Discussion thread for the "Polls only" thread (Part 1)

I voted to take the patient to the closest ER, but my reasoning is a bit more complex. First, quoting the poll -

Ok, first, note that while perhaps not intentionally so, you, the driver, are not explicitly an EMT or Paramedic. Most drivers are, some are not according to a quick google search. So, right off the bat, you may be utterly unqualified to make the evaluation stated in the first line. And if they’re in the back being treated by the other EMTs, who have more firsthand knowledge, why are YOU making the decision? And even if you -are- all paramedics/EMT, you just don’t know enough to be SURE. If things are bad enough for an ambulance to have been called and assuming the original analysis is correct that it requires urgent care, then get more info for the patients safety ASAP, which means the closest option, with none of the unknowns about traffic or other issues, which brings us to this:

Again, huge number of unknowns in terms of taking them to their preferred location. The whole question is stated to be based on a real case, but we’re supposed to (in that final line) assume there are no consequences, legal or otherwise. But at that point, it makes the poll largely pointless, because the final clause says there ARE consequences, just not legal ones. The patient survival vs costs. At which point, survival > saving money.

Plus, speaking from some experience, if the PPO is going to nitpick about an emergency room visit despite most boilerplate agreements, they’re going to ding you for everything else, including the damn ambulance ride. My wife was once billed $5 grand for an ambulance ride because it was out of area / network, after she was thrown in one by an EMT against her will for what was serious but not critical dehydration issues.

Our system is fucked up, the whole network thing is only going to add one minor, probably negligible layer of suckitude and not worth the risk. Because even if I’m somehow not liable for any legal issues, if my patient dies because they were trying to save money, and I agreed, I’m going to be far more damaged by the event than by my worries about her budget.

In my last experience with an ambulance there was actually a fairly long conference, like 15 minutes, between the two EMTs and the radio dispatcher about where they could take my wife that was inside of an hour’s drive where she might actually be seen (this was circa 2021, non-Covid related, like 200A). We’re in a highly urbanized area, so it’s not like there’s a dearth of choices here.

I’m surprised at how many people thought a typing course should be mandatory in high school. Don’t kids these days get issued Chromebooks practically at birth? By the time they get to high school, they’ve been typing assignments for years.

Required classes? Reading, writing, math, science. Once you’ve really got those subjects nailed down you can add to it

That’s not always true. People do sometimes choose not to spend all their money (and money that helps story their family) on chasing the last few months of life.

I knew a woman who discovered her health insurance sucked after she developed breast cancer. Her odds weren’t great with the most aggressive treatment. She chose palliative care and not bankrupting her family.

My mother was old and failing and when she fell and broke her hip she was able to convince the ambulance to take her to the hospital she was a trustee of (where her healthcare was free) rather than to the closest place. It want just the money, she also knew she’d be treated by people she knew (or at least, who knew her) at her hospital. She had a DNR at the time, and if it had been life or death, her choice was death.

And no, health plans won’t pay just because it’s an emergency. Maybe they’ll pay the emergency department fee, but the women is then going to be admitted to the adjoining hospital, and if it’s out-of-network she might be screwed.

If it’s a basically healthy person with traumatic injury the choices are different, but even then “good care” can trump “closest hospital”. They take those people to the trauma center, not to whatever is closest.

But even so, the patient should be given the best possible information and if they are conscious and rational, they should have the autonomy to choose.

I’ve never been fond of oreos, because I don’t like the overly-sweet filling. As a kid I did eat the chocolate cookie part when my sister would separate them and only eat the filling :slight_smile:

As an avid fisherman I’ve been stuck by sharp fins, spines, and teeth more times than are countable, but mostly no worse that getting stuck on a rose bush or a minor knife cut. The ubiquitous Hardhead catfish, however, have spines that are covered in venomous slime and you will remember even the smallest nick for the rest of the day. A band-aid might get applied after I get home and my SO tells me to do it.

The one time I was hit by a stingray it only got the tough skin next to the nail on my big toe, but it still hurt like hell and I limped for a couple of days. My father-in-law got hit in the calf once and part of the stinger broke off in his leg. Even after applying hot water (courtesy of my truck’s radiator), an ER visit, and topical pain relievers, he was in pain and couldn’t walk for at least a week.

I’ve never been stung by a man-o’-war in the water (they’re pretty easy to spot), but have stepped on tentacles on the beach a couple of times. They still pack a wallop even after lying on the sand for several days.

I miss eating the muscadine grapes that my grandparents grew, and in past decades could be found in grocery stores. The skin was fairly thick and had a wonderful tartness.

