Wednesday, January 6, 2010

vacation over: a rude welcome back to the real world

So my long vacation comes to an end. I was going to write about music on Monday night; however, that was before I was hit by a car while biking home. Don't worry, I'm totally fine, which makes me really lucky! In addition, now I get to write about how awesome my hospital experience was!

A few minutes after the accident, once I got over the initial shock of being hit by a car, I pretty much realized I was okay. I didn't lose consciousness and didn't have any major injuries (just some general pain all over the place). In fact, at that point I was actually telling the driver to calm down, as she was far more hysterical than I was about the whole situation. The police had already showed up; they were asking me questions to make sure my head was on straight, and had called an ambulance. The paramadedics showed up shortly after, asked me a few basic questions (any neck, back, or head pain?), took my blood pressure and skin conductance, etc., and then suggested that I go to the ER just to make sure I was okay. I asked them if that was really necessary given that I answered all their questions normally and had no major trauma. They said that though I was probably fine, they recommended a trip to the ER anyway. I asked how much the ambulance ride would cost, but couldn't get an answer out of them. At this point, I assumed my insurance, and at some point down the line, the other driver's insurance, would cover most of the cost anyway, and didn't feel like ignoring the paramedics' advice. They know what they're doing, right? Better safe than sorry?

I also assumed that once we got to the ER the doctor I saw would actually do something the paramedics hadn't done. Instead he just took did the same tests as the paramedics and asked the same questions, followed by, "so why did you come to the ER?" Umm, I don't really know. Thanks, doc! So in the end, my trip to the hospital left me with some bandages, a much higher chance of contracting a staph infection, and a much bigger bill (at least for someone).

I don't know whether I'd be more annoyed if the doctor had done something even more unnecessary to justify my trip to the ER, or whether I'm more annoyed that the paramedics told me to go in the first place. Either way, it all seemed pretty silly. By the time the ambulance left the scene of the accident with me inside, twenty or so minutes had passed, my blood pressure was nearly back to normal, and nothing about my behavior indicated that I needed any further medical attention.

Maybe it was just a simple case of caution after an accident, but it seems more to me like a significant failure of communication between the ER and the paramedics.


  1. Well this is an odd way to find out about your brother being in a CAR ACCIDENT.

    May I (meekly) defend the healthcare profession here? I assume the paramedics suggested your ER trip as a routine precaution against, say, an epidural hematoma or delayed-onset bleeding disorder or any of the many unlikely things that wouldn't have shown up in a cursory exam so soon after an accident. Sure, these complications would be EXTREMELY unlikely, but the probability-adjusted cost-benefit ratio here is probably still in favor of suffering the minor inconvenience, waiting it out and (in theory) having a more complete history and exam from an emergency medicine physician. (By the way, the chances that a healthy, immune-competent young person will develop a full-blown infection of any kind from casual contact at a hospital is vanishingly small.)

    Thus I'd say It was pretty unprofessional of the doc to challenge your having come into the ER.

    Is your bike OK?

  2. i agree about the doctor in the ER. but what else about the ER visit would have detected any of the things you mention, even if i were suffering from them? really all they did was take my blood pressure again, ask me questions, and then treat the wounds.

    the bike also miraculously escaped unscathed...the major damage was to my right shoe and sock (both ripped, but i'm pretty sure the sock wasn't in such great shape anyway)

  3. I'm kinda with Sarah on this one --- just the risk of some delayed-onset problem probably justifies the trip to the ER ... Plus, insurance makes everything free; isn't that how it works?

  4. This is Mom putting on health economist hat: Well Sarah might be right about cost-benefit but Dad is definitely off-base (but I guess was being ironic) about insurance. "Free" insurance is making everyone too risk-averse. Come to think of it why didn't the paramedics say get yourself to ER if (fill in symptoms of delayed bleeding/hematoma etc...)

  5. Let's talk about this using game theory with costs and benefits to the players in question, the paramedics staffing the ambulance.

    Case 1: They get you to go to the ER and you turn out to be seriously hurt. No harm or benefit to them.

    Case 2: They get you to go to the ER and you are fine. No harm or benefit to them.

    Case 3: You don't go to the ER and you are fine. No harm or benefit to them.

    Case 4: You don't go to the ER and you are seriously hurt. Serious liability for them, with
    you having the option to sue - whether or not the suit has any chance of success, major pain in the patoot for them.

    -Doug Shaker, old college pal of your dad's.