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Archive for April, 2012


Monday in a rural health clinic is, well, interesting. As in the old Chinese curse “May you live in interesting times”. I am sitting in my little office cubby at the back of the building tackling the teetering pile of charts that have messages or lab and test results to be read, when I hear a panicked voice yelling “We need you NOW!”. Dashing out, I am directed to the waiting area where a young man is laying on the floor and the other patients who were waiting to be seen are backing out the door, wide-eyed.

The man was unconscious, not responding and his breath whistled whheep, whheeeep, wheeep, like a kid with epiglotitis. Oh, crap, he probably has something lodged in his throat. I turn him around to check his airway, and check his mouth and he coughs a little, mucous tinged with blood dribbles out. I put him back on his side. Panicked staff crowd around, “What do we do?” one yelled. “Call 911, get me oxygen and the ambubag!” I replied.

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He is still not responding, though the wheeping is slowing down a little, and suddenly stops. “Shit, he stoppped breathing!”, I have a sinking feeling in my chest, this guy is going to die on me. I grab him by the shoulders and shake him. “Don’t you DARE stop breathing!” I yell into his ear. He suddenly gasps a little, with a more normal sound, and starts to come round, his eyes open. He whispers “Anxiety attack”. The 911 crew arrives, just as he is starting to sit up. They ask the story and I tell them what happened. At the mention of the words “anxiety attack”, their interest cools considerably. A staff member hands me the patient’s chart, as they now know who it is. He has esophageal ulcers, asthma and GERD listed in his problem list. I pass this information along to the now bored EMTs. I mention they might want to check his lungs as possibly he may have aspirated some stomach acid, they say “thanks, sure” and out they go.

Two days later, the guy shows up for an office visit with his mom. She thanks me profusely for saving his life. When I asked him what precipitated his anxiety attack, he said “Nothing. I was just driving along and started coughing, I couldn’t catch my breath and then the panic started.” I see on his med list he is supposed to be taking Advair for asthma, and Nexium for acid reflux and the esophageal ulcers. He admits to not taking his medicine, that he didn’t feel it was necessary. I explained that a combination of refluxed stomach acid and bronchial spasms from the asthma had probably led to his coughing and panic attack. His mother gave him the stink-eye and said “I TOLD you to take your medicines!” The guy sheepishly promised to take all of his meds in the future.

Later, a guy walks in with a hospital gown on over his jeans and a hard neck brace on his neck. He hands me a pile of papers which are hospital records from an ED visit last night. The records show he has a transverse C4 fracture, nondisplaced. The story of how he got the broken neck was colorful and included beer, motorcycles and police officers and a total lack of memory about how it happened. There were multiple scrapes, bruises and marks on him, one of which looked like a boot print. Quite a night.

“I was supposed to see a spinal surgeon today,” he tells me. “But, the one I was told to see doesn’t take Medicaid. He said I had to get a referral from my primary.” That would be us. The nearest spinal surgeon that accepts Medicaid is at Shands, which is over an hour away. The patient would have to drive himself. When our scheduler called Shands, they told us they would call back to set an appointment after noon tomorrow. Our scheduler “suggested” that she would fax the referral and the pertinent information from the hospital records now and she would call them first thing in the morning to see what time the patient should show up tomorrow. We’ll see how well that goes. I pointedly reminded him to keep the brace on and not try to turn his head until seen by the spine doctor.

The sad part is, if the hospital had admitted him, he could have been seen by the local spine surgeon in the hospital, had his surgery and it would have been covered by Medicaid.

What is wrong with this picture?

 

 

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Well, it is happening. The clinic I work in will be closing its doors soon, partly due to money issues and partly because the physician is retiring, and I am back on the employment search train again. The sad part about this, though the PA I work with is going to try to take as many patients along to the next job (and mine will go with me), is how many physicians won’t take Medicaid anymore. It just doesn’t pay, and the loss of income on each patient, coupled with the impossibility of finding specialists to refer Medicaid patients to, and the restrictions on what we can and can’t order for them, it is not a viable option for a lot of physicians to take Medicaid. On the patients’ side, if they have share of cost, it is often so high, they can’t afford to get healthcare anyway. The whole thing just stinks.

The good news is that there are several options for me and I will not be jobless for long, if at all. The bad news is that things are so up in the air that I haven’t found a lot of emotional space to write in my blog recently, though I did get a new bike, well actually a recumbent trike. An arthritic girl’s best friend! And my dog’s favorite thing, too!

 

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