A tale of two hospitals

[BirdinHand]

So…my husband had some serious chest pain Sunday night. He was at our shore house, because he had been running “doubles” (morning trips from 5am-noon, afternoon trips from 1pm - 9pm). Add in clean up after, and he was getting done around 11pm.

Sunday at 2am, he called me with pain that was bringing him to his knees and I told him hang up, call 911, go outside and call me back.

An ambulance came and took him to the closest hospital about 10 miles away.

He was embarrassed. He didn’t want to be the guy that called 911 “over indigestion”. I told him if you are calling me at 2am, it’s not indigestion. (As I’m stumbling to get shoes on and get out the door, arranging child care, etc at 2am)

They start running tests and I arrived about an hour and a half later

By the time I get there - they had already told him it was basically a pulled muscle - gave him a muscle relaxer and told him to take ibuprofen/Tylenol and the muscle relaxer and take it easy for a few days and follow up with his family doctor.

He was embarrassed. He thought he overreacted. All he wanted to do was go back to work and was mad he had overreacted.

I start going through the discharge papers and reach out to a friend that’s a cardiac nurse. He asks me about triponin levels and I said I don’t see where they checked that.

He tells me to take him to another hospital immediately.

A little convincing my stubborn husband that we don’t know for sure it’s just a pulled muscle and here’s why, they missed this test…a 75 mile drive “home” to a bigger/better hospital - and a battery of tests (first one out the door that they did besides an immediate EKG was cardia enzymes - triponin - that my friend was asking about) and he’s admitted and then eventually getting a heart catherization.

His triponin levels were elevated and 2 hour blood work follow up showed they were rising - SOMETHING cardiac was happening.

More tests, more vague markers, continued pain…and into the cath lab with a cardiologist he goes.

He had a 99% blockage in his circumflex artery. The cardiologist was able to put a stent in, relieving the blockage, and husband will be 100% ok.

That artery doesn’t show blockage on EC(k)Gs well. It often doesn’t show on echocardiograms. You don’t find it unless you know what to look for (triponin) and other markers and do a cath.

The cardiologist said he was within 2-3 days of a massive heart attack.

Had my husband simply listened to that first hospital - he would have been on the boat, miles offshore - and likely had a massive heart attack in a situation where it would have taken the Coast Guard too much time to get a boat/chopper and aide to him and very well could have died.

The canyon of difference in care between HOSPITAL A and HOSPITAL B is mind boggling to me.

Hospital A was in southernmost NJ, it’s supposed to be “good” but walking in the doors, I wondered if I had driven back in time to like 1993 instead of being in 2023.

Hospital B - different world. In every possible way. Like, they met him in the lobby of the ER with a chair, had him attached to monitoring wires and were drawing blood within MINUTES…checking that triponin level.


I somewhat take healthcare for granted because of where we live. You have your choice of several major hospital systems, all with different specialties. If you go on social media - people are asking which hospital system do others recommend for XYZ. We can stay on “our” side of the bridges in NJ, or within minutes, cross over to the Philly side of the bridges.

Where our boats are and where he was? There’s ONE hospital. For like 20 miles. That’s it. Then you get branch campuses of other hospital systems or a few independent little hospitals past that 20 mile range.


Healthcare shouldn’t be like this. You shouldn’t have to double check doctors and hospital results with friends. You shouldn’t have to question level of care. You shouldn’t have to drive yourself/family 75 miles to get better care and competent care.

There shouldn’t be the disparate impact of your geography that can mean you live/die in medical emergencies.

Standard practices - such as checking cardiac enzymes for a patient presenting with crushing chest pain - should exist in EVERY hospital.

What if we didn’t have a friend with 20 years of cardiac nursing experience that asked the right questions? And revealed we didn’t have the right answers?

Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

Something needs to change. Fundamentally.

 

[reinaert]

Your man's outlook is good? Fortune to you that it is.

 

[BirdinHand]

Your man's outlook is good? Fortune to you that it is.

