Oh No, it's a Moral Conundrum: what to do about crappy hospitals?

[Coach]

Ok here is a serious one... Now the Hospitals and Doctors here are spotty at best, a joke usually(I am not kidding, Scranton is like the land that shitty doctors come to and forget how they got here.) My question is, If I as an Emt/Medic am supposed to be an advocate for the patient..how am I to do that if I am worried/know that the patient is getting subpar care? I know that they can get better care out of the area. Yet according to protocols they have to go to x hospital, where I know that the ER staff will give them shitty care and send them on their way.

[Dr Steve]

Ok here is a serious one... Now the Hospitals and Doctors here are spotty at best, a joke usually(I am not kidding, Scranton is like the land that shitty doctors come to and forget how they got here.) My question is, If I as an Emt/Medic am supposed to be an advocate for the patient..how am I to do that if I am worried/know that the patient is getting subpar care? I know that they can get better care out of the area. Yet according to protocols they have to go to x hospital, where I know that the ER staff will give them shitty care and send them on their way.


Coach:

you're right that EMT protocols demand usually that a critically ill patient be taken to the nearest ER that is capable of handling the problem. They only have to go their for stabilization though, their is nothing in the rules that I know if that compels them to stay there beyond that. Requesting a transfer to another hospital is always the right of the patient, especially one that is being offered admission.

If it's a culture of crappy, lazy medical care, you have a real problem on your hands. However, the federal government is now paying attention to outcomes and quality standards, so I believe you'll see this kind of thing tighten up. Usually it's a competition thing; when the hospital administrator sees numbers declining because people don't have confidence in the medical care at the facility, he/she will begin to exert pressure (subtle and not-so-subtle) to fix the problem. I heard once about an ER doc who had 800% more CT scans than the next guy...those stats came out and when it became apparent he couldn't stop himself from ordering all these tests, his contract was terminated. The system is fixable, and does respond to competition regarding quality.

I'd really like to know if this is partly cynicism on the part of some of the EMTs or if it's a real problem or both. If it's a real problem, how did this happen, and why is it still going on? The Joint Commission will shut down underperforming institutions (well, supposedly they will, they're SUPPOSED to, I just don't know of an instance where they actually did but I don't know everything) and if they don't, they'll often scare them straight.

There are things you can do to stimulate a hospital to do better if they're really, really bad, though I hate to bring things like this up for fear of being accused of fomenting protest. It rhymes with "Pedicare Flaudit" (wink wink).

I don't know the situation or the area or what the problem is, so I'm just blowing smoke. I always say that quality is a given in American medicine, that people can't compete on quality because everyone is already practicing quality medicine. I could be wrong.

let me know more, if you have anything on this.


your pal,



steve

[weekapaugjz]

i try to go to the local hospital a little as possible. it's awful. horrendous wait times, and there was an ER surgeon who actually amputated the wrong leg a few months back.

[underdog]

i try to go to the local hospital a little as possible. it's awful. horrendous wait times, and there was an ER surgeon who actually amputated the wrong leg a few months back.

My wife's grandmother (who lives in your area) flies back to Boston for a lot of her work.