Now, wait a second DDG.
Granted, I’m not totally familiar with the US medical system, but, are you telling me that if “Friend” goes to the hospital and the ER residents on call believe that he has MS and order an MRI, it isn’t going to occur to them to have a trained professional - a Neurologist, for example, examine the results? Or do they just order the test and then toss them?
If so, that seems like a strange use of resources.
Alice,
You are correct. What will happen, should the MRI be positive for something, is that they will either admit your friend or refer him to a neurologist, or whatever specialist is indicated by the findings. The neurologist will see him, whether he has the money to pay or not. They cannot just abandon the patient. It is both unethical and illegal.
On the other hand, DDG has found some excellent resources. There are always ways for the working poor to get free medical care, it just takes some work to find them. An added bonus is that those physicians staffing them tend to be some of the more caring and consciensious around, more concerned about providing care than making money. Actually, almost all physicians care much more about patient care than getting paid but these are the ones so motivated they actually provide their services for free.
I’m telling you that the residents on call probably aren’t even gonna attempt to diagnose MS in the first place, let alone diagnose it and then order an MRI and then throw away the results. ER residents aren’t set up to diagnose chronic conditions like MS that aren’t immediately life-threatening. They aren’t getting paid to look for MS, so they generally don’t, is what I’m saying.
How the U.S. medical system works:
The hospital emergency room is set up to deal with “emergencies”. Gunshot wounds, drug overdoses, women in labor, cardiac arrest, stuff like that. They are not set up to deal with run-of-the-mill ordinary illnesses, like the flu, unless you have actual pneumonia. If you go to the ER with the flu, all they’ll do is give you some OTC cold medication.
Bottom line, there are only two ways the ER can help you. First, if what you’re presenting with is life-threatening enough that you obviously require hospitalization (the gunshot wound, the drug overdose, the baby on its way, the cardiac arrest), then they will keep you, they will assign you a doctor, they will give you a bed upstairs, they will order tests.
Second, if what you’re presenting with is something that they can fix immediately “While-U-Wait” and then send you home–a cast for your broken leg, antibiotics for your middle ear infection, stitches for the huge cut in your head from getting whacked with the volleyball standard–then they will fix that. And they will send you home.
But something chronic like MS or vague “nerve trouble”, they can’t do a damn thing for you except “palliative care”, which means “pain relievers”, which means Tylenol, or maybe Percodan if you get lucky. They’re not geared towards diagnosing what your vague “nerve trouble” might be. They’re there to treat emergencies, and unless Friend’s nerve trouble gets so bad that he can’t physically move a limb at all, or is in obvious agony, they can’t help him.
That’s the way it works.
I live in a city with two excellent hospitals. I’ve personally interacted with St. Mary’s ER many times, as it’s the one closest to my pediatrician’s office, so I’ve had plenty of opportunity to get to know these people. It’s a Catholic hospital, although they treat all comers, and they’re wonderful, warm, caring people.
But–if I were to show up at their ER, and say, “I have these weird nerve symptoms, and I think I have MS, could I please have an MRI?” these wonderful, warm, caring people would gently but firmly say, “No.”
The Triage Nurse would say, “I’m sorry, but it’s not an emergency. Go to a neurologist, he will evaluate you and schedule you for an MRI if he thinks you need one.”
And health insurance wouldn’t change anything, because the insurance company needs proof that a doctor ordered the tests (whatever kind of tests), or that it was an emergency, before they’ll pay for them. They’ll pay for emergency room X-rays of your broken leg, but not for an MRI for non-life-threatening “nerve trouble” if a doctor didn’t order it.
That’s just the way the system works.
Right - same as in Canada. However, if I walked into an ER here and said “I suddenly lost vision in my eye. It lasted for 2.5 hrs. It’s back now, but it was really weird” (which is what someone suggest that “Friend” say)they’re going to give you an MRI pronto, and have a Neurologist look at it pronto because it’s not necessarily MS.
It could be a fast growing tumour pressing on the optic nerve. It could be a problem with the optic nerve. It could be a slow bleed causing foggyness. It could be MS. It could be someone bullshitting the system to get an MRI. However, the resident won’t be able to diagnose this without the appropriate tests and interventions from a Neurologist/Neuro surgeon. Right?
BTW - I’m sure the resources you listed are excellent. However, from a purely hypothetical standpoint, I do think the “Sudden blindness in my eye” story would get “Friend” seen by a neurologist faster.
I appreciate the input, and so will my good bud.
By the way, in no way do I feel antagonistic toward people who do qualify for free or quasi-free services. Call me a commie if you want, but I happen to believe “the government” has the same obligation to offer everyone the full panoply of medical care and treatment, as to defend our borders from foreign invasion. And without bankrupting the person; or compelling him to engage in various deceptions.
Duck Duck Goose, I will definitely pass along these leads. If I were to read the descriptions provided, I might doubt that they will provide what you are suggesting, namely a neurologist. But I’ll gladly go with your interpretation.
I think a lot of people have “heard” the maxim “if you’re sick and can’t pay, go to an ER.” We wouldn’t have bothered if there were a big sign saying HERE’S WHAT WE DEAL WITH–IF YOUR PROBLEM IS ANY OF THE FOLLOWING, GO DIRECTLY TO…
And what gets me is: the Triage Nurse finds out what sort of thing you’re there for…and yet doesn’t level with you.
Again, thanks, dopers.
DDG:
While you are correct in your analysis of how the ER system in the U.S. was originally set up that is not the way it works now. Now, the ER staff, particularly residents, will try to diagnose any problem, no matter how chronic. Headache for 2 months, 3 YEARS of intermittent abdominal pain, fainting–anything that comes their way they try to solve. The do not say “You moron, you’ve had a headache for 6 months, go see your family doctor.” Rather they say "Wow, could be a SAH lets do a CT scan. Damn, I have no clue what I am doing, let’s order an MRA as well, could be a leaking aneurysm.? The ER has become a place where people can get the most benign and mundane complaints worked up STAT.
Dauerbach, I congratulate you on evidently having found some kind of American Shangri-La hidden in a secret valley somewhere, where ER residents will attempt to diagnose mysterious non-life-threatening chronic conditions.
Question–if the American ER really has become “a place where people can get the most benign and mundane complaints worked up STAT”, then why in the world is Scott even here, with this thread, with this problem? Why hasn’t his friend succeeded in getting his obviously not mundane and hardly benign complaint “worked up STAT”?
Answer–because you live in Shangri-La. The rest of us live in the real world. You wanna help Friend, why not tell him which mountain he has to climb over to find Shangri-La?
And emergency rooms everywhere would much prefer that people did not seek them out for routine care. They’re not a “clinic”, they’re an “emergency room”, for “emergencies”.
Press release from Arizona, from a Google cache…
Scott, I wasn’t saying that Friend could walk into any of those clinics and demand to see a neurologist. I doubt whether they have neurologists on staff, or even on call.
Those are just starting points. He should go down there, have the physical checkup or whatever, and talk to them about his problem.