Yeah, he’s good. He should get discharged today and be back to normal within a few days. Just gotta let the artery in his wrist that they used to do the cath heal up, take some meds for a few months and follow up with doctor appointments, etc.

We dodged a bullet - thanks to good friends and a better hospital system.

And mind you - he’s an outward healthy guy. Never saw that coming at ALL, especially at our ages (he’s only 46)

 

[ElChupacabra]

Yeah, he’s good. He should get discharged today and be back to normal within a few days. Just gotta let the artery in his wrist that they used to do the cath heal up, take some meds for a few months and follow up with doctor appointments, etc.

We dodged a bullet - thanks to good friends and a better hospital system.

And mind you - he’s an outward healthy guy. Never saw that coming at ALL, especially at our ages (he’s only 46)

Hope he has a speedy recovery.

 

[ttwtt78640]

So…my husband had some serious chest pain Sunday night. He was at our shore house, because he had been running “doubles” (morning trips from 5am-noon, afternoon trips from 1pm - 9pm). Add in clean up after, and he was getting done around 11pm.

Sunday at 2am, he called me with pain that was bringing him to his knees and I told him hang up, call 911, go outside and call me back.

An ambulance came and took him to the closest hospital about 10 miles away.

He was embarrassed. He didn’t want to be the guy that called 911 “over indigestion”. I told him if you are calling me at 2am, it’s not indigestion. (As I’m stumbling to get shoes on and get out the door, arranging child care, etc at 2am)

They start running tests and I arrived about an hour and a half later

By the time I get there - they had already told him it was basically a pulled muscle - gave him a muscle relaxer and told him to take ibuprofen/Tylenol and the muscle relaxer and take it easy for a few days and follow up with his family doctor.

He was embarrassed. He thought he overreacted. All he wanted to do was go back to work and was mad he had overreacted.

I start going through the discharge papers and reach out to a friend that’s a cardiac nurse. He asks me about triponin levels and I said I don’t see where they checked that.

He tells me to take him to another hospital immediately.

A little convincing my stubborn husband that we don’t know for sure it’s just a pulled muscle and here’s why, they missed this test…a 75 mile drive “home” to a bigger/better hospital - and a battery of tests (first one out the door that they did besides an immediate EKG was cardia enzymes - triponin - that my friend was asking about) and he’s admitted and then eventually getting a heart catherization.

His triponin levels were elevated and 2 hour blood work follow up showed they were rising - SOMETHING cardiac was happening.

More tests, more vague markers, continued pain…and into the cath lab with a cardiologist he goes.

He had a 99% blockage in his circumflex artery. The cardiologist was able to put a stent in, relieving the blockage, and husband will be 100% ok.

That artery doesn’t show blockage on EC(k)Gs well. It often doesn’t show on echocardiograms. You don’t find it unless you know what to look for (triponin) and other markers and do a cath.

The cardiologist said he was within 2-3 days of a massive heart attack.

Had my husband simply listened to that first hospital - he would have been on the boat, miles offshore - and likely had a massive heart attack in a situation where it would have taken the Coast Guard too much time to get a boat/chopper and aide to him and very well could have died.

The canyon of difference in care between HOSPITAL A and HOSPITAL B is mind boggling to me.

Hospital A was in southernmost NJ, it’s supposed to be “good” but walking in the doors, I wondered if I had driven back in time to like 1993 instead of being in 2023.

Hospital B - different world. In every possible way. Like, they met him in the lobby of the ER with a chair, had him attached to monitoring wires and were drawing blood within MINUTES…checking that triponin level.


I somewhat take healthcare for granted because of where we live. You have your choice of several major hospital systems, all with different specialties. If you go on social media - people are asking which hospital system do others recommend for XYZ. We can stay on “our” side of the bridges in NJ, or within minutes, cross over to the Philly side of the bridges.

Where our boats are and where he was? There’s ONE hospital. For like 20 miles. That’s it. Then you get branch campuses of other hospital systems or a few independent little hospitals past that 20 mile range.


