone, you call the interventional radiologist and you say "hey, do you think you could remove some of this fluid and let this poor woman be more comfortable so she could spend the night in her own bed feeling better instead of being uncomfortable in a scary hospital over night with nothing happening?" I guarantee you he will say yes because he is a nice guy who is good at his job but she is either too lazy or stupid to do that and just wants to make it somebody else's problem while spending tax payer money. So my partner does her job and he gets it done. He then leaves, feeling he has done at least half a solid for the world.
An hour later, the crappy ER doc calls and says the patient still has to stay. She's in pain. Yes, says my partner, I know she's in pain. Hence the morphine she takes three times a day. Well, says the shit-for-brains ER doc, we gave her some pain medicine and it didn't help, so she has to stay. They gave her LESS pain medicine than she takes at home and, unfathomably, it did not work. My partner has to talk them into actually giving her a reasonable dose of medicine (which the ER doc refuses to order because she does not feel comfortable with such a big dose - which isn't really all that big for someone with cancer who is chronically on opiates) and, hey, look at that, it works. He increases her pain meds over the phone and somehow the idiot ER doc lets her go home.
I know the ER doc doesn't treat people with cancer and may feel uncomfortable with all this. I'm OK with that. I don't expect her to know how to do what I do. FSM knows I couldn't set a broken bone or manage a heart attack. But when we walk her through the process step by step and do half the work for her and she still can't manage the patient properly then it may be time for her to get a job with a pharmaceutical firm selling Provasic and getting out of the way of people who want to do more than just work their shift and cash a paycheck. It just really gets me sick and makes me worry about the future of healthcare.