I know they had both blood test and EKG results. In fact, soon after I checked in they hooked me up to some sort of radio EKG that continuously transmitted results to the nurse’s station on the ward. On the probable assumption that was being recorded, a doctor could have displayed my EKG results at any time during my stay. Now I can see why hospitals are so paranoid about cell phones. Patient vital medical data literally is being transmitted by radio.
When I showed up in the hospital I was in a state of ARF. If I had a heart attack and this enzyme was released, likely it would have still been detectable in the blood. They had to base the diagnosis of a possible heart attack based solely on the blood and EKG results. At no time did I report symptoms that would have specifically suggested a heart attack, such as pain in the chest area, etc. I was genuinely surprised when they mentioned heart attack, as the idea it could possibly be that never even occurred to me. I’m not a hypochondriac when it comes to my heart.
Whatever it was that made them suspicious about my heart, they sure thought likely something was wrong. They wanted to shoot me over to cardiac care and do some sort of invasive medical procedure to actually look at my heart. I can’t believe that they would want to do something like that with someone who already announced they couldn’t pay for medical care. Although I’m not sure that whatever cardiologist that looked over the tests was aware of anything about the state of my financial health. It may have been a case of him looking at the test results of patient #27878345638 knowing nothing about my credit status. It just doesn’t seem likely to me that a cardiologist would be calling the billing department before ordering tests. And now that I think about this a bit, as this was ER case, it might not have even been legal for the cardiologist to do this. The medical staff seemed in general oblivious to my real life circumstances. The situation seemed surreal to me. In my mind from the beginning it was “will I be able to get out of the hospital within 24 hours or so can I get back to my life?”, while in the hospital were casually saying to me “We’d like to admit you and keep you around for multiple days until we get this ARF matter under control. At which point we want to send you over to cardiac care to do some invasive testing and possibly even heart surgery if they think it is warranted. We have no idea how long that will take, but it could possibly be quite a while.” They never even considered even if hopsital bills weren’t an issue that for some people other real life sitations would have made this impossible.
Note here I am not suggesting that hospitals should be basing medical care decisions based on ability to pay. In that regard what the hospital did was the right thing to do. The issue is that perhaps the hospital could take into account better the real life situation of the patient. Don’t make presumptions like everyone can just on no notice spend a week in the hospital. To me, I interpret that as being a death sentence in and of itself. Lay the naked medical truth on the table, and then let the patient evaluate the options. The hospital should have quickly got the idea what my situation was like as soon as I started questioning the doctor whether after being informed I had ARF about what is the mimimum time it would take to treat this so I could get out of there? The doctor knew fully well I understood the gravity of what ARF meant. After first an extended pause in total horror, I then asked “Let’s make sure I understand what you are saying. So you mean that my kidneys currently just aren’t working?” Doctor: “Yes, but this may well be temporary, and your kidneys will start working again.” That I actually had to consider whether to consent to treatment for ARF rather than just leaving right there should have made it obvious my real life circumstances were very frail.
After that incident, they should have realized when they later came in and said “Your tests also indicate that you may have had a heart attack, and we would like you to stay around after we get this ARF thing under control and thoroughly evaluate that” what my response would be. Which was “thanks, but I have to go.” At that point they should have just worried about post-ER care options. The hospital social worker was nice enough to quickly send me the paperwork on that. This week I’ll be applying for Medicaid so they can deny me, and apply for the hospital financial aid assistance. Presumably this should at least cover diagnostic tests. And since they already think I had a heart attack, likely they would be predisposed to running heart tests on me.
If you think that is stunning, are you aware that I am a soft atheist and don’t believe in an afterlife. This reminds me of a Simpsons episode with an alert warning sign outside the reactor. If thing go seriously wrong with the nuclear power plant, the sign flashes “Repent sins”. I have no problem with receiving medical care from compentent professionals. It is just in some cases my real life situation just doesn’t allow this. In such an event, praying is the best that I can do.
And it wasn’t stupidity, but instead necessity. Had necessity not been in the way, I would have eagerly accepted all that other medical care.