Healthcare shouldn’t be like this. You shouldn’t have to double check doctors and hospital results with friends. You shouldn’t have to question level of care. You shouldn’t have to drive yourself/family 75 miles to get better care and competent care.

There shouldn’t be the disparate impact of your geography that can mean you live/die in medical emergencies.

[snipped the rest to allow reply]

This is true for government run systems/facilities as well, like our K-12 schools. While public school A may be doing a good job actually educating students, public school B may be simply using ‘social promotion’ to pretend that they are. You were fortunate to seek (and be able to get) a second opinion.

 

[Loulit01]

Best wishes for a speedy recovery.

 

[TheParser]

Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

1. I join other members (and guests) in hoping that your husband has a full recovery.

2. Yes, our healthcare system is "broken" in terms of paying for services and in terms of the competence and dedication of the particular health workers.

3. Here in the Los Angeles area, there are many hospitals.

a. Some have sterling reputations.

i. One is so famous that some elderly celebrities living abroad have returned to L.A. just so they can live near that hospital and die there.

ii. On the other hand, we once had a hospital whose staff was so incompetent and lazy that if a Los Angeles police officer were wounded while on duty, it is reliably reported that s/he would beg his/her colleagues: "Please don't take me to Killer [name of hospital]." It became so infamous that it was finally closed down and repurposed for minor problems only.

 

[post]

-snip-
Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

Something needs to change. Fundamentally.

It comes down to luck (your spouse's bad, followed by good) of the draw, right or wrong place at the right or wrong time, politics, networking, training. Including my wife, four of seven immediate family members underwent cardiac catherizations, the first, my youngest sister back in 1970.

In 2019, my wife suddenly was sweating. I measured her BP and her pulse rate was 122. I drove her to Emory Hospital E.R.
@ 4:00am. She was the patient receiving the most attention, several echo cardiograms. A double pulmonary emboloism was
the diagnosis. TPA was administered via a double catherization inserted at the groin by fellows staffing the cath lab under the
supervision of Dr. John Douglas, age 78 at the time, who I met the next day at my wife's bedside in the Cardiac Care I.C.U.

Judging by the level of attention and concern expressed during nine hours in the E.R., I have no doubt Dr. Douglas and the fellows
he trained saved my wife's life.

Pulmonary embolism - Wikipedia

en.wikipedia.org

Calling It Quits: Cath Lab Pioneers Grapple With When to Go and What Comes Next

Many prominent interventional cardiologists have been active since the birth of their specialty and see pros and cons to moving on.

www.tctmd.com

NEWS Features

Calling It Quits: Cath Lab Pioneers Grapple With When to Go and What Comes Next​

Many prominent interventional cardiologists have been active since the birth of their specialty and see pros and cons to moving on.​

byTodd Neale
FEBRUARY 28, 2018

"Interventional cardiology remains a relatively young field, but it’s been around long enough that many physicians who took up catheter work in the early days are reaching the age when it’s time to start thinking about what comes next....
“A lot of us were very young when we started doing this . . . and really our professional identities are very much connected to our being [a part of] the leading wave of interventional cardiology over the last several decades,” Bonnie Weiner, MD (Saint Vincent Hospital, Worcester, MA),..
.....
Most of the interventionalists interviewed by TCTMD—some of whom were active long before Andreas Grüntzig, MD, performed the first balloon angioplasty in September 1977—.."

Andreas Gruentzig - Wikipedia

en.wikipedia.org

...Emory University Hospital 1980-1985​

"In 1976, Gruentzig was presenting his animal research at a Miami medical meeting. Dr. Spencer King, a cardiologist from Emory University met him for the first time. In 1980, Dr. King visited Gruentzig in Zurich. Gruentzig was contemplating a significant change in his career because he had become frustrated with the slow pace of his efforts in Europe compared to the United States. He was considering joining the Cleveland Clinic. He said that he had two goals: to further his research to become a professor. King pointed out that Cleveland Clinic did not have a medical school so he would not be a professor there. This led to Gruentzig joining Emory University where he was immediately a professor.

