debrief.

i decided i need to blog more. i need to debrief myself of what goes on through the day. to avoid any HIPPA violations or other problems, stories will be left vague and key details will be changed. you should know that i now have two jobs -- one is at an outpatient clinic in the suburbs at an underserved clinic. our population is about 80 percent spanish speaking, and only 30 percent have any type of insurance at all -- 2/3rds of those have medicaid. 70 percent are self-paying out of pocket (or just not paying). the other job is at an urban trauma one center emergency room.

a man came to the ER for a bump on his penis. when i asked him why he was there (meaning, what brought you in, what is your chief complaint?) he responded, "because i don't have insurance". the ER becomes not only an emergency medicine department, but a primary care, OB-gyn, opthalmology, social services, STD clinic and homeless shelter. the ER is always the money-suck for a hospital. completely non-profitable. this is ONE of the reasons healthcare is so expensive. we need more preventative care. people need primary care providers.

that being said... there are also some really shitty ERs out there. a patient who had shoulder surgery done in the past which included some hardware fell and dislocated a screw that had been surgically placed inside his shoulder. he went to the ER. they discharged him to see me (at an outpatient clinic) with a metal screw sticking an inch to an inch and a half through the skin out of his shoulder, surrounding by a pus oozing abscess. really? because he didn't have insurance, and they didn't have the proper people on-call, they send him to me. what did they expect me to do... whip out my phillips and screw it back in?

other notable patients since i began working include a mother being seen for depression when the story comes out that her brother has been sexually abusing her daughter (his niece) and now her mother won't speak to her, because she reported it and her brother (mother's son) is getting in legal trouble. her chief complaint began as an ulcer on her toe. you never know how its going to go down once you get in the room.

i also had a new patient walk in (to my outpatient primary care clinic) with a wound vac (vacuum suction like device that attaches via a hose to an open wound in the body, usually covered with a sponge -- it helps it heal faster) attached to a wide open 6-8 inch wound in his chest, which he told me was from a sternumectomy (they removed his sternum supposedly because he had so many bypass surgeries). his chief complaint was that he "needed to establish care with a new doctor" -- his old doctor didn't take medicaid anymore and so he was sent to me.

this is why i am a proponent of single-payer healthcare. not to mention an electronic medical record system that is equivalent across the country would save so much money, provide for more efficient, better quality healthcare, and reduce mistakes.