The heart attack wasn’t necessarily recent. The EKG will change permanently if you have a heart attack, though my experience is that they like to compare the EKGs. Of course, with my husband, they are checking for changes since his last EKG, which was (obviously) abnormal. I think they can tell that an MI has changed the EKG from “normal” and into “MI likely.”
The doctors and nurses do not care that you can’t pay. It’s not their problem. They also wouldn’t care if you simply didn’t want to pay. I’ve had issues with some aspects of my husband’s care at times, but I have never had an issue with the professionalism shown by hospital employees when it comes to money. Their job is to make you well.
The test they likely wanted to perform on you was a cardiac catheterization, or angiogram. They use that to look at blockages in the arteries supplying the heart muscle with blood–the blockages that cause heart attacks. If you’ve had a heart attack, heart surgery would be used only if they found an imminent danger of another one during the cath. More likely, they’d try an angioplasty, the thing with the balloon that they expand in the artery to smoosh down a blockage.
I dunno if they would have had an old EKG on file for me. I recall in the late 1990s they did run one during an ER visit I had. (It had nothing to do with heart issues. However, they seem to like doing an EKG in cases even where it doesn’t seem relevant. It only takes a few minutes to do one.) If they do archive EKG results back into the last millenium, then indeed they would have had an old one of mine to compare it to.
They did seem not to care if I could pay. Which was why I was trying to convey the message because I can’t afford to pay, I also can’t afford to stay. I am not only poor, but also lack any social support in the context of family, friends etc. who care about me. Thus all but the briefest hospitalization would be out of the question for me. If I were told tomorrow that to live much longer I’d have to stay a month in the hospital, that would mean it would be time for me to cash in my chips and exit this universe via self-deliverance. If I gotta go, I want it to be quick and relatively painless.
Bingo. Sounds like what they were talking about before I quickly vetoed even considering such a matter. They mentioned “inserting a tube into me and looking at my heart”. This would be a simple, one sentence way to describe an angioplasty. They also mentioned if they found anything wrong they could would somehow go in and try to fix it. That sounds a lot like angioplasty.
Good thing I did quickly veto that idea. As it was I had to rush out of there quicker than they wanted me to after the ARF. Fortunately, as I am still alive presumably I won my bet that I was stable enough that I could go home.
Do you have a cite for this claim? I am a resident of the UK, and a far from well-to-do resident at that. Consequently I have to rely on the National Health Service (a socialized medical system funded through taxation) for any treatment I require. The conditions of the wards in which I have been treated have been uniformally abysmal. We wait months for essential treatment and, when we finally get it, we run a higher than average risk of contracting MRSA because our hospitals are understaffed. Doctors waiting rooms are typically jam packed 24/7 so doctors typically get to spend only a couple of minutes with each patient, many of whom are clogging his schedule with trivial ailments because the service is “free”.
I find it difficult to believe that US Private health care could be significantly worse that the British socialized system. However, cases like rfgdxm’s give me pause for thought. As such I would gratefully appreciate a cite or two for your claim. Thanks.
Again, they probably don’t need an old one to say that you’ve probably had an MI.
There are lots of reasons to complain about our system, but you seem to be complaining that they didn’t discriminate against you for your poverty. Yes, they talked about keeping you longer, but they can’t force you to stay. Staying would have been wise for your health. Would you really prefer a situation where they’d try to shove you out the door faster than is medically warranted?
It’s your health. You get to make the final decisions. But don’t expect other people to cut off care because you can’t afford to spend the time. That’s not their call. I hope it never is.
Do you have a cite that in general the UK health system is that bad? I’m not saying that it isn’t, but I’d be interested in learning more.