After explaining the risks, the ambulance should take the lady to where she wants to go, period.

I’m very seriously considering going to the store for Oreos and milk now.

I just returned from a vacation where we brought two boxes of Oreos. One box went away quickly. The other box remains unopened on my shelf.

I know myself well enough to leave it sealed.

I’ll give it to you if you want to swing by the house.

mmm

Repeating this for truth. Being an ambulance driver doesn’t give you the right to override somebody else’s medical decisions.

Granted, individuals, especially in the scenario you mention, where the party is at end-of-life or other edge cases are going to be different. The reason that I quoted the original poll though was to step around the many different possibilities, both because of the very limited information, and the poll poster’s explicit ask to only consider patient $ vs. patient odds of survival.

Given the hypothetical, if those are literally the only considerations, I’ll stick with survival still being > patient $.

Again, this is why I had to do the full quote of the poll. Because it was the only way not to fight the hypothetical.

IRL however, there are a metric ton of other considerations, exactly as you point out. It would be interesting to game it all out, but that’s a thread of it’s own most likely.

But those aren’t the only considerations for the ambulance driver. Because they also have the preference of the patient. And i believe the patient gets to decide, and gets to decide what considerations matter how much, not me, and not the ambulance staff.

I know the question said, “assume the only considerations are the chance of survival and the cost”, but it also said

Yes, it says you won’t be sued for making a different choice. But i think it’s still right to respect her choice. Tell her everything you know about the risk, and let her weigh the cost and the risk.

I’ll repeat, I’m sticking by what the very limited info and guidelines of the poll. If we want a more nuanced discussion, we need a better thread for it. :slight_smile: And in the section you quote again, in the italic points, it says “if you can get her to an ER quickly”. We know the out of network options are nearby, thus reasonably ensuring quickly. We explicitly know nothing about the possibilities at the in-network other than they are farther and we know nothing about traffic and other variables that may slow the arrival.

IRL, we’d be able to look at a smartphone and get semi-reliable info on time to destination in under a minute, but we’re precluded from all that common-sense options in -this- scenario. And I’m not worried about being sued, if anything we’re more likely to be sued if we don’t take her to the hospital and she suffers any more avoidable injury or loss of ability.

Heck, pretty sure we’re going to get sued IRL no matter what, because either we risk her life to take her to her own requested location, or refuse to do so and get sued for that.

But really, this seems super important to you @puzzlegal - if you want to talk about the morals and ethics of such choices vs professional judgement, better to have it’s own thread where we aren’t hobbled by the limits of the original poll.

I’ll recognize your right to say it. I may even defend it. But to the death? Nah.

Yeah, i think personal autonomy is an important human right, and dragging someone off to a hospital against her will seems like a very wrong thing to do. And the poll makes it clear that you are doing exactly that.

And I’m really curious about the real life incident this was based on.

Unfortunately, I know nothing more of the real life incident other than that there was an injured woman who was asking the paramedics in the ambulance to make sure they only took her to an in-network hospital. I don’t know what the parameds eventually decided or which hospital they went to, or whether the woman even survived.

IIRC, it was a story in some newspaper or something, highlighting the absurdity of the US healthcare system. It was many years ago.

I’ve opened a thread to discuss that scenario and greater themes in more detail. :slight_smile:

I chose to think of the paraphrase of Voltaire as hyperbole.

Where I worked I had probably a unique circumstance. We had 4 hospitals that were relatively equidistant to each other. One is a trauma center so that’s the obvious choice for certain issues.

It was up to the patient where they wanted to go. If the patient was unable to decide for physical reasons the medical personnel decided. If the patient was unable to decide and the family wanted them to go somewhere else for stupid reasons I had no problem convincing them otherwise. I can’t remember one time when someone wanted to go to a specific hospital for strictly insurance purposes. Usually it was for reasons like “That’s where I always go” or “My doctor says to go there.” It may have been the case many times when it didn’t matter where they went. I wouldn’t know about that because there wouldn’t have been any further discussion.

Where I live now there really isn’t a choice. There is only one hospital in practical driving distance. One time when I walked (stupidly) in to the ER with a serious medical issue I was quickly put on a helicopter and sent to another hospital.

I’ve never liked Oreos…even when I was a kid. The cookie was too mushy and not chocolatey tasting enough, and the filling tasted like sweetened Crisco. I won’t take one if offered. Why waste the calories?

I liked Hydrox. Sadly, the guy who claimed to have recreated the recipe for Hydrox hadn’t.