I’m glad. And, not to turn it too political, but bear in mind that *this *is the sort of treatment people get that can’t afford anything else. When you hear, “We already have universal health care in America! Anyone can go in to the ER and they have to treat them!” …Well, this is what “treatment” looks like. All they have to do it stabilize the person. That means making sure the patient is more likely to live than to die in the next 24-48 hours. People get sent home with instructions to “see their doctor” or “go to the clinic” in the morning all the time. Sometimes, they’ll tell us they don’t have the money to go see the doctor or go to the clinic and we can try to find some sort of assistance or program for them. More often, I fear, they’re too embarrassed to say anything or they’ve exhausted their options for programs they qualify for and there’s no assistance available. They go home with their sad little painkiller prescription and never get that arm set properly, or that bullet removed, or that stress test and cholesterol test.
Let’s not forget that we don’t know what type of clinic doctor they sent him to. It’s possible that they sent him to a surgical outpatient clinic. I would certainly rather have a trained surgeon remove a bullet than an ER doctor.
I would think that the fact they have a bullet in them is reason to take it out.
It really isn’t though.
Exactly. You can do a lot more damage poking around in there, trying to pull the thing out when it’s not doing any harm in place.
Small projectiles are even worse for that. I have a childhood friend with a BB buried in the muscle near his knee since grade school. It was way more risky and damaging to try to burrow in there and get it out.
Og damnit, where’s the **Like **button?
but why?
Operations are risky and frequently have complications. Retained foreign bodies are frequently harmless.
The benefit of the procedure should clearly outweigh the risk in any medical intervention.
Everyone seems in agreement, in this case, however, that it should be removed. And, while I understand that the ER is more expensive than a clinic, how is it less expensive to have two visits than to have it done in one? I still find that reasoning a little odd.
Definitely an eye opener for me too! Who knew having a bullet removed from your neck is not an emergency? Or not in the ER mandate? Not I!
The cost per hour in the ER is almost surely way more expensive than the cost in a clinic. Not only that, we’re not even sure what the hospital told them since they’re legally unable to talk about it. The guy came into the ER for the gunshot wound (good idea), the ER got the bleeding stopped and evaluated his situation. He was stable and out of danger. Now it’s time for them to send him on his way so they can deal with the next emergency.
For all we knew, they told him it was probably fine in place and better to leave it there, and follow up at a clinic for wound care/monitoring, the guy said WTF?! (like many people in this thread, wanting the bullet out), and the ER staff member suggested asking at the clinic whether it looked more feasible to remove later. Maybe after the initial swelling went down, it might suddenly appear easy to remove.
Because it’s about $600 for the nurse and doctor to look at you. The second he says, “Nurse, I need a suture surgical tray,” the price starts whizzing upwards, and at a faster rate than it does at the clinic.
The 7-11 comparison is apt. The ER runs more like a convenience store than a grocery store. Everything, from gloves to sutures, costs more there.
And “should be removed” isn’t the same as “should be removed ASAP.” There are good medical reasons not to remove something right away sometimes. When a bullet goes into a body, the body freaks out and swells a lot around the bullet. It’s going, “get it out get it out get it out arrrrrrgh!” and sends a lot of blood there to kill any bacteria that might be on it. This swelling may increase the risk that the surgeon could do damage. Swollen tissue is harder to see in, harder to cut around, and much easier to accidentally nick a nerve or sever a blood vessel.
It’s often safer to wait 24-48 hours and let the swelling go down a bit before you start poking around in there. There’s absolutely no reason that you need to stay in the hospital waiting for the swelling to go down if the bullet is safely lodged in muscle tissue where it’s not doing any immediate harm.
Bullets sound scary, because they come from guns and kill people. But if it’s inside you already and you’re not dead and it’s not making anything bleed, it’s essentially a large metal splinter. Haven’t you walked around with a splinter you can’t get out for a day or two?
Yeah, I get all what you’re saying, about costs and ease of removal, possible scenarios, I’m not questioning your thinking on any of that.
I guess I just don’t see the efficiency of two visits, to two medical facilities, two sets of forms and the time to complete, two different doctors, etc. Once he’s in the ER the efficient thing, cost wise, would be to do it then, wouldn’t it? (And I understand he may wait while they deal with more urgent matters, clearly!) What am I missing here?
You’re thinking about 1 guy, instead of the 50 people they patch up and send off for an clinic visit every day. If they had to treat those 50, they’d need a bigger ER, more rooms, more staff, both during the day and at night.
