I’m at wit’s end.  In the last couple of weeks, I’ve had to practically beg physicians to accept patients referred or transferred from our emergency department.  Not indigent, intoxicated patients, mind you.  But paying patients, with real medical problems.  A very nice young man from Charlotte, NC (about 3 hours away from here in little old Seneca, SC) had an open finger fracture with a tendon injury.  He wanted to have it taken care of as soon as possible.  Our orthopedic surgeon wasn’t comfortable with the hand injury.  The hand surgeon in the next town, Greenville, said, ‘I don’t want to operate on someone who will follow up in Charlotte!’ And the ultimate insanity?  The hand surgeon in Charlotte told me, with remarkable snottiness, ‘You know Doctor Leap, it isn’t rocket science.  You clean it out and close it and send it to us this coming week.’ 

Problem is, it was a bad wound, and too swollen to close.  It was hard to get good analgesia/anesthesia.  And the patient wanted to either have it taken care of immediately, or have someone in Charlotte accept him.  At least 10 phone calls and four hours later, one hand surgeon (bless his heart!) said, ‘just put wet to dry dressings on it, cover it, splint it and I’ll see him in the morning!’  It was so easy.  That’s all the first guy had to say; I guess it was too simple.  And for some reason, the fact that the paying patient was in another town just violated some unspoken territorality.  ‘More than 30 miles away?  Not in our clan, not in our pack.  Someone else’s job!’

We had another very similar patient with a Workman’s Comp injury who wanted to go back to Gwinnett, GA, near Atlanta.  No one would take him.  He finally left, knowing he could arrive at a hospital there and be treated.  They called back.  ‘Why did you send him here?’  No doubt hoping for an EMTALA violation.  ‘We didn’t.  He got tired of waiting and left.’

A few days ago I cared for a lovely older lady with jaundice and an abnormal liver and pancreas on CT scan.  Not too uncomfortable, she needed an outpatient ERCP   (for the non-medical, that’s a procedure to look up into the ducts of the liver and pancreas).  The gastroenterologist in Anderson, the next town, said, ‘You know, they do those in Greenville too.  I’ve taken enough from Oconee this weekend.’  Even a local doc, and friend, when asked to follow up on an uninsured lady with an artificial bladder and fever, said ‘You know, I’m getting a little tired of these uninsured patients.’  Well guess what, it’s just reality.  And I see them all the time, so what’s the problem? 

I know doctors feel put-upon by the uninsured, and by the volume of patients they see week after week.  I know that insurers and regulators wear us all out. I know that we somehow believed gold would fall into our laps as doctors.  At least some folks thought so, apparently.  But some stark realities remain:

None of the patients I mentioned wanted to be patients.  They needed care, they needed surgery, they needed medicine, they need procedures.  They’d have been just as happy to stay home and never darken our door.  We went to medical school to take care of them.  I know it isn’t a perfect system, but it’s what we have.  What if it was our child, our son, our mother? 

Next, even though we lose money on some folks, and even though I’d like to see everyone pay their bill (so everyone would pay less), we still make money.  The problem seems to be, it doesn’t fall from the sky as big bags of free gold.  If you want to make money, and you decline a paying patient I send you, then you are simply out of touch with reality.  Sickness or injury in insured patient, plus trained medical doctor, equals money.  Or am I doing the math wrong?  I always had trouble with simple math…

And here’s one last reality. This is America.  It isn’t the Communist block with bizarre borders and border guards.  If a patient needs your care, but isn’t from you community, why does it matter?  I’d keep them if I could, but I can’t, so help me out!  I know you may have financial incentives, or you may be overwhelmed already, but I’m not sending them by the bus-load, only rarely, and one at a time.  And only when I can’t do it myself.

Attention Doctors…step up to the plate!  Let’s be the professionals, heal the sick, treat the wounded, comfort the dying.  The money will come, I promise, if we act like the heroes we can be, the heroes we should be.  Let’s reclaim medicine! But we can only do it if we take care of those ‘pesky sick people.’ After all, they need us. 

Pass it on!

Edwin Leap, MD