An article in the Journal of the American Medical Association from November 6, 2023, shows that staying overnight in the emergency room is dangerous for an older person who is sick enough to be admitted to a medical ward. Older individuals with signs of frailty may have their risk of dying double from staying in the ER waiting for a bed.
Thank you David. Your comments always cut to the core issues and I could not agree with you more. One of the conditions of my license in my state was providing continuous care for my patients 24/7/365. The charge to us in medical school and later training was to first be advocates for our patients. That means doing and recommending what is best for them, not what is best for the hospital or our finances. That is professionalism and when corporate entities dominate the system, professionalism automatically goes out the window. We can't have patient-centered care until every level of the system advocates for patients interests, not CEO's or stockholders interests. We cannot have better health at lower cost without major changes in policy.
I have always found American emergency room procedures to be anachronistic. In the land of innovation I am forced to suspect greed as a driving factor.
It is miserable but I keep things in perspective. In 1990, I had large cell lymphoma and they told me I would be cured or dead in 6 months. Surgery and radiation with aggressive chemotherapy cured me and I have done a lot of living since with a totally different perspective
Bill: I continue to enjoy your writings as you describe in detail, some of it very personal, the many metastatic components of a health care system that is rotten with cancer, and give examples for some of the possible solutions and healings. (Although I think that most of these have more value at the margin and for those of us with good insurance.) Our country made a decision to convert medicine from a profession linked to the public’s health into a corporate enterprise, this happening during our careers as primary care physicians. I used to manage my complex patients whether in the home, office, hospital, or long term care facility — often navigating with them the transitions to and from all of these settings. Like almost all of our colleagues our age, I burned out from the lack of support for primary care and the institutionalization of specialty care. I have enormous respect for those of my colleagues, like yourself, who have managed to stay in practice. Now, however, the gaps in care, the gaps in quality, the gaps in continuity, are not just the problems of our health system, they are its main features. Most residents in any specialty and most nurses today don’t remember and haven’t the slightest idea of a model of truly continuous primary care that, like a candle in the wind, blew out almost before it got started in the 1960s. When it became obvious that the nation’s health care could become an extractive money making industry, akin to almost all large corporate missions and goals, our ERs were destined to become dangerous places, as you so well describe. Best regards, David
Thank you David. Your comments always cut to the core issues and I could not agree with you more. One of the conditions of my license in my state was providing continuous care for my patients 24/7/365. The charge to us in medical school and later training was to first be advocates for our patients. That means doing and recommending what is best for them, not what is best for the hospital or our finances. That is professionalism and when corporate entities dominate the system, professionalism automatically goes out the window. We can't have patient-centered care until every level of the system advocates for patients interests, not CEO's or stockholders interests. We cannot have better health at lower cost without major changes in policy.
I have always found American emergency room procedures to be anachronistic. In the land of innovation I am forced to suspect greed as a driving factor.
Greed definitely is a major barrier to needed extensive reforms in our healthcare system
Oh god that sounds awful. A colic can be insanely painful.
It is miserable but I keep things in perspective. In 1990, I had large cell lymphoma and they told me I would be cured or dead in 6 months. Surgery and radiation with aggressive chemotherapy cured me and I have done a lot of living since with a totally different perspective
Sounds like a reasonable and healthy attitude. Probably not always easy to feel that way in the middle of an attack though. ;)
It makes these repeated attacks easier to bear but it is a challenge. You are right!
Bill: I continue to enjoy your writings as you describe in detail, some of it very personal, the many metastatic components of a health care system that is rotten with cancer, and give examples for some of the possible solutions and healings. (Although I think that most of these have more value at the margin and for those of us with good insurance.) Our country made a decision to convert medicine from a profession linked to the public’s health into a corporate enterprise, this happening during our careers as primary care physicians. I used to manage my complex patients whether in the home, office, hospital, or long term care facility — often navigating with them the transitions to and from all of these settings. Like almost all of our colleagues our age, I burned out from the lack of support for primary care and the institutionalization of specialty care. I have enormous respect for those of my colleagues, like yourself, who have managed to stay in practice. Now, however, the gaps in care, the gaps in quality, the gaps in continuity, are not just the problems of our health system, they are its main features. Most residents in any specialty and most nurses today don’t remember and haven’t the slightest idea of a model of truly continuous primary care that, like a candle in the wind, blew out almost before it got started in the 1960s. When it became obvious that the nation’s health care could become an extractive money making industry, akin to almost all large corporate missions and goals, our ERs were destined to become dangerous places, as you so well describe. Best regards, David