This has to be a new low in hospital care. They tell him to go home for the weekend and go to a clinic Monday.
Man, these people really care about their patients. :rolleyes:
We leave bullets in people all the time. It’s often riskier to try to remove it than to leave it in place. What I find odd is the suggestion that he’d have it removed in an outpatient clinic.
Especially in the neck (or so I understand) - there’s almost no part of it that isn’t crammed full of quite delicate, but quite vital structures.
Yup. As bad as it sounds, the ER is for emergencies. They’ll stabilize you and send you on your way for follow-up care. I don’t know anything about the case so I don’t know whether the doctors made the right call or not, but if he was stable, it probably was.
It’s also worth mentioning that the cost for care in the ER is much, much more expensive than that in a clinic, so it’s good for the patient to be seen elsewhere for non-emergency issues.
It’s just a flesh wound…
Sorry - my inner Python got out.
I’m not sure I understand why you believe this is a breach of ordinary standards of care. I’m not a doctor, so I welcome correction, but as I understand it, as long as the patient is stable, it’s not an emergency situation, and wouldn’t normally be treated in an ER.
I’m not a doctor, either, but I would think that getting shot in the neck would qualify as an emergency situation.
Maybe waiting for some inflammation to go down?
Initially, sure. But after evaluation, it is – as I understand it – perfectly possible to conclude that the situation is not an emergency.
Am I mistaken?
Not in my opinion.
Lots of my patients still have bullets in them. I don’t take them out unless there’s a very clear need for them to come out.
Yeah but, if it’s simple enough to be done in a walk in clinic, and he’s in the hospital already, why not just do it?
They seem in agreement it should come out. Today, Monday, why not right then in the ER?
Would it be okay for them to stabilize your broken leg, but not cast it till Monday?
Yes. Broken bones are frequently sent home with instructions for ice, rest and elevation for 24-72 hours. When the swelling goes down, then it can be set and casted.
A bullet removal that’s safe enough to do in a clinic will run you, probably, about $200. The same removal in the ER, assuming they’ve got extra staff standing around with nothing to do, would be around $1000.
If the nurses are understaffed (they are) and running around handling other trauma cases and your resident hasn’t done this sort of removal before and the attending doc is helping three other patients, it’s much easier and more realistic for everyone to make sure you’re okay and send you to the appropriate place to have the bullet removed.
What difference does the writing on the outside of the building make in the cost of care?
The people inside the building make different amounts. A clinic doc probably makes less than an ER attending. An ER nurse makes more than a clinic nurse.
Also, there’s more overhead with the ER. There are more machines that go Ping!, there are CNA’s and techs and lab people to pay. Your lights and water are used all night. There’s a security force to pay. There are multiple people doing Housekeeping 24 hours a day, not just an overnight dust and mop crew.
ER medicine is expensive medicine. It’s really, really stupid that it’s the kind of medicine people are forced to use specifically when they can’t pay for medicine.
You know how a box of cereal is like $8 and small at the 7-11, but the same box comes in several sizes, all under $7, at the grocery store?
The ER is like the 7-11 or any other convenience store in this case.
I used to be a handyman like you, then I took a bullet in the neck.
What WhyNot and others said. ERs are supposed to handle emergencies. You don’t want he doctor trying to pull a bullet out of someone needlessly when they could be tending to a guy with chest pains.
And yes, they don’t put a cast on your broken limb in the ER. I broke my wrist, went to the ER to make sure it wasn’t displaced, got x-rays, and was sent home with a splint, a scrip for a few Vicodin, and a recommendation to see an orthopedist within the next couple days. The guy who shattered his leg in a compound fracture? Him, they sent to the OR to get hardware installed.
This thread has been an eye opener for me.
I come from a smaller community and the expectation is you’re treated at the ER or admitted to the hospital for treatment the next day.
Sending someone home with a broken bone and a pain script isn’t what I would have expected. Trying to get a “next day” appointment with a Orthopedist isn’t easy. The bone can set improperly and start healing within a few days. You can’t delay treatment for long.
A couple or 4 days isn’t long. Far worse to cast right away, have the swelling go down, and then have the cast be too lose. THAT can cause problems. Leave them in the splint until the leg is ready for casting. That’s standard of care.
Now if it’s a complex fracture that needs open reduction and internal fixation, then it can be a different story. If the bone is sticking out, other measures are taken. But a simple fracture, splinted, does just fine. Sometimes it’s not even worth casting, if the splint is applied appropriately.
They will make room for you to get the bone set properly, if something starts to knit up a bit because you had to wait 2 days, they can always pump you full of pain killers and pop it apart before realigning it properly and casting.
Ortho is some medieval stuff at times.