I have seen the future.

She got assessed by a nurse and then chose to go home. That's what she got billed for.

Emergency rooms are really bad places. Emergent cases take priority over non-emergent ones...like fractures.

The bit about the guy dying from the heart attack is excruciatingly sad though.

From:

She was not seen by a doctor, she did not have her complaint addressed, and she was not provided with any treatment or medical diagnosis. She owes nothing, because they did nothing.

She waited 3.5 hours for a triage nurse to show up, ask her what the problem was, then go back to ignoring her for the next 15.

Unless you want to have her pay, and then sue the nurse for practicing medicine without a license and the hospital for letting her do it. I'd be okay with that, really.

PS: fractures are emergent, and cannot be treated outside a hospital. They're just not *usually* life-threatening.

From:

She had her vitals taken by a medical professional. The machines cost money. Nurses cost money. You're not just paying for the services of the doctor when you go the hospital.

I doubt the triage nurse was ignoring her. Have you ever been to an emergency room? To an emergency room in a really large city? One that handles trauma? They're madhouses. The people who are dying take priority (as they should) over the people who are not.

Registered nurses are licensed to practice medicine by the way. That's the 'registered' part of the whole thing. What they can't do is prescribe medicines or provide diagnoses, unless they are nurse practitioners under a doctor.

Fair enough. Fractures are emergent. But they're less emergent than gunshot wounds, stab wounds, car accidents, heart attacks, etc. etc. And they can be treated outside a hospital, in say, a clinic.

I'm not saying it's okay that she didn't get treated. I'm really sorry she didn't get her leg set. But acting like the doctors and nurses in the emergency room were just sitting on their asses and ignoring patients isn't the right impression either.

From:

kadath.livejournal.com

sue the nurse for practicing medicine without a license and the hospital for letting her do it.

Dude what? Nurses are licensed to practice medicine, what with being medical professionals and all.

fractures are emergent, and cannot be treated outside a hospital. They're just not *usually* life-threatening.

Fractures are not necessarily emergent, nor do they necessarily require hospital treatment. A fracture that threatens arteries or nerves is emergent. The way to know is to go through triage.

The article does not contain enough information for me to confidently armchair-diagnose the type of fracture the woman sustained, but the fact that it "seems to be healing" suggests a minor stress fracture ("hairline") a common sports injury which is neither emergent nor life-threatening.

I am not disagreeing with your thesis that the American medical process is FUCKED, but your facts are wrong in this case and you're making pronouncements that are outside your area of knowledge.

From:

unclebebby.livejournal.com

Parkland is one of the busiest hospitals in the DFW area, and from what I've heard, they normally only keep about a single doctor on staff at the ER, two during the busy time.

Ironically, this is the same hospital that Kennedy was brought to when he was assassinated.

From:

jerril

But acting like the doctors and nurses in the emergency room were just sitting on their asses and ignoring patients isn't the right impression either.

You need to reread everything Weaselking wrote.
He's not acting like they were sitting on their asses.
He's not suggesting that.
He's not stating that.
He's not implying that.

He's offended she had to pay despite not receiving treatment. Yes, the nurses salary has to be payed, but a couple of points:
1) I see no reason why the patient should be paying for being triaged by a nurse, and not being treated by anyone. If I go talk to a lawyers office, talk to the secretary, and get told the lawyer isn't taking any new customers (or is on vacation, or is otherwise occupied right now), the law firm does not send me a bill for $162 for the secretary's time. An RN is qualified to give treatment, but a) I'm not sure that includes bone setting, and b) that is a strawman as THIS RN did NOT give any treatment in this case.
2) There's no equipment use involved in this case. There's no way she got an x-ray AND a nurses time AND a radiologists time all for $162 in the USA. So that's no excuse.

She got no services.

Triage of a broken bone largely consists of

double checking to make sure the suspected break isn't anywhere potentially dangerous (torso, neck, head, thighs, you get the idea),
isn't compound (and therefore potentially dangerous wherever it is),
and confirming the pt doesn't have any other potentially dangerous complaints from whatever broke the bone ("oh, by the way, I also hit my head when I fell and now I'm seeing double").

I've been in ERs regularly for various bits of trauma that were suspected sprains or breaks to my limbs. Triage for simple breaks and sprains is not treatment.

From:

drjon.livejournal.com

We have "socialised" medicine here in Oz.

It can be a bit of a pain sometimes.

It don't blow goats like Texas, though.

From:

Actually, I did read everything he wrote, especially the part where he said the nurses were ignoring the woman with the fracture which implies that they weren't doing anything else.

It costs money to get your vitals taken. You are paying for the medical professional's skills as well as for the cost of the equipment. Gettings your vitals taken is a part of treatment as the attending physician needs to know if, say, your blood presssure before administering treatment. Furthermore, nurses only act under the direction of the attending physician which means the nurse took the patient's vitals at the physician's orders. That's all a part of treatment. Acting like vitals is somehow unimportant doesn't help your case at all.

Furthermore, the comparison between a secretary and a lawyer isn't the same. Secretaries aren't licensed professionals for one thing. Nor do they have to attend several years of highly intensive and structured schooling in order to be secretaries. I'm unaware of any bachelors of secretaries degrees or masters of secretaries of degrees or Ph.D.'s in secretarying. Comparing nursing to being a secretary demeans the profession, and that's what nursing is, a medical profession.

