March, 2006 Archive

March 10, 2006, 4:15 pm

Your ER Bill: A Bitter Pill (Or Why You Pay Through the Nose For Injuries to Toes)

Oh great.

This never even occured to me until I saw this ad.

All those times I ran into the back to grab a bite of the Super Garlic large pizza with extra garlic-flavored cheese on a garlic filled crust…..

Could I?

Do I?

Must I add Tic Tacs to my pocket arsenal of patient tools?

I suppose I could always say that it’s an olfactory hallucination that always happens with chest pain or dyspnea or abdominal pain or stubbed toes.

You know, blame the patient.

Knowing me, I will now become fanatical about this and brush my teeth four times a shift and lose twenty pounds eating nothing but Certs for breakfast, Tic Tacs for lunch and Ice Breakers for dinner with a snack of Altoids in between.

But I will not give up my coffee or my diet Pepsi. A nurse has to take care of herself somehow!


It’s a holiday weekend. The doctor’s office is closed

Besides, your doctor is on vacation anyway for two more weeks.

Your left big toe is three times its normal size secondary to an ingrown toenail you hoped would go away by itself but you dropped a desk on it and now you are in agony and really would like to walk without a scream escaping from your throat with each step.

You decide to go to the ER.


Have a seat in the triage room. If it isn’t a crazy night, the nurse will take a look at your toe, commiserate with your suffering, grab you a wheelchair, elevate your foot, take some vitals, get a history and send you to registration.

Okay, your registration is complete and your nurse has your chart in hand and she calls your name. You are wheeled to your room, where you hop on the gurney.


You have just spent a few hundred dollars.

The ER doc will see you, commiserate with your suffering but she knows what to do! After an x-ray to make sure you did not fracture your toe, your toe is numbed, your rather severely infected abcess is drained and the offending nail is cut out.

Your nurse places a gauze bandage on your toe. You may need a cast shoe for comfort for a few days.

It’s sort of late by now and your doctor wants to save you the trouble of going to the pharmacy so she asks the nurse to give you your first dose of antibiotic before you leave.


You just spent a considerably few hundred dollars more.

You are given your discharge instructions, prescription and told to follow up with the doctor on call for yours in two days to recheck the wound and make sure it’s healing well.

Thanks for using our Most Excellent ER! Take care!


Six weeks later you get the bill from the Most Excellent ER and it is well over one-thousand dollars.

After you pick yourself up off the floor, you look at the bill to see where it says they gave you a heart transplant, because surely an ingrown toenail can’t have cost that much!

But it does.

That charge includes:

  • the triage, the registration, the “room charge” which is based on your initial complaint
  • the medications used to numb you and the antibiotic used to treat you which were obtained from the drug dispenser maintained by pharmacy
  • the disposable instrument tray used to cut you, the gauze used to bandage you and the cast shoe used to help you obtained from the equipment dispenser maintained by central supply
  • the nurse who went over your discharge instructions (and was assigned to your care)
  • the fact that you had a procedure (the incision and drainage of your infected foot).

But still, you say, over one-thousand dollars?


Because you took advantage of a service that is available to everyone who needs it, twenty-four hours and a day, seven days a week. The ER. Your bill pays for the salaries of those four RNs and one tech who are there whether there is one patient in the department or twenty patients every hour or none at all during a night shift. Your bill covers the services of those who have no insurance but never pay their bill, those who are indigent, or homeless and post-cardiac arrest.

You are paying for the advantage of having, and using a 24/7 emergency health care operation.

Oh, and by the way, the ER doctor and the x-ray department radiologist (the specialist who will ultimately read your x-ray officially) bill separately. They are not employees of the hospital.


Now I gave an example of someone who really had no other choice. This infection could have turned serious very fast and they were in excruciating pain. I added the element of the x-ray to make a point.

It doesn’t make economic sense to use an emergency department for a non-emergent problem. If you aren’t sure what constitutes an emergency, or if your pain is umbearable, we are there for you. Don’t take a chance.

But…if you are not in any danger of losing your life, limb or eyesight

  • Call your doctor, even after hours. Speak to whomever is on call. See if they have some advice they can give you over the phone. They may say, go to the ER! If so, come on down!
  • Wait until office hours the next day, if you can. That sore throat you’ve had for a week will not go away just because you visit an ER that night. Trust me. Even if we start treatment, you won’t be immediately cured. You may have to go through a possibly lengthy ER wait/visit when your doc may have been able to fit you in.
  • If you feel you are not having an emergency but must be seen, and if you have access to an Urgent Care Center (often called a “Doc-In-The-Box” as a joke), use it. It will be cheaper and hopefully faster than most ERs.

An Emergency Department is there to care for anyone and everyone who needs their services.

No one can be turned away.

It can be a lifesaver or it can be one very expensive band-aid.

If you need the ER, use it! If you have another option, you’ll save time and money.