You do triage, get people stabilized and out of danger, you’re shifting the non emergency work to folks who can handle it more efficiently, and minimize the amount of work that has to be done with the least efficient department.
What about lead poisoning? Wouyldn’t having a lump of lead inside you make you sick?
Some historians think James A. Garfield might have survived being shot (and having a bullet in him). Their theory is that what actually killed him was his doctors’ inept attempts to remove the bullet. Having a bullet in you isn’t invariably fatal, and removing one is not a risk-free operation (though it is, of course, much less risky now than it was in 1881).
Nope. Metallic lead lodged in soft tissue is fairly biochemically inert (as opposed to swallowed lead, which is exposed to stomach acids, or soluble lead salts).
Over ten years ago I had surgery to remove a vertebra and put a plate and screws in my cervical spine. Several years after that, I had occasion to get my neck x-rayed. The x-ray showed that one of the screws had backed out completely from the plate and was just sort of floating there in my neck. It looked rather alarming, but the neurosurgeon assured me that there was much greater risk involved in trying to go in and remove the loose screw than in just leaving it alone. It’s still there and causing no harm…
A few months ago, I fractured all the bones in my ankle. At the ER (and I have no health insurance…) they determined that it was too swollen for immediate surgery so they splinted it up, handed me a pair of crutches, an Rx for pain pills and a referral to an orthopedic surgeon. It was over a week before I had the surgery (more plates and screws! 
) The bill that I subsequently received from the ER doctor (just the doctor - the hospital billed me separately) was twice what the surgeon charged for the fracture repair! :eek:
There is also an accounting game with medical prices.
There is the price negotiated by your insurance company.
There is the price negotiated by other insurance companies.
There is the price set by Medicare.
There is the price set by Tricare.
There is the price set by Medicaid in your state.
THEN there is the retail price. The retail price can be way off, and is not regularly collected. Instead, it is the beginning of the negotiation for those without insurance. There is a financial incentive to keep that high (anchoring early, in negotiations speak). There is another financial incentive - the write off. If you price retail high, each person who comes in uninsured and treated can be written off at the higher price. This can be very nice from a taxation perspective.
I believe that was why later on, when Teddy Roosevelt was shot right before giving a speech, doctors decided to leave the bullet in, because removing it would be much more dangerous.
Ol’ Teddy was shot in 1912, and died in 1919. So, even with the state of medicine back then, you could survive with a bullet lodge in your chest! (Of course, this IS TR we’re talking about, and he was pretty badass to begin with)
The bit I put in bolding would apply to me, with my insurance, and to Mr. Gotbux, with lots of money, too. If we needed surgery later, we’d be discharged, and if we needed surgery sooner, they’d call our regular physician, get a recommendation, and admit us to the hospital proper. We’d be moved to the surgery ward. That would lower our costs and, more important, free the bed in the ER.
You can call it overhead or indirect costs or whatever you like. The cost just to keep the Emergency Room staffed, equipped, maintained, cleaned, open, and insured is huge. That’s before anyone does anything. A piece of that cost is assigned to every action and every patient hour.
In the projects I do, if something new, say, removing a tree, is added to a job, it can be done three ways. It can be done with one of our crews, it can be done by the contractor with the project, or it can be done by a subcontractor, under the supervision of the contractor.
If we remove the tree, there are labor costs and there are equipment costs. If the Contractor does it, the markup set by regulation to represent his fair assignment of overhead and indirect costs to that new bit is 15%. If it’s done by a subcontractor, the regulated markups are 15% for the subcontractor and 7% on that increased amount to the contractor. That’s a combined markup of 23%.
If we’re talking about the ER, we can start adding zeros to those markups.
Going back to the medical need to remove - I have floaters in my legs. It’s common for people with osteoarthritis in their knees. Bits of bone break off of the ends of the long bones and start to migrate. When I had surgery on one knee, the doctor was disappointed. The floater had been right near the incision point on the last x-ray and he had though that he could snag it, but on the day of the surgery it wasn’t there.
He did some very mild poking to see if it was close enough to feel and then he left it alone. Not only has no one ever suggested planning surgery to get them, it wasn’t even worth making another cut when the whole left side of the knee was already open. Let the floaters float.
You forgot the part where after he was shot, he went on to give the speech for 90 minutes. His opening comments to the gathered crowd were, “Ladies and gentlemen, I don’t know whether you fully understand that I have just been shot; but it takes more than that to kill a Bull Moose.”