When Dr. Gruentzig initially joined Emory, he collaborated with Dr. King to lead demonstration courses."

Dr. Gruentzig had homemade stents on his kitchen countertop before he emigrated.

Spencer Bidwell King III, MD​

https://onlinelibrary.wiley.com › doi › pdf › clc
by ME Silverman · 2009 — Over the next 5 years, Gruentzig and King worked closely together, along with John Douglas, refining angioplasty, establishing a large database, publishing ...

Profile | Emory School of Medicine

med.emory.edu

Dr. John S Douglas
"He completed fellowship in cardiology at Emory University and subsequently joined the Emory University School of Medicine faculty and the Emory Clinic where he has practiced invasive and interventional cardiology. In 1980, Dr. Douglas was a member of the team that performed the first coronary angioplasty at Emory University Hospital and in 1987 the first coronary stent in the United States. He was a partner of the late Andreas Gruentzig, the inventor of coronary angioplasty and participated in the development of current coronary angioplasty and stent techniques."



Dr. Gruentzig died shortly after this interview while piloting his private plane,

 

[Jessie C]

Your friend saved his life by sending you to a different hospital. In MOST ER's arterial bloodwork is the first thing they do, enzyme levels tell it all. There's no excuse for hospital #1 missing that. So glad he's OK!

 

[ElChupacabra]

<snip>
Healthcare shouldn’t be like this. You shouldn’t have to double check doctors and hospital results with friends. You shouldn’t have to question level of care. You shouldn’t have to drive yourself/family 75 miles to get better care and competent care.

There shouldn’t be the disparate impact of your geography that can mean you live/die in medical emergencies.

Standard practices - such as checking cardiac enzymes for a patient presenting with crushing chest pain - should exist in EVERY hospital.

What if we didn’t have a friend with 20 years of cardiac nursing experience that asked the right questions? And revealed we didn’t have the right answers?

Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

Something needs to change. Fundamentally.

Indeed, but in a profit driven healthcare system the resources tend to follow where the people are, and we've been seeing that shift in rural areas for quite a while now. In urban centers, you'll have easy access to hospitals, but the level of care varies along the socio-economic make up of the neighborhood a hospital services. In these hospitals there is also the challenge of having high case loads, so doctors are often having to manage all sorts of emergencies, which means they have limited time to spend on each person.

 

[Parrish]

So happy that he is recovering! Good wishes to you all.

 

[Jessie C]

Indeed, but in a profit driven healthcare system the resources tend to follow where the people are, and we've been seeing that shift in rural areas for quite a while now. In urban centers, you'll have easy access to hospitals, but the level of care varies along the socio-economic make up of the neighborhood a hospital services. In these hospitals there is also the challenge of having high case loads, so doctors are often having to manage all sorts of emergencies, which means they have limited time to spend on each person.

Sounds like you're making excuses for hospital #1. DON'T! There's a thing called triage all ER's use to determine urgency, and patients who present with acute chest pain are at the top of the list. NO excuse for medical professionals to not do arterial blood gases. NONE.

 

[phoenix2020]

Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

Something needs to change. Fundamentally.

I'm glad this was caught and he is on a better path now.

As to the issue at hand, this is one case where AI--for all the negative press it receives--is going to radically change things for the better. The vast majority of medical diagnosis is, ultimately, pattern matching, and a well trained AI can do so far more accurately (and quickly) than a human who, no matter their level of training, will only have seen or studied a subset of symptoms / measurements and their likely implications.

This also is why the Theranos fiasco was, in so many ways, disappointing. Imagine low cost blood analysis matched with robust AI--it likely would be the single most impactful step change in preventative medicine in the history of humanity... it could be that big. The AI part of that nut is on the verge of being cracked. All that's missing is the low cost, widespread diagnostic capability, and then the "fundamental change" you mentioned will be at hand, as your husband in that situation may have learned weeks or months in advance of a developing risk long before symptoms manifest.

Then, executing a treatment plan becomes the primary role of a hospital, and that is something that hospitals can be measured on (cost/quality) and patients--who are now really customers--can shop around.

 

[ttwtt78640]

I'm glad this was caught and he is on a better path now.

As to the issue at hand, this is one case where AI--for all the negative press it receives--is going to radically change things for the better. The vast majority of medical diagnosis is, ultimately, pattern matching, and a well trained AI can do so far more accurately (and quickly) than a human who, no matter their level of training, will only have seen or studied a subset of symptoms / measurements and their likely implications.

This also is why the Theranos fiasco was, in so many ways, disappointing. Imagine low cost blood analysis matched with robust AI--it likely would be the single most impactful step change in preventative medicine in the history of humanity... it could be that big. The AI part of that nut is on the verge of being cracked. All that's missing is the low cost, widespread diagnostic capability, and then the "fundamental change" you mentioned will be at hand, as your husband in that situation may have learned weeks or months in advance of a developing risk long before symptoms manifest.

Then, executing a treatment plan becomes the primary role of a hospital, and that is something that hospitals can be measured on (cost/quality) and patients--who are now really customers--can shop around.

While some “shopping around” is possible, many medical care insurance plans (both public and private) don’t cover the costs of such (preventive or ‘just in case’) diagnostic tests and pass much (or even most) of their cost on to the patients.

 

[Gateman_Wen]

So…my husband had some serious chest pain Sunday night. He was at our shore house, because he had been running “doubles” (morning trips from 5am-noon, afternoon trips from 1pm - 9pm). Add in clean up after, and he was getting done around 11pm.

Sunday at 2am, he called me with pain that was bringing him to his knees and I told him hang up, call 911, go outside and call me back.

An ambulance came and took him to the closest hospital about 10 miles away.

He was embarrassed. He didn’t want to be the guy that called 911 “over indigestion”. I told him if you are calling me at 2am, it’s not indigestion. (As I’m stumbling to get shoes on and get out the door, arranging child care, etc at 2am)

They start running tests and I arrived about an hour and a half later

By the time I get there - they had already told him it was basically a pulled muscle - gave him a muscle relaxer and told him to take ibuprofen/Tylenol and the muscle relaxer and take it easy for a few days and follow up with his family doctor.

He was embarrassed. He thought he overreacted. All he wanted to do was go back to work and was mad he had overreacted.

I start going through the discharge papers and reach out to a friend that’s a cardiac nurse. He asks me about triponin levels and I said I don’t see where they checked that.

He tells me to take him to another hospital immediately.

A little convincing my stubborn husband that we don’t know for sure it’s just a pulled muscle and here’s why, they missed this test…a 75 mile drive “home” to a bigger/better hospital - and a battery of tests (first one out the door that they did besides an immediate EKG was cardia enzymes - triponin - that my friend was asking about) and he’s admitted and then eventually getting a heart catherization.

His triponin levels were elevated and 2 hour blood work follow up showed they were rising - SOMETHING cardiac was happening.

More tests, more vague markers, continued pain…and into the cath lab with a cardiologist he goes.

He had a 99% blockage in his circumflex artery. The cardiologist was able to put a stent in, relieving the blockage, and husband will be 100% ok.

That artery doesn’t show blockage on EC(k)Gs well. It often doesn’t show on echocardiograms. You don’t find it unless you know what to look for (triponin) and other markers and do a cath.

The cardiologist said he was within 2-3 days of a massive heart attack.

Had my husband simply listened to that first hospital - he would have been on the boat, miles offshore - and likely had a massive heart attack in a situation where it would have taken the Coast Guard too much time to get a boat/chopper and aide to him and very well could have died.

The canyon of difference in care between HOSPITAL A and HOSPITAL B is mind boggling to me.

Hospital A was in southernmost NJ, it’s supposed to be “good” but walking in the doors, I wondered if I had driven back in time to like 1993 instead of being in 2023.