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March 8, 2006, 1:44 pm

New Friends, Loose Ends

Ah, the cigarette anatomy class!

That double filtered Viceroy tip always messed me up on exams.

I could never get the number of filters right.

One nurse (on the left) had clinical experience with the double filter, so for her, this was just a review.

Wearing caps was a requirement for that class.

Just for the record, that is exactly how my cap looks except the stripe is forest green with a tiny gold stripe in the middle.


I’ve added a couple of links to my sidebar.

Marcus at Fixin’ Healthcare was his state’s representative at the winter meeting of the National Governors Association.

The weekend was devoted to the 2006 Healthy America Forum. Marcus has devoted a series of posts to the topic(s) of the forum.

Many of us are exasperated by the state of healthcare, Marcus is actually in a position to help affect changes. Very exciting!

The first three posts should have been in Grand Rounds, but (ahem) they vanished into the ether and more have been posted. Check ’em out!

Treatment Online is a web site that describes itself as “… the internet destination for the very best in psychological support and evaluation.”

Jon had submitted a great article from that site, on “ADHD and Amphetamines” that also pulled a vanishing act this week at GR.

It was a good article for me because I have little knowledge of ADHD, and yet saw a nephew’s GPA rise from a 1.8 to a 3.8 after he was diagnosed at 14 and placed on medication. Another good read, sure to be controversial in some areas.

And I think that brings me up-to-date on missing linkage! LOL!

Oh, do yourself a favor and click on Doc Around the Clock on my sidebar to check out his parody of “American Idol” called “American Demerol”. It’s so good Randy would put him in the dawg pound!!! Get ready to split a gut laughing……

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March 7, 2006, 1:51 pm

Report From the President of Horrendous Treatment of Most Links (HTML) Annonymous

Who needs Belladonna when you’ve got “Grand Rounds”?

Trust me, I had functional GI spasm.

And functional cerebral spasms, functional throat spasms, functional tear duct spasms, functional screaming spasms, non-functional (thank god) waves of nausea and acute diaphoresis that would have made a cardiologist blanch.

I think I have some hair left.

I even invented some new four-letter-words!

Nothing like hosting Grand Rounds to bring out your inner creativity.

But I figured it this way: would a nurse walk out on a patient just because they were going bad? Of course not.

So I pulled a double shift!

I’d like to offer some advice for future hosts of Grand Rounds that I learned the hardest way possible.

  • DO NOT TRUST BLOGGER or whoever you use to produce your web page/blog.
    • Write the entire post using a web word processor and then post it to the blog.
  • The following does not constitute backing up
    • Saving your html to a folder on your “desktop”. I thought I had backed up. All it did was “translate” the html into a wierd version of the Blogger posting page.
    • Saving a copy of the actual submission in a folder on the desktop. Nice, but didn’t do me a bit of good because once you save it, the web address is altered.
    • Saving as a draft as you go along means nothing if Firefox crashes. Which it did, exactly five seconds after I had finished rebuilding the post the first time.
  • Save all emails with the submissions in them. Thank god I did this. I would have been helpless without them.
  • When I posted all links were functional. Once posted, I went to fix a bad link, and the repost showed that the bottom third of the links had ceased to be links. I then took the entire post offline thinking it would be easier to work on before more people saw the broken version. I think that was where the first mistake was made. But I’m not sure why. Once it is up, leave it up and work on it while it is posted.
  • Do not bullet your links. I had a submission with multiple links and I put them in a bullet format. It wasn’t until I put them in as links in the narrative that I was able to make links of the submissions below.
  • Even though Grand Rounds is officially on Tuesday, have it ready and post it on Monday night so if it turns into a disaster you have time to fix it. Thank god I posted it at 1701, one minute after the deadline (I was excited to see it!). Had I discovered it any later than that, there would have been no time to have something on Tuesday morning.

I am as compulsive about my blog as I am with my charting, and the original Grand Rounds had every link in red, italicized and underlined. The colors you see on it now, I had nothing to do with any of them. All I wanted by that time was just a functional link.

How do you explain to your husband that there are approximately 60 professionals/patients from around the world who are depending on you to get their stories out and you can’t let them down? He wonders why I have such a stressful hobby. Doesn’t have a clue. Only a blogger would understand.

I was so excited to be hosting and I wanted everything to be perfect. I had planned the theme weeks in advance, so this has felt like a major failure. Ironically, I get my first Instalanche and it is bittersweet.

Thanks to everyone who sent their support. I owe a few of you some linkage, will put it in the next post. Won’t be Grand Rounds, but I’ll send folks your way.

Now, no more downer stuff!

I want to thank Rita over at the MSSPNexus Blog who made me laugh at loud with this photo she enclosed in an email.

I get all my stuff off the internet, people are always asking me where I find it, but this one definitely came from her.

Thanks, Rita, I definitely needed that!

Oh, and by the way, are you wondering if I would host Grand Rounds again?

If given the chance?

In a heartbeat.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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