An Emergency of Ethics

Tuesday, April 14, 2009

Over at MDOD, a medical blog I occasionally visit, are two morbidly interesting snapshots of what the altruistic ideal of sacrifice, as forcibly implemented by the state, has been doing to medicine. Specifically, each of these shows what is happening at emergency departments across the nation thanks to EMTALA (the Emergency Medical Treatment and Active Labor Act), an unfunded congressional mandate that makes it "illegal for a hospital to refuse care in an emergency setting, regardless of [a patient's] ability to pay."

In the first such snapshot, 911Doc solicits from his readers the "worst example of ER or EMS abuse that you have personally witnessed." As of now, not counting the example he used to kick off the thread, there are twenty-eight comments, some detailing more than one example. Since these are personal accounts, no one has listed the news story I recently encountered in which nine "people ... racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million." Here's a survey:

  • An astounding number or patients come in specifically for non-emergency reasons, including: pregnancy tests ("I didn't trust the home pregnancy test, and I know that yours are better."), MRI (in order to sue an employer for disability), medical "paperwork" (in order to sue a contractor her landlord had hired to do work on her home), prescriptions for narcotics or other unnecessary drugs, and even transportation (e.g., "to visit her friend who lives a block away from [the] hospital," and "he had a drag show to get to").
  • Some patients are not sick at all, but only believe they are. In one case, emergency personnel had the pleasure of explaining to a female patient that she had described the symptoms of a perfectly normal occurrence. It was an orgasm. Another patient had a mysterious burning sensation in his throat -- after consuming an entire jar of hot sauce. Still another found herself alarmed to be menstruating -- after she had stopped taking the pill. One patient explained during triage that he was still hungry after six bowls of cereal. At least he was caught at triage. Some locales, notably Detroit, do not triage at all, meaning that such "cases" sometimes delay treatment for real, urgent emergencies.
  • Some patients, if they are to be believed, suddenly go from gross neglect of one condition or another to blind panic. One patient came in for severe pain -- fifteen years after an automobile accident. Many simply skip the long-term neglect and panic immediately. Complaints included pink-eye (transport was by ambulance), low-grade fever (without taking anything for it before seeking medical advice), a paper cut, sore throat, insomnia, and cold symptoms.
  • Some patients are actually sick, and some urgently need medical attention, but this is due to their own negligence, such as failing to heed earlier medical advice. Not surprisingly, such patients are often also found to be suffering from other medical conditions when being examined and have to be treated for those as well.
Such visits waste the time of emergency department personnel and money (often stolen from third parties by the government) intended for medical care. Also, they often directly endanger the lives of people with real medical emergencies.

The only thing more astounding than the above list is the fact that the one simple thing that could end practically all of it is not even on the political radar. That would be, of course, bringing freedom back to medicine. Specifically, if patients had to pay for their own medical care, they might think once or twice before taking an expensive ambulance ride to a hospital or occupying the emergency room.

The next post shows just how far away from bringing freedom back to medicine we are, politically. The same author explains that, "every time a reasonable solution to the crisis has been tried it has been found to be illegal by a court of law OR has brought such an outcry from victim groups." Even the nominal fee of five dollars for emergency transport and treatment has been shot down.

911Doc's angle in this second post is interesting, too. He notes that in the face of being constantly taken advantage of and never being able to even begin to change things for the better, many emergency medical personnel experience burnout within a decade of starting their jobs. He ends on an ominous note: "[I]f a bunch of us ER docs quit, and the specialty is already underserved across the country, it wont matter much if you are riding the ambulance in with an intracranial hemorrhage or a broken toe, you will not receive care."

The consequences of continuing to treat one man's need as a moral claim on the property, time, and effort of another are clear, and yet our current political trends are not to begin to stop doing so, or even to reconsider whether any of this is a good idea, but to do even more of this. Why?

911Doc partially answers his own question when he notes whose voices are heard -- the alleged spokesmen of "victims" -- and by the kinds of objections he raises to all of this. The "victims" appear to be in the right because the dominant morality in America is altruism, and all he seems able to do is raise practical objections.

There is nothing wrong with a physician profiting from his own work just like anyone else. In fact, it is just that he be paid and it is good that his own efforts promote his own life when he trades with you to promote yours. Until more people start to question the idea that a person's need (real or imagined) is an entitlement to what others own, there will be no political resistance to socialized medicine, no matter how lousy it turns out to be. Patients will fail to see that it is in their own best interest that physicians be free to name the terms for their services and the physicians themselves will, as we see here, feel morally disarmed, overwhelmed, and, rightly, taken advantage of.

-- CAV

4 comments:

Jaz said...

Gus,
I enjoyed reading this post and thanks for drawing attention to the MDOD posts that were very interesting to say the least -I liked the spirit of a producer that came through from the blog writer when he affirmed the fact and observed that: "[I]f a bunch of us ER docs quit, and the specialty is already underserved across the country, it wont matter much if you are riding the ambulance in with an intracranial hemorrhage or a broken toe, you will not receive care."

I was, however, a little perplexed by the following in your post (i.e. I was confused about the premise it came from):'Such visits waste the time of emergency department personnel and money (often stolen from third parties by the government) intended for medical care. Also, they often directly endanger the lives of people with real medical emergencies.'
- especially the usage of terms 'waste' and 'real'.
Could you please clarify that statement?

Jasmine

Gus Van Horn said...

Jaz,

I am not sure I understand your questions, but I'll try to answer anyway.

Certainly, in one sense, one cannot really speak of stolen money being wasted, but if the government is going to allocate money for medical care, it would be nice that it not end up being used for things like this. (That said, I'll reiterate that the government shouldn't be in the business of paying for medical care at all.)

Also, EDs are meant for people suffering from a life-threatening condition requiring medical care, which is what I am thinking of when I say "real emergencies". All this government-sponsored malingering and hypochondria is preventing people who would, ideally, be the hospital's customers from getting what they are coming for: timely, life-saving care.

HTH,

Gus

Jaz said...

Gus,
Thanks for taking the time to reply to my query.
I will try to explain my initial concern on the particular statement I pointed to in your post.
Reading the post the first time, that particular statement came across to me as starting from a perhaps a "utilitarian economics" perspective I guess. Having been a regualar reader of your blog in recent months, I know that would never have been your intent or the point you would want to put across.
Thanks for clarifying the point.
Jasmine

Gus Van Horn said...

Jasmine,

It is important to me to know when what I am saying could be misconstrued. Thanks for bringing that up, and please do so again in the future, if you see the need to do so.

Gus