Hospital B - different world. In every possible way. Like, they met him in the lobby of the ER with a chair, had him attached to monitoring wires and were drawing blood within MINUTES…checking that triponin level.


I somewhat take healthcare for granted because of where we live. You have your choice of several major hospital systems, all with different specialties. If you go on social media - people are asking which hospital system do others recommend for XYZ. We can stay on “our” side of the bridges in NJ, or within minutes, cross over to the Philly side of the bridges.

Where our boats are and where he was? There’s ONE hospital. For like 20 miles. That’s it. Then you get branch campuses of other hospital systems or a few independent little hospitals past that 20 mile range.


Healthcare shouldn’t be like this. You shouldn’t have to double check doctors and hospital results with friends. You shouldn’t have to question level of care. You shouldn’t have to drive yourself/family 75 miles to get better care and competent care.

There shouldn’t be the disparate impact of your geography that can mean you live/die in medical emergencies.

Standard practices - such as checking cardiac enzymes for a patient presenting with crushing chest pain - should exist in EVERY hospital.

What if we didn’t have a friend with 20 years of cardiac nursing experience that asked the right questions? And revealed we didn’t have the right answers?

Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

Something needs to change. Fundamentally.

Glad he's gonna be ok.

 

[bave]

Healthcare shouldn’t be like this. You shouldn’t have to double check doctors and hospital results with friends. You shouldn’t have to question level of care. You shouldn’t have to drive yourself/family 75 miles to get better care and competent care.

There shouldn’t be the disparate impact of your geography that can mean you live/die in medical emergencies.

Standard practices - such as checking cardiac enzymes for a patient presenting with crushing chest pain - should exist in EVERY hospital.

What if we didn’t have a friend with 20 years of cardiac nursing experience that asked the right questions? And revealed we didn’t have the right answers?

Our healthcare system is SO broken. People die because of how broken it is. I’m grateful it wasn’t my husband this time, but it could have been.

Something needs to change. Fundamentally.

Not an excuse, but this stuff happens. I have sat on hospital boards and M&Ms where you saw these sort of things pop up at *all* facilities, though some more prevalent than others.

This is largely happening because of money/shortages, but no one will admit it. You end up with EDs being staffed exclusively by PAs with a single supervising (overwhelmed) EM physician who is trying to catch everything everywhere and stuff gets missed. The proliferation of midlevels is expanding this problem combined with a huge number of highly trained, experienced, and qualified professionals (both RN and MD) retiring in droves over the last ~4 years. MGMA estimates that the rate of retirees amongst MDs is running ~2x a year for the last 4 years and higher in certain specialties (specifically neuro/surg and CT). They are being replaced by medical students who frankly aren't fit to wear the coat more often than not. The same is true to a lesser extent for RNs. Further, you have a massive displacement in qualified RNs courtesy of COVID. A ton of the most experienced/motivated RNs switched to travel work rather than W-2 work because of the comp difference and that is still a problem in the system.

As to the geography, good luck. Geography is largely dictated by three things. First, where the residency programs are. If you are in a major city with a ton of residency slots (for you, Philly) then they will have a lot of quality young residents backfilling positions. Second, med-mal. If you are in a litigious area you are going to bleed out physicians (particularly in certain specialties). This is why PA trains more physicians than almost anywhere else but they lose almost all of them because of how bad the state is for medmal. Third, compensation. My wife did her training in Philly, she graduated and was offered a job making $125k. She took a job in the surbubs and that number doubled. She worked part time when we moved to Nashville area and the number doubled again (for less work). Why? Demand, reimbursement, etc. Medicine is one of the few professions, if not the only one, where the more highly trained you are generally the less you will be paid.

Standard practices exist in every field of medicine, for every type of complaint. Without looking at the chart it is difficult to say if the first hospital followed them, but probably not. SoC for someone presenting with chest pains is an immediate blood panel and EKG regardless of anything else. They are cheap and easy and the risk to miss is huge. So odds are the facility you first went to dropped the ball pretty hard.

This really isn't a system problem honestly. This is a human being problem. This sort of thing happens in every system all over the place, I would argue more often in places with more holistic systems in place.

 

[bave]

I'm glad this was caught and he is on a better path now.

As to the issue at hand, this is one case where AI--for all the negative press it receives--is going to radically change things for the better. The vast majority of medical diagnosis is, ultimately, pattern matching, and a well trained AI can do so far more accurately (and quickly) than a human who, no matter their level of training, will only have seen or studied a subset of symptoms / measurements and their likely implications.

This also is why the Theranos fiasco was, in so many ways, disappointing. Imagine low cost blood analysis matched with robust AI--it likely would be the single most impactful step change in preventative medicine in the history of humanity... it could be that big. The AI part of that nut is on the verge of being cracked. All that's missing is the low cost, widespread diagnostic capability, and then the "fundamental change" you mentioned will be at hand, as your husband in that situation may have learned weeks or months in advance of a developing risk long before symptoms manifest.

Then, executing a treatment plan becomes the primary role of a hospital, and that is something that hospitals can be measured on (cost/quality) and patients--who are now really customers--can shop around.

AI isn't going to fix a garbage input. If you have an ED staff that isn't running a blood panel and EKG for chest pains then I would argue there is no way the inputs are correct for an AI diagnosis.

Where AI is going to be real is radiology. There won't be radiologist in ten years. It is already proven that AI does a better job, vastly faster, than human radiologists. The only thing keeping them from extermination is lobbying.

 

[BirdinHand]

Not an excuse, but this stuff happens. I have sat on hospital boards and M&Ms where you saw these sort of things pop up at *all* facilities, though some more prevalent than others.

This is largely happening because of money/shortages, but no one will admit it. You end up with EDs being staffed exclusively by PAs with a single supervising (overwhelmed) EM physician who is trying to catch everything everywhere and stuff gets missed. The proliferation of midlevels is expanding this problem combined with a huge number of highly trained, experienced, and qualified professionals (both RN and MD) retiring in droves over the last ~4 years. MGMA estimates that the rate of retirees amongst MDs is running ~2x a year for the last 4 years and higher in certain specialties (specifically neuro/surg and CT). They are being replaced by medical students who frankly aren't fit to wear the coat more often than not. The same is true to a lesser extent for RNs. Further, you have a massive displacement in qualified RNs courtesy of COVID. A ton of the most experienced/motivated RNs switched to travel work rather than W-2 work because of the comp difference and that is still a problem in the system.

As to the geography, good luck. Geography is largely dictated by three things. First, where the residency programs are. If you are in a major city with a ton of residency slots (for you, Philly) then they will have a lot of quality young residents backfilling positions. Second, med-mal. If you are in a litigious area you are going to bleed out physicians (particularly in certain specialties). This is why PA trains more physicians than almost anywhere else but they lose almost all of them because of how bad the state is for medmal. Third, compensation. My wife did her training in Philly, she graduated and was offered a job making $125k. She took a job in the surbubs and that number doubled. She worked part time when we moved to Nashville area and the number doubled again (for less work). Why? Demand, reimbursement, etc. Medicine is one of the few professions, if not the only one, where the more highly trained you are generally the less you will be paid.

Standard practices exist in every field of medicine, for every type of complaint. Without looking at the chart it is difficult to say if the first hospital followed them, but probably not. SoC for someone presenting with chest pains is an immediate blood panel and EKG regardless of anything else. They are cheap and easy and the risk to miss is huge. So odds are the facility you first went to dropped the ball pretty hard.

This really isn't a system problem honestly. This is a human being problem. This sort of thing happens in every system all over the place, I would argue more often in places with more holistic systems in place.

The treating doctor in the ER was an MD that sits on the board of trustees for the hospital and graduated from a highly respected medical school in Philadelphia. The ER was NOT busy at the time, there were only a handful of patients - one being a child with an ear infection, one being my husband, and one being an elderly confused patient. They did not run troponin (cardiac enzyme) panels. Period. Had they run that simple blood work, they would have noticed the elevated cardiac enzymes.