One problem with comparing systems is that in many ways it is apples and oranges. From my point of view, the UK system might be better than the US private health care system in that in the US, I can get basically no access to a system which for those who can afford to pay it is quite good, while in the UK I would get at least some access to a system that isn’t that great. A poor man would prefer a land where everyone gets some cheeseburgers for free than a land where the rich eat all the steak and shrimp they can afford, while the poor starve to death. Also I noticed that you wrote “I am a resident of the UK, and a far from well-to-do resident at that. Consequently I have to rely on the National Health Service (a socialized medical system funded through taxation) for any treatment I require.” This implies the rich have access to private care, while the not so well off must rely on the National Health Service. If the UK truly had socialized medicine, then the rich and poor would have to use the same system. Thus the UK seems to me a 2 tiered system.
The US system is sort of a 3 tiered one. The wealthy can get all the health care they pay for. Those poor who qualify for Medicaid, largely those families on welfare and who are disabled, get access to a system which isn’t nearly so good, but often is adequate. Those who are poor and don’t have Medicaid get zilch, beyond emergency room care where they just don’t pay the bills. Sounds to me in the UK you have a private system which the wealthy have access to, and the NHS which is comparable to Medicaid for everyone else.
Have you ever compared the UK health system to that in the Scandinavian countries? I’ve never examined this in depth, but from what I have read the best health care system in the world from my point of view would be like they have in Scandanavia.
What I was thinking more is that health care should consider the economic and other circumstances of the person being treated. For example, imagine a clinic where any poor person could come in for an office visit. A doctor in such a clinic would be of little service to his patients if he frequently wrote prescriptions for drugs that would cost $500 a month they’d have to pay for out of their own pocket. Since they could never afford such, these patients would be no better off than if this clinic didn’t exist at all. A doctor at such a clinic would be better off writing scripts for cheap medicines that were less than optimal for drugs the patient could afford instead. DoctorJ in a previous post wrote: “Also remember that if you need meds to treat, say, high blood pressure, there are ways to get them. Some of the best BP meds are the cheapest–$8/month cheap. Other more expensive ones have patient programs that you’d probably qualify for.” A doctor at a clinic serving the poor would do better for a patient with high blood pressure to write a script for the adequate $8 drug than the latest, fancy patented high blood pressure medicine that costs $200 a month.
The problem I had was that my only source of medical care was through an ER, which largely deals with people who aren’t impoverished. This isn’t the hospitals fault really, but that the whole system is broken. If I had access to a good clinic that focused on poor people I could have gone to for an office visit, I probably never would have ended up in the ER. Note my subject line is “…the system is crazy.” It isn’t that this ER is crazy, but that it is the whole system it is part of is crazy. Heck, ERs aren’t supposed to be a primary provider of health care services. However, in my case they are the sole provider.
I think you have that backwards. ERs largely deal with people who are impoverished and use the ER as their only source of medical care.
Your situation sounds very unusual. I want doctors and nurses thinking about care, not wondering if the patient is one of the 1% (made up statistic) of people who believe that staying in the hospital will lead to their demise. Again, that isn’t their job. It should never be their job. Their job is to encourage you to do the things required to be medically viable, not to figure out your money situation.
The UK spends about half per capita as the US on healthcare, so naturally the UK will not have it as good as the US on some parts. Plus like rfgdxm said it is my understanding that the UK has both private and public healthcare (which is good). The public system catches you if you can’t/don’t want to pay for the private system. You may have to wait months for operations but in the US roughly 45 million people have no healthcare coverage and another 50 million have insufficient healthcare coverage, rougly 1/3 of the population has no/inferior healthcare. And as a nation we pay about 2x as much per capita for our healthcare than people in the UK do. In 1997 the US spent $4,565 per person on healthcare while the UK spent $1,625. Given the choice between flawed healthcare system that covers everyone for $1600/year or flawed healthcare that only covers 2/3 of the people for $4500/year i’ll take the former. Plus with the money i’d save in the UK I could get private coverage.
in the US hospitals are understaffed too.
All in all it is like rfgdxm said, even though the UK system has flaws i’d take it over the US system. It only costs half as much and everyone is covered. You also have to consider that in the US those who do ahve healthcare usually get it through their jobs, making them unable to quit or move to another job. This also makes us non-competitive globally as when factories consider opening in the US they have to spend an extra $8000-ish to give healthcare to their worker and his/her family. I can’t remember the statistics but a large number of americans (tens of millions) only stay in their jobs because they need the healthcare coverage, giving us far less choice than you have in the UK. In the UK you can visit doctors of choice and quit your jobs at will, in the US you must see ‘in network’ physicians and you can’t quit your job for fear of losing coverage.
