The emergency room is a place where some health care reform myths come to die. A night spent there is full of valuable lessons about that reform for those whose ears are not plugged with the certainty of unconsidered opinion.
If you really pay attention, the first thing you learn is that most of what you thought you knew about health care cannot stand up to 12 hours of the ER version of reality. If you are lucky, each night just tears holes in what you thought you knew for certain. A really bad night will tear it to shreds.
Think Medicaid moms are all deadbeats living forever off the dole? You will meet some whose only difference from you is that you have a job and they just lost theirs. Think your health insurance should depend on being employed by a company that provides it? Talk to a patient who has lost her job and therefore insurance, then was bankrupted by an illness and lost her home, and then tell me what you think.
Think health insurance should not be a right? Talk to a working family with no health insurance whose child has just been diagnosed with a devastating disease they have no way to afford treating appropriately, and think again. If you don’t think again, your brain is not perfusing, perhaps because your heart is made of stone.
Every patient is a suffering lesson to be learned. The patient with blocked bowels who needs a nasogastric tube placed painfully through the nose and down into the stomach to decompress the heaving digestive system is a reminder that disease, like our health system mess, requires painful remedies that carry their own risks. The only thing worse than fixing the problem is leaving the problem to run its ravaging course, something to remember as we struggle with the pain of fixing a health care system that leaves 45 million of us uninsured and the rest of us insured but unaffordable.
The patient having a heart attack who wants to leave the ER to avoid the cost of being hospitalized is a stark reminder that some patients will sacrifice their health — even their lives — in order to avoid health care costs they cannot afford. The fact he will inevitably return in worse shape is a metaphor for our current health care crisis; if we fail to deal with the mess now we are simply going to have to deal with it in the future when it has caused us even more harm.
In the critically ill patient with every physiological system — cardiac, respiratory, neurological, and more — screaming desperately for attention is the reminder that when everything is falling apart, the basics require attention first. For the patient, it is the ABCs of Airway, Breathing, and Circulation, because if you fail to support those things amid the clinical chaos, not much else matters. In health care, it is insurance for all, some measure of cost control and primary and emergency care for every person, because without those things, not much else matters.
In negotiations with the patient over what less expensive, alternative care they can afford to the right care — this antibiotic versus a cheaper one that may not work as well, tooth repair versus tooth removal, good counseling for the anxiety disorder versus coming to the ER repeatedly for panic-generated chest pain — one sees the bizarre bazaar this “free market” health system has become.
And in each case, if one looks past the symptom to the disease, there is evidence of just how sick our health system has become and how much its illness has spread. It is making us ill, as a nation, and in many cases, as individuals. That is the most important take-home lesson from a night on duty in the ER, for it should motivate us all to stick with health reform until we insure every American in an affordable system.
We cannot walk away from the battle this time just because it’s difficult, contentious and tedious, any more than the doc on duty in the ER can walk away because the ER is clinically challenging, physically exhausting and emotionally draining. Health reform, like ER work, is not for weenies.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.