There is zero excuse for that oversight.

 

[bave]

The treating doctor in the ER was an MD that sits on the board of trustees for the hospital and graduated from a highly respected medical school in Philadelphia. The ER was NOT busy at the time, there were only a handful of patients - one being a child with an ear infection, one being my husband, and one being an elderly confused patient. They did not run troponin (cardiac enzyme) panels. Period. Had they run that simple blood work, they would have noticed the elevated cardiac enzymes.

There is zero excuse for that oversight.

How big of a hospital was it (ie: beds)?

Sitting on a board of trustees for a hospital doesn't mean a lot. An MD can easily get on a stack of boards at a hospital because most quality physicians generally won't touch it with a ten foot pole. Hospital boards/committees are absolute cesspools of politics and bickering that a successful physician will steer away from in record time because they are already so busy they simply don't have time for it.

Do you have the records? What was the admission note? Which CTP codes were used? How old was the attending?

 

[Jessie C]

How big of a hospital was it (ie: beds)?

Sitting on a board of trustees for a hospital doesn't mean a lot. An MD can easily get on a stack of boards at a hospital because most quality physicians generally won't touch it with a ten foot pole. Hospital boards/committees are absolute cesspools of politics and bickering that a successful physician will steer away from in record time because they are already so busy they simply don't have time for it.

Do you have the records? What was the admission note? Which CTP codes were used? How old was the attending?

Why do you insist on defending the indefensible? NONE of your argument changes the fact that there's a protocol for chest pain, and ABG's (troponin panel) are top of the list. Just stop. The ER dropped the ball big time. Period.

 

[bave]

Why do you insist on defending the indefensible? NONE of your argument changes the fact that there's a protocol for chest pain, and ABG's (troponin panel) are top of the list. Just stop. The ER dropped the ball big time. Period.

Which words are confusing you? Nowhere did I defend anything.

 

[BirdinHand]

How big of a hospital was it (ie: beds)?

Sitting on a board of trustees for a hospital doesn't mean a lot. An MD can easily get on a stack of boards at a hospital because most quality physicians generally won't touch it with a ten foot pole. Hospital boards/committees are absolute cesspools of politics and bickering that a successful physician will steer away from in record time because they are already so busy they simply don't have time for it.

Do you have the records? What was the admission note? Which CTP codes were used? How old was the attending?

Which words are confusing you? Nowhere did I defend anything.

Frankly, I don't have any desire to get into spelling out every last detail to you.


First, I don't trust a word you say. Second, nothing you say would change the situation anyway.

Why you think you know better about the situation is beyond me.

 

[bave]

Frankly, I don't have any desire to get into spelling out every last detail to you.


First, I don't trust a word you say. Second, nothing you say would change the situation anyway.

Why you think you know better about the situation is beyond me.

Lol.

Sounds like a pretty typical complaint you would see come in through the hospital chain then. Someone says they have a friend, they know things, but doesn't have any of the details.

Got it.

It's either that or a "well trained MD" failed the most basic aspect of EM SoC. Do you realize how improbable that is?

 

[BirdinHand]

Lol.

Sounds like a pretty typical complaint you would see come in through the hospital chain then. Someone says they have a friend, they know things, but doesn't have any of the details.

Got it.

It's either that or a "well trained MD" failed the most basic aspect of EM SoC. Do you realize how improbable that is?

You should go back to the “I don’t trust a word you say” part of my earlier statement.

 

[bave]

You should go back to the “I don’t trust a word you say” part of my earlier statement.

Mmkay.

The treating doctor in the ER was an MD that sits on the board of trustees for the hospital and graduated from a highly respected medical school in Philadelphia.

This guy. In your words a highly trained physician on the hospital board of trusteees, who wasn't working in a busy ED, who examined your husband who was complaining of chest pains........ that guy...... failed to follow the most basic SoC in EM.

Something doesn't add up. If I am wrong, file a complaint with the NJ board of medicine and file suit.