I realize that the uninsured/indigent issue has left lots of consultants with a bitter taste in their mouths.  Countless times, I’ve planted myself by the emergency department phone and called out of town consultants who were not obligated to care for our patients (oral surgery, ENT, plastic surgery, etc.), and who flatly refused…often with remarkable rudeness, in fact.

I certainly understand their position.  They have enough to do at their hospitals without helping out other small hospitals.  Unfortunately, lots of patients live in the area of smaller facilities.  And, specialists are often hard to recruit to small, rural hospitals.  Ergo, some facilities don’t have specialists; or at least, don’t have them all the time.  So, we have to transfer patients.

Thus was my situation with the dog-bite I recently saw.  It was a facial bite, which we would ordinarily care for in-house.  But it needed a meticulous closure.  And our ENT’s were both unavailable.  It was by no means a life-threatening problem.  But the cosmetics merited a better hand with a stitch than me!
So, upon calling the next town, I was told summarily to ‘call somewhere else.’  Fair enough.  I understand.  The irony is, the patient had very good insurance.

There’s an implied belief that any patient transferred from one hospital to another is transferred because of non-payment issues.  However, not only is that illegal, it’s not usually true.  Furthermore, even uninsured patients may attempt to pay their bills!

Nevertheless, we’re told not to discuss money in regard to transfers.  It might make the transaction go badly; or it might actually remind the accepting doctor that the reward for his help is, you know, money…the stuff we get paid with!

I never got the chance to tell the guy in the other town that he’d make cold, hard cash from the case.  He assumed I was one more hick doctor from one more hick town sending him just another hick.  But even hicks (which the patient wasn’t, and I’m not usually) may have jobs and money.

Maybe if I’d been able to tell him that, or at least hadn’t been taught that it was ‘naughty’ to do so, the interaction might have gone better.

The unintended consequences of feel-good legislation, like EMTALA, grow larger every day.  Fewer physicians available to do larger amounts of work.  Angrier, more frustrated physicians, taking out their venom on other doctors, just trying to do the right thing.  And patients enduring the negotiations between doctors, that bear a striking similarity to the times when the car salesman leaves the room to ‘talk with the sales manager.’

I don’t know the answer.  But I do know that the doctor who finally accepted my patient will make a pretty penny because good old Rex lost his cool and bit the face that feeds him.

And I know someone else, Dr. Snippy Assumptive, missed the money.

The times are strange, and growing stranger every day.

Edwin

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