The Cost of System Abuse

Of course the health care bill isnt going to do shit……its going to be written and run by the government, which has been the downfall of medicaid and medicare. And as for earache boy, I have been told idiocy can not be cured (but I did meet his brother who took an ammalance to the hospital for his long toenails!)

Point granted, but in this case, the followup should be, “Get out of my ER, and go fill your prescription.”

And the current system discourages such common sense.

One problem with limiting repeat customers is that these are sometimes the patients where the doctor missed something. Nothing about this guy tugging on his ear suggests that is the case, but there are plenty of cases, where the return of a patient leads to a more accurate diagnosis. A repeat visit is certainly better than having a visit from a lawyer.

I have no problem with being critical of this patient. The problem is that some medics hear that this is a repeat trip to the ED, bypass all thoughts of assessment, and assume that it is abuse.

We need to try to make EMS encourage common sense, such as assessing a patient, before jumping to conclusions. While you don't base your treatment/lack of treatment on hunches, there are plenty who do. One of the things many old timers will rag on others about is being fooled by a faker. This generates an environment of never threat something that might be bogus, rather than act as professionals and perform whatever assessment is appropriate to the situation – in this case, a brief targeted assessment should be more than adequate.

The problem is discouraging medics from making those front door diagnoses of, This is obviously nothing, even though they have not even come close to performing an appropriate assessment. This is something that is as legitimate a problem as system abuse, and the two are connected.

You have a great point rogue, but I think AD's taking issue with the system that fosters both repeat idiocy offenders and lazy medics…

Just trolling: instead of giving him a tour around the city in an ambulance, wouldn't it be a lot cheaper to just give Earache Boy the pain meds he's craving for?

On a more serious note, I hope this kind of crap won't reach us here on the other side of the ocean. I don't work in an ambulance, but if I did, I'd quit the moment I couldn't tell this patient to stop bothering me for such nonsense. Surely, if he really needs an ER, the nearest ER capable of handling his problems is quite fine? Did you actually take him to the other ER (probably on the other side of town) for a simple aching ear?

On a side note, I learned a few weeks ago that (mostly left-sided) ear pain might be referred pain from a MI. In everything solely left-sided, you'd better call the paramedics! Pain in the left ear, left buttock, left toe, who knows what kind of ischemia might have hit you

As usual, it's not about heAlth, care, or reform – it's about power and control.

Rampant waste, fraud and abuse is a feature, not a bug…

There are supposed to be some rules with some insurance, that if the ED doctor does not write that the ED visit was necessary, the patient is responsible for a larger out of pocket payment. Sounds like a great start at dealing with abuse, but many doctors have stated that they do not want to do this, because they are afraid of receiving negative Press Ganey scores. why does the opinion of a system abuser allowed to have any influence on this? Because the hospital administrators have become so caught up in the Press Ganey and JCAHO/TJC nonsense, that they believe it actually makes sense. The hospital administrators encourage this abuse.

OK – please tell me how someone “woke up dead”?

I think I had this same guy. The problem, aside from him not taking any responsibility for his own actions, is the current system writing him the $4 script, then not giving it to him. If we can tell him to go to the walk in clinic and get seen, and he does and gets what he needs, not wants but needs, then he never calls you back.
Of course everyone has access to “health care” via EMS, 911 and the EDs. That just happens to be the absolute most expensive manner of providing it. Without a change in the way we deliver care, he will continue to walk up to your station and expect somethign different to happen. imagine the power in first telling him no to an ambulance and being able to arrange a ride to the clinic, then a clinic that assesses, treats, prescribes and follows up with him. THAT is health care.
The current bill is so watered down it actually increases profits while restricting care. But when you have people determined to see it fail, it will fail.

The solution for regulars is to stop taking them, plain and simple. and it won't take improving education or fancy new techniques, but systems trusting their people to make the right decisions and backing them up. that's what i was in the UK firsthand. It works, people. We just have to want it to work here.

B I N G O ! ! ! !

I think I had this same guy. The problem, aside from him not taking any responsibility for his own actions, is the current system writing him the $4 script, then not giving it to him. If we can tell him to go to the walk in clinic and get seen, and he does and gets what he needs, not wants but needs, then he never calls you back.
Of course everyone has access to “health care” via EMS, 911 and the EDs. That just happens to be the absolute most expensive manner of providing it. Without a change in the way we deliver care, he will continue to walk up to your station and expect somethign different to happen. imagine the power in first telling him no to an ambulance and being able to arrange a ride to the clinic, then a clinic that assesses, treats, prescribes and follows up with him. THAT is health care.
The current bill is so watered down it actually increases profits while restricting care. But when you have people determined to see it fail, it will fail.

The solution for regulars is to stop taking them, plain and simple. and it won't take improving education or fancy new techniques, but systems trusting their people to make the right decisions and backing them up. that's what i was in the UK firsthand. It works, people. We just have to want it to work here.

Happy, that would work except for a few major flaws:

1. What if there are no 24 hour urgent care clinics in your area? The majority of their clientele is Medicaid and uninsured patients, and the reimbursement isn't enough to keep the doors open. In many parts of the country, it costs more to treat a Medicaid patient – even in a doctor's office – than it pays. Ergo, increasingly fewer doctors take Medicare or Medicaid patients. That's only going to get worse once they expand the Medicaid rolls while not reforming the current reimbursement model that heavily favors specialty procedures over primary care.