I'm not sure how long it's been since you've been to an emergency room, but taking vitals does require equipment. I'm also not sure if you read the article as it clearly states that the got the X-ray taken at a chiropractic school, and not at the hospital.

The services she got were having her vitals read by a trained medical professional. That is a medical service, and it was done at the direction of a physician. And you're wrong about triage by the way...it's the beginning phase of treatment. Assessing a patient's severity and taking their vitals are a part of treatment.

If we want to talk about familiarity with the system, my Dad is an ER physician. My Mom is a nurse. I was recently in the ER for a serious medical emergency.

She sounds like she's pissed for not being seen when she wanted to be.

From:

fearmeforiampink

There are issues with it, but it means that when I'm ill I go to the doctors, and I don't worry "But how will I pay for it".

Also, a lot of percieved problems with it come from the fact that it's at the size where diseconomies of scale are being felt, and thus while it provides efficient, and generally high level of healthcare, it's very hard to improve it further, and costs a lot to do so.

From:

drjon.livejournal.com

Whilst I'm by no means an expert, it seems to me that there's been too much political meddling. The level of healthcare is excellent, but accessing that healthcare can be problematic. More beds, more Doctors, less meddling. I'm in Qld, we just had a new Children's Unit inappropriately place for political reasons.

From:

This is a great idea. I'm gonna open up a restaurant, take orders and never give anyone food!! I can still charge them cause the order was taken by a trained foodservice professional!!

Once I get some money for that, I'm gonna open up a auto garage, and have a trained automotive professional tell people they need a new engine, never do it, and then charge them anyway!!

From:

And if they complain, you can say they just didn't wait long enough!

From:

Because working in the food service industry or in an automobile repairshop is exactly like working in an Emergency Room.

Who knew?

From:

No. Because charging someone for not performing a service is the same anywhere.

From:

So, you're saying she should not pay for services rendered (which, for the record, were having her vitals taken by a nurse)?

That'll set a great precedent, yeah.

From:

Taking vitals = service rendered.

From:

She's not being charged for seeing a doctor.

She's being charged for exactly what happened...having her vitals taken by a nurse.

That is not free. You don't get to say it's free because you're unhappy.

From:

She went there to get her leg fixed. They did not fix her leg. If she was objecting to the 200 bucks as a part of the bill for getting her leg fixed, I would agree with you. If you want to get paid, you have to perform the service that is needed.

From:

I didn't say it was free. Its called overhead. If in any other business, I left the customers business half finished, would they be expected to pay? Cause, again, see my restaurant and car dealer argument above.

From:

Bullshit. Medicine is not the sort of thing where it's "Satisfaction guaranteed or your money back!"

She went there to be seen by a physician. She did not wait long enough to be seen by a physician. She was, however, seen by a nurse and her vitals were taken. Therefore, she needs to pay for the services she received.

She's objecting to the bill because she feels like she's above paying for services rendered. If she didn't want to pay anything, she should have left before they took her vitals. You don't get the tests done and then say, "Oops, I didn't want them." after the fact. They still need to be paid for.

If she hadn't seen anyone at all and got charged, she would have a case. However, she did see someone and she did receive preliminary treatment in the form of vitals. No one else gets that for free, and she shouldn't either.

From:

First of all, medicine, especially emergency medicine, is not any other business. You're not cooking a hamburger; you're restarting someone's heart.

The patient left before the doctors could see her. To use your piss-poor example, if someone dropped their car off at your dealership and picked it up before you finished repairing it, they would still owe you for the work you'd done so far because they had made the conscious decision (not you) to leave before the work was done. They can't decide to not pay you because they picked their car up early.

In other words, the physicians did not leave her half-finished, she got up and chose to leave. Emergency rooms are really busy places because they're dealing with emergencies. If you don't want to wait, go to somewhere else less busy, like a clinic. But it is not the doctor's fault that he was treating someone who was actually dying and you got upset and decided to leave. You still owe the hospital for the services you received while you were there.

From:

I'm saying that paying for health care at all is a sign that you're in a backwards third-world hellhole without even basic standards of care, and probably not hygeine either - but, while you're there, you should pay only for *services*.

Triage is not a service. Triage is what they do to determine how long they have to provide you with a service.

They did fuck all, and so even in your pathetic shithole of a country she still owes them nothing.

From:

The same would apply to your equally poor restaurant example.

If someone ordered a appetizer and an entree but chose to leave after they ate the appetizer but before receiving the entree, they would still owe you for the cost of the appetizer.

However, emergency medicine is not about customer service. It's about saving lives in the shortest amount of time possible. A hairline fracture is not life-threatening emergency. Physicians shouldn't have treated her if someone else came in with a more life-threatening complication. Yeah, that'll make the non-emergent people upset, but it also saves the lives of the emergent ones.

From:

We're not talking about the state of American healthcare which I agree is deplorable.

We're talking about if she received medical services, and by being triaged and having her vitals taken, two things which can only be done by medical professionals (Joe the Plumber cannot triage you, for example) that means she received services.

From: