HOW TO AVOID ER(RORS)

I think that having local doctors running local emergency rooms is a good idea. Problems occur when a local hospital contracts with a large group of doctors that are not invested in the community and that work in multiple larger hospitals.

Out of necessity those doctors are trained to do things the same way in every hospital's ER. They have no understanding or caring that what works well in a large, big city Hospital does not work well in a smaller community hospital.

In a large hospital, the ER doctor often serves as a glorified triage nurse, merely stabilizing patients and deciding whether they need to be admitted. They often don't address every significant medical problem, putting the patient at risk for an adverse outcome.

At large hospitals, attending doctors are available in the hospital at all times and patients are evaluated by them in the ER prior to admission . In a small hospital, a doctor may not see the patient for several hours after admission and depends on the ER doctor being skilled and competent enough to keep the patient stable until reevaluated.

Relationships with other local doctors are important to establish trust and confidence . A primary care doctor needs to know that a patient being admitted from the ER is going to have all important health care issues addressed at the time of admission and that all those issues have been discussed.

It is also important for ER doctors to know the strengths and limitations of the local health care system. Small towns do not have the same resources as larger cities. Not every patient is best served by being sent out of town for tests, procedures or referrals.

Small communities are best served by local institutions which are best run by local people. This is true of government, banks and healthcare, especially where the ER is concerned.

THE BIGGER THEY ARE...

I think that the disturbing trend of the government allowing businesses to get too big by merging with and buying out competitors is now also involving healthcare. Just as financial institutions are allowed to merge and acquire smaller entities with little oversight, so too are healthcare groups.

Banks promoted that by becoming larger, they would be more efficient and pass those cost savings on to their customers. I would argue that the end result has been more reckless behavior, less flexibility and higher customer fees.

I am concerned because a similar situation is happening in healthcare. Fewer and fewer entities (think IU Health and St. Vincents) are controlling more and more of Indiana's hospitals and doctors practices. This creates at least 3 potential problems.

The first is the adverse effect on costs to the patient. Plastic surgery and laser eye procedures have been the only things in healthcare that have decreased in price over the years. This is because insurance is generally not involved and there is great competition amongst many providers.

The second is that if these large institutions were to make bad financial decisions resulting in insolvency , the government would have to bail them out to prevent a catastrophic collapse of the healthcare system. This policy is bad for consumers and bad for America.

The third is the de facto creation of socialized medicine this causes. If there are only 2 or 3 providers of healthcare and they all have to follow the government's rules on Medicare and Medicaid, the government is effectively running our nation's healthcare system.

Competition is good and necessary for the healthcare (and every other) industry. The harm from bigger and fewer healthcare entities vastly outweighs the benefits.