CYA and Healthcare Reform

Ok, so I know that I haven’t written a post for some time now and you are about to understand why. About one month ago, my dad called me to tell me that his primary care doctor had instructed him to go to the ER immediately because his routine EKG showed a change from last year. She had in fact stressed him out to the point of probably giving him a heart attack with her behavior which included wanting to call 911 to take him directly to the ER from the clinic.

Was he having symptoms (chest pain, shortness of breath, diaphoresis, decreased exercise tolerance)? No. In fact, he felt totally normal. Was he having ST elevation or depression on his EKG (findings typical of heart attack or diminished blood flow to the heart respectively)? No. He had “nonspecific t-wave changes”. Were his vital signs concerning? No. His blood pressure was 128/72, heart rate was 88. So why call 911? Because the primary care physician wanted to practice CYA (cover your arse) medicine.

For some reading this post, the term CYA medicine might be something of a novelty. Certainly one never sees Dr. House, MD or Dr. Cox from “Scrubs”, or even Dr. Green and Carter from “ER” practicing this type of medicine. What exactly is this type of medical practice?

It basically involves the most limited degree of mental commitment possible in a medical encounter, where you are asking yourself only one question, “How can this patient hurt me later?”.  Based on the medical provider’s answer to that question, they then proceed accordingly. It doesn’t matter how much this will cost the patient – insured or not. It doesn’t matter how many needless tests you have to order at the patients physical, financial and emotional expense. It also doesn’t really matter if the patient agrees with you or not, especially if they are insured – because you can always threaten them with an AMA (against medical advice) discharge where their visit will not be covered by their insurance. They are your prisoner so you can strategize your defense from a medical malpractice lawsuit.

As an ER physician myself, I cannot always blame providers who practice medicine this way. I don’t believe that anyone graduates residency intending to practice medicine this way. Its after someone comes after you for something only God could have forseen that you get gun-shy. At the end, it becomes a vicious cycle of abuse from both ends.

This is the biggest problem with Healthcare reform – the hidden nooks that politicians can’t see the way we, as healthcare providers, see them from within. There are too many groups mining in the medical gold mine – malpractice lawyers, insurance companies, drug companies, etc. – and they each have powerful lobbies to back their interests. The purity and simplicity of the doctor-patient relationship with all that it used to contain of trust, friendship, understanding and forgiveness has been plundered and I personally am not sure we can return to that after having let in the greedy pirates mentioned above.

So, back to my dad. He asked me to come with him to the ER – in my car and not the ambulance – to make sure they didn’t rape him there with unnecessary tests and procedures. He had me stand behind the ER provider who was practicing CYA and give him thumbs up or down depending on whether I agreed with the management or not. They of course told him that he could die if he wasn’t admitted for “further testing”, but he did just fine at home until his next follow-up appointment.

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11 Responses to CYA and Healthcare Reform

  1. WarmSocks says:

    Glad to hear your dad is doing okay.
    Welcome back.

  2. Yvonne ED RN says:

    Welcome back.I am sorry you and your Dad were victims of CYA (health bullies) .Your perspective is thought provoking.thanks.

  3. Jess says:

    Years ago, a doctor did the same thing to my wife. The nurses were surprised when she walked into emergency. Long story short: Expensive much ado about nothing. If worry was money, I’d have retired the next week.

  4. Joe says:

    Stumbled across this blog on accident, but since then, I’ve been addicted as if this was a sitcom (I’m a pre-med at the moment), and read all your entries(it’s only exam season :P).

    Looking forward for your next entry!

  5. Badhorsie says:

    I just read your whole blog top to bottom. Please come back! Surely there are some new stories to tell since last September….

  6. acai order says:

    Welcome back ! I hope your dad is OK.

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    […]CYA and Healthcare Reform « ER Drama: The Blog[…]…

  8. All Long story short: Expensive much ado about nothing. If worry was money, I’d have retired the next week.

  9. Editor says:

    Things are crazy in the ER, and will be getting crazier. Only those with money will be able to escape.

    For some really amazing ER stories, check out Robert Lanz’s blog. Some incredibly touching stuff, and some really hilarious stuff. I believe these are excepts from a book of his about to be published:
    http://robertjlanz.wordpress.com/

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