I finished my last patient care rotation today. As alluded to in a recent post, I was doing a critical care rotation in the Shock-Trauma ICU. Holy shit, I’m glad that’s over. They even gave us tomorrow off. It’s a really awesome feeling to know that I wrote my last patient note and saw the last patient that I’ll ever see today. While rounding this afternoon, I checked off the patient names as we went down the list.
Now all that’s left is what I call “filler rotations.” You know, the electives that are classroom based with no patient interaction and you’re always home by noon. I can’t wait.
Based on my observations over the last month, I’ve come to a few conclusions. First, there is no doubt that the patients in the STICU are very sick – and I don’t particularly care for sick people. Second, most of the patients in the STICU are there because of their own stupidity. Sure, there are very sick innocent people in the STICU but they are generally the exception to the rule.
Here are some scenarios for a “stupid” STICU patient:
- An alcoholic decides to jump behind the wheel after a night of binge drinking. On the way home, he has what we call “motor vehicle vs. telephone pole” and is brought into the STICU. No insurance? No problem. He runs up a $3,000 per day hospital bill for 10 or so days at which point he leaves the unit to be discharged home or to the floor – all on the taxpayers dime. Of course, he’s got money to buy beer.
- Another person decides that it would be loads of fun to ride his ATV at midnight without a helmet after taking numerous pills of unknown origin. He smacks a tree and rolls it over onto himself. Cha-ching – three grand a day for 5 days. Self pay. He even has the balls to call back to the unit 2 days after discharge wanting us to give him money to buy his “pain medication.” What the fuck is this, a charity? Last time I checked you had the money to buy cocaine.
- A self-employed contruction worker has his routine 12-pack of beer breakfast and then falls off of the roof and is brought into the unit. He’s so disoriented that he stays for 15 days in the unit and another 15 days on the floor. His family doesn’t wish to take him. No placement? Who cares. Let’s just keep him on the floor for two weeks at $500 per day. Your hard-earned tax dollars at work.
In referring to people who make poor life-altering decisions – such as becoming addicted to drugs and/or alcohol – I’ve always been a strong proponent of the school of thought that “health care is a priviledge, not a right.” These people know right from wrong, or at least that is expected of them from a common-sense societal standpoint. None of the patients that fit the criteria for the “stupid” STICU patient was mentally incapacitated to the point that they couldn’t make rational decisions. At least not from our initial workup.
These people chose to make the wrong decision, which ultimately resulted in a very expensive hospital stay that will be passed down to the consumer in the form of increased hospital fees. This will, in turn, result in increased healthcare costs for the positive contributers of society that choose to purchase health insurance. This is one of the contributing factors to the enormous insurance costs today. Hospitals must recoup these costs, and to do so they pass them down to the insurance companies with increased fees. A patient is billed $10 for a Tylenol at my teaching hospital – a perfect example.
Increasingly, private hospitals are refusing self-pay patients and with good reason. They have to stay open. In order to stay open, they must turn a profit. It’s simple economics, folks. Stay in the black for another day. Is this unethical? Many of you reading this might say yes. I say no – medicine is simply a business whether you want to believe that or not.
The solution is very simple in principle, but hard to initiate. These people need to keep their asses off of the booze and drugs and get a damn job. Hell, McDonald’s is hiring and I hear they have a pretty good health benefits package. If these addicts would stay sober long enough to pass a drug screen they might have a pretty good chance at picking up some reasonably priced health insurance and have the money to pay for it.