Crash Cart: Flying hot dogs; Berating Patients; Concierge EM Services

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California emergency physician fired after berating basketball player suffering from anxiety that reportedly couldn’t inhale and couldn’t move body and asks patient “Are you dead, sir?” (ABC News)

Mark Plaster, MD, PhD: There by the grace of God… If anyone says that they haven’t at least felt like that ER doc once or twice in their life, they are either a liar, an administrator or both.  But jeez lady, “Don’t say it!”  I heard that there was more to the tape than was put out on the internet.  There usually is.  But we have to live our professional lives as if we are always hot mic-ed.  When you encounter a patient that seems to be standing (or jumping up and down) on your last nerve, just say, “Excuse me I have to go pee.”  And go take a cold shower.  Or get someone else to see the patient.  They can tell the patient that you won’t be seeing them because you hung yourself in the bathroom.

Nicholas Genes, MD, PhD: This is terrible. There was a lot of chatter about this on social media and EM professional society listservs. ACEP already has a policy on recording devices in the ED, but some argue that it doesn’t offer guidance to docs already recorded without consent. Still…when it comes to this kind of blatant unprofessional behavior, our specialty should be really careful in how it responds. Talking about the doctor’s rights, or suing the patient’s family, should be a distant, tangential consideration. And yeah, ACEP should advocate for its members, but sometimes that means removing bad apples or pushing for working conditions that restore basic empathy.

William Sullivan, DO, JD: We need to put away the pitchforks and douse the torches. When we willfully ignore one half of this interaction and imply that lying about one’s symptoms, taunting a professional who is trying to help you, illegally recording the interaction, selectively editing the video and then going to the news media to complain are all OK, it also makes us all look bad. The doctor got baited, took the bait and lost her cool. But now there seems to be a precedent that when physicians don’t give patients what they want, patients can taunt physicians, get video like this, selectively edit the video, publish it to the national news media — all with no consequences … and then the doctors can’t say anything to defend themselves because of HIPAA. Why don’t people make recordings like this in court? Because it isn’t tolerated and they’d probably get thrown in jail if they tried it. Will we see an uptick in videos of “bad apple” physicians? Will those videos create a public impression that all physicians are just “bad apples?” Allow incidents like this to continue and I think you already know what the answer will be.

Philadelphia Phillies baseball fan gets hit by hot dog shot out of a cannon during a game, goes to ER and gets CT scan of brain. (Action News)

William Sullivan, DO, JD: When I first read this, I thought they were joking. How could someone in the stands get hit — much less injured — by a flying hot dog? Then you see that the hot dogs are wrapped in duct tape and shot out of a cannon into the Philadelphia Phillies crowd. The pictures with the article show that the lady had some significant bruising around her eye. Yeah, I’ll pass on the Ballpark Franks, thanks. Does someone need a CT scan of the brain to “rule out a concussion” from a flying wiener? Doubtful. Perhaps to rule out a globe injury or maybe a facial fracture? Wonder what the Phillies do to fans from opposing teams.

Mark Plaster, MD, PhD: Just be glad they weren’t serving up baked potatoes.  I used to know an ER doc who had a potato gun made from PVC pipe.  He would ignite hair spray in the chamber closed off by the potato.  He could shoot it a half mile.  Don’t tell the Philly Fanatic about this though.  He might kill somebody.  No one can ever accuse a guy who walks around in a goofy costume for a living of being a “rocket scientist.”  My heart goes out to the lady.  And pass the mustard.

Nicholas Genes, MD, PhD:  I feel bad for this fan that got injured. But the article says “she ended up in the emergency room for a CAT scan to make sure she didn’t suffer a concussion” — maybe the mTBI was affecting her understanding of what transpired. In residency I got to cover the infirmary at the old Shea Stadium — from foul balls to fist fights, it was wild. But I never saw a hot-dog related injury — not even GI complaints.

New York City startup offers concierge emergency medical services to patients that agree to pay $3,000 to $5,000 per year as a membership fee … and there is a waiting list to get in. (CNBC.COM)

Nicholas Genes, MD, PhD: The ED is one of the last places in the U.S. where the rich rub elbows with the poor. So, I guess it’s not surprising that they’re working on a way to avoid that. When the NYTimes covered this concierge ED, they mentioned they got the idea after a visit to my ED — where the median time to be seen is 25 minutes. The founders of the concierge ED were specifically upset about a long wait for a CT scan, but for some reason they didn’t see a business opportunity in improving Radiology transport times.

Seth Trueger, MD MPH FACEP: All acute unscheduled care isn’t the same and these are not emergency departments. I have no problem if people want to set up expensive concierge services and people can choose to pay for them, but they aren’t ERs.

William Sullivan, DO, JD: This initially screamed EMTALA violation at me, but EMTALA only applies to participating hospitals with dedicated emergency departments. If the group doesn’t accept federal funding, then it isn’t a participating hospital. The pricing is steep, but the group appears to be cherry picking the wealthier patients by offering quick care and streamlined testing and follow up appointments. One person interviewed for the article noted that he paid $4,000 for an emergency department visit, so the yearly fee for this service was covered by saving just one ED visit. Will it catch on?

Mark Plaster, MD, PhD: I think this is a great idea even if it seems to currently only cater to the wealthy. Because eventually someone will get the system streamlined and offer it to the middle class.  That’s the real market for this service and that’s when telemedicine, economies of scale, appropriate use of physician extenders, will show that this is a real improvement over our current system of mixing everything in the ED.  I compare it to the advances in science that start out in space, the race track or the military.  At first they are very expensive and only available to a few, but before long they become widely available at reasonable costs. Remember when electric windows on a car were considered an expensive luxury?

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