Lemme get this straight. Your complaint is that medical care isn’t available to you until a crisis has been reached. But when that point has been reached, you can’t be bothered to follow the course recommended by your doctors. Why then, should we believe you’d follow any regimen recommended by a doctor you might see for your regular checkups were insurance and a doctor available to you?
This sounds less like a failing of a healthcare system, that the failure of a patient to follow the doctor’s orders.
Another UK resident here, with rather better (and very recent) experience of the NHS. After a recent bout of illness some symptoms were not going away, so I got an appointment with the doctor of my choice within a day. She took a listen to by chest and referred me to the local hospital for an X-Ray – immediately. The X-Ray and results took an hour or so, at which point the doctor on duty stuck me by a bed in the Clinical Diagnosis Unit where he said I would probably be for the next couple of days. My stay ended up being five days and nights, four X-Rays, countless blood tests, a tube in my chest and various drugs.
This all costs nothing (at the point of supply, I am aware of taxation) and the only thing I can really complain about was the food.
I hate to think what would have happened if I was in rfgdxm’s position. I was coping with the discomfort and would probably not have gone for treatment at all if I thought I couldn’t afford it.
Hmm…but do doctors think that this is the ideal of what ERs should be? Why call it the “emergency room” rather than the “impoverished care” room? I think you may be right that in the US ERs largely do deal with people who are impoverished and use the ER as their only source of medical care. But is this what it is like in an ER in Sweden or Finland?
More accurately an inability of the patient to follow doctors orders. Does the US provide for short term economic assistance if following doctors orders would mean loss of income? If the doctor prescribes a poor person to take drug, does that mean the government will immediately pay for the drug as it is per doctors orders? Your arguments are valid so long as the patient would have absolutely no excuse for ever not following any regimen recommended by a doctor.
Only if this ends up meaning I am long term disabled. Hopefully, things aren’t that bad. And, to even possibly qualify for disability I would need to be examined by a number of doctors that could assess my health. This would require that I apply for possible available financial assistance for health care, and when and if that is approved (this could take quite a while) that I see the right doctors, get the right tests, etc. that show I am disabled. For example, to get Medicaid I have to first prove I am disabled. I can’t just walk in to the welfare department, claim I am disabled, and immediately temporarily get Medicaid which I can use to make doctors appointments and such to determine if I really am disabled. Catch-22.
I can find plenty of articles about the WHO survey but I can’t seem to find a direct link to the survey or complete rankings. This is the best I could find. I swear I think they did this study and then hid it from everyone but news reporters. It appears that the UK is 18th according to the BBC . Looking at the GDP numbers as ** Wesley Clark ** has pointed out the UK spends about half of what the US and France does. To compare France is the number one ranked and the US is the 37th ranked. It seems on the face of it that socialized medicine provides more bang for your buck but not suprisingly if you do not fund it it is not as good.
If you were a not so well to do resident of the U.S. you would not be able to afford any essential care or doctors visits. You would only recieve emergency care for immediately life threatening ailments. When you consider that this is the situation that 1/5 of the country is in it is not hard to see why the U.S. ranks 37th.
To me the health care situation in the U.S. is ass-backwards. You wouldn’t dream of driving your car without changing the oil or having fairly regular checkups. Thats becuase its more cost effective to pay 20 bucks for an oil change every so often than to pay $3,000 to replace an engine. Unforunately we do it the other way in the U.S. by only paying to replace engines and not to change the oil.
This reminds me of a Simpsons episode with an alert warning sign outside the reactor. If thing go seriously wrong with the nuclear power plant, the sign flashes “Repent sins”. I have no problem with receiving medical care from compentent professionals. It is just in some cases my real life situation just doesn’t allow this. In such an event, praying is the best that I can do. 