2. Trusting your people to make good decisions is a nice theory, but the sad fact is, there are way too many medics who can't be trusted to make those decisions. I've worked with them, and chances are you have, too. Not to mention the fact that educational standards are extremely variable across this country. In my experience, the really good medics who can be trusted to make those triage decisions aren't the norm. In fact, they're the outliers. Barely competent is the norm. And until education improves – nationwide – that's not going to change. And it may never change even then, unless reimbursement improves to the point where we can afford to pay them what they're worth.

My impression is that it works in England because a) the medics there are generally better educated than their U.S counterparts, and b) the patients don't have the “big white taxi” sense of entitlement ours do.

What levels of EMT or medic do they have in the U.K.? I have a couple of friends who are medics with London Ambulance Service, and from my understanding, their education was roughly comparable to mine – which is to say, not terribly extensive, but more so than many places in the U.S.

What levels of EMT or medic do they have in the U.K.? I have a couple of friends who are medics with London Ambulance Service, and from my understanding, their education was roughly comparable to mine – which is to say, not terribly extensive, but more so than many places in the U.S.

You sound like you work where i do! fucking trash all day long. 90% or greater of my 15+ calls a shift are jittney rides. Fuck um!

25 years ago, we had an old country doctor who was called into the ER one night for such an ER abuser. I looked him over then wrote him out a $100 bill for services rendered and made the dude pay him in cash before he left the ER. We never saw the dude again! Until we as a society stop coddling these folks and start making them pay for the services we render up front, the abuse will continue.

What kills me is that no matter what kind of service you work for, fire, private, district, this is a problem that plaques the system.
T 4 wrote: ” I hope this kind of crap won't reach us here on the other side of the ocean. I don't work in an ambulance, but if I did, I'd quit the moment I couldn't tell this patient to stop bothering me for such nonsense.”
You would have left your job with-in HOURS!
I dare someone to tell that patient that this is not a medical emergency and it would be cheaper to call a cab. Sir, it'll be 5 dollars for a cab, or 500 dollars for an whambulance ride. I would dare to guess that you would be crucified by your agency when the phone calls start coming in.

The whole system is broken. We need to reevaluate how we treat and transport patients. Every patient should not have the ability to be transported where they would like to be transported. If this patient would have called a taxi cab he would have only been transported to a facility that was within the boundaries in which he could pay for cab fare. If a person needs an ambulance it should be for emergent situations. Calling an ambulance should trigger an assumption that the person requesting transport believes that their situation is an emergency. At that point, the medical professionals who are assessing the patient should be the ones who decide where the patient is transported. Transport should be to the closest most appropriate facility, not one that dispenses the best medications. Transporting to the closes most appropriate facility will get units back to their coverage area quicker and the patient will receive a level of care that is appropriate for their situation.

Why do we have to always transport to hospitals? Why can’t we transport to clinics that can better treat certain patient complaints? Why do we have to transport? What is keeping our profession from progressing to the point where we can treat and not transport on the scene? Especially in a situation where the patient was just seen less than 24 hours ago for the same complaint and they have not taken the measures prescribed by the emergency room physician. What is holding back telemedicine? Obviously, the profession is young and we are moving forward, but we need more people moving forward. This profession is not just about lights and sirens, driving fast, and emergencies. It is about delivering compassionate care to people regardless of their situation.

Please, if you are progressive keep moving forward. If you are not involved in shaping our profession please get involved.

Like I said we need to change the whole system. Payment should be attached to the care provided, not the mileage traveled to the hospital.

Also, please remember that individuals on the street are not the only ones that abuse EMS. This goes for ground and air transport. Hospitals and other health providers abuse EMS providers by falsely documenting reasons for ambulance transport from one facility to another. I have transported many patients that could have been transported by other means but because there was a wait, the physician documented that it was an emergency. When is it an emergency to transport a patient to a medical bed without any telemetry? The industry is abused from many angles. Patients, Hospitals, Physicians, tax payers, politicians, and ourselves. Where does it end and how do we choose who is allowed to abuse EMS?

If you are just getting into the medic field you had better learn to spell, and learn the rules of grammar.

I want my non first responder friends to read this article. My first responder friends will confirm that the system is overloaded with people like this. I've picked up a person 4 blocks from the hospital that greeted us at the curb and did't want to pay for a taxi. Went to a house because the person had no minutes and could only call 911 for a ride to the ER for her minor cat scratches. Every shift brings more stories like this, the cost of a system with no consequences.

“While the paramedics were treating a mother. fucking. ear. ache”

Really?!?

I remember a call we got one time not too long ago for a tooth ache. Yes, a mother. “f”ing. tooth. ache. Can you believe the gall of someone to call for that of ALL things.

Well, thanks to my training and the fact that I actually give each and every patient a through assessment from top to bottom now, thanks to some screw ups I've made; I found out by doing a 12-lead that it wasn't a mother. “f”ing. tooth. ache. It was a mother. “f”ing. MI. Remember that damn little nuisence called defered pain?

This guys only sign or symptom was the classic jaw pain that he interpited as a tooth ache.
Don't be so quick to judge. Treat EVERY request for service as that…a request for service.

As for the code that was happening at the same time; we are not gods or father time and we certainly can not control the timing of these events. What if “Toothache Boy” was a code and the other code still happened? That's right; the other ammalance is STILL three minutes away!!

I too have had the patient with bilateral jaw pain that turned out to be an inferior wall MI. HAd that one a couple of times, in fact.

In the case of Earache Boy, I was convinced that it wasn't REferred pain (what is deferred pain, by the way? Something that shows up after the event?) by the redness and purulent drainage from his right ear, and the antibiotic scrip in his pocket.

Why do you assume we didn't assess our patient?