AMA

Two weeks ago, I had an ER visit due to left arm numbness and heart palpitations. The visit was prompted by a phone call to our family doctor because these symptoms are not conclusive of a heart attack or heart issue. My doctor’s nurse that we spoke with said her computer spat out the answer: See doctor within four hours. The urgent care clinic closed in about fifty minutes and always has long lines, so that left the ER.

We would be in the ER for seven hours. Much of the experience was waiting around. The waiting makes sense in the context of having a test (blood work, cat scan, ct scan, and chest x-rays) and then waiting for the test to be processed and interpreted before the next test is given. Having a context makes the waiting tolerable, instead of annoying.

All the tests proved me normal.

But—you knew this “but” was coming—the doctor would not release me even though the heart palpitations had gone away and the numbness was reduced by half. She wanted to run more tests for which I would have to be admitted into the hospital for the night (it was 10:45pm by this time), because no one could run the tests until morning. The hitch was the hospital had no beds and I would have to go by ambulance twenty miles to a different hospital in a different town, but part of the same healthcare system.

I thought to myself this a bad plan. My belief was that I would not be checked into the far-away hospital until 1:00 a.m. with little likelihood of getting any sleep. Also, I thought it would be real expensive and, because it was an ER visit, there is no pre-approval by the insurance company that any of the ER visit is covered.

I asked the doctor to order the tests and I would come back in the morning after sleeping in my own bed for the remainder of the night. The doctor said no. That is not allowed. I do not understand this process. I assume this is a hospital legal department decision learned through the hard experience of lawsuits.

After a discussion about runaway medical costs and the travesty of modern American health insurance, the doctor explained to us our option of going home, instead of being admitted to the hospital. To go home would require us to sign AMA forms. AMA stands for Against Medical Advice. On the form the doctor spells out the worst case scenario and that they advised me to be admitted to the hospital for further observation and tests. In my circumstances her predicted worst case scenario was death from heart attack or disfigurement from stroke. The AMA is a good cover-your-ass form. I signed it, thus officially shifting legal responsibility of my health away from the doctor and hospital, to myself.

I find it sad that over the years I have had to learn to say NO to doctors, especially when costs are unknown and insurance payments are not guaranteed. I have had a number of unnecessary tests that, according to me, were cases of doctors covering their liability rather than reasonable medical decisions. Also, I do not understand why four tests that reported normal caused the ER doctor to want to order more tests, instead of considering other non-heart-attack or non-stroke factors. I assume my history of panic attacks (which if severe can cause numbness in my left side) and previous injuries were available to her via computer, but I do not know if she had the time to read my health record since an ER is busy and chaotic by nature.

Another thing I have concluded over the years is that doctors are very smart in the box of their knowledge, their specialty, but their box may be very small and they may have little faculty to think outside their box.

One specialist I saw many years ago ran five tests on me that proved me in the normal range and cost a lot. I asked why the doctor kept running tests and wanted to run more. He told me he believed that the referring doctor must be right about my problem, so the answer must be in his field. He never considered the referring doctor may have been wrong to send me to his specialty. Insurance covered the first two test, but not the last three claiming they were unnecessary—costly bummer for me.

A third thing is that the worry about cost and the worry about doctors ordering unnecessary tests just to cover their legal exposure, forces me, the least trained in health care, but the person who knows my body best, to make impactful decisions. I have grown accustom to this over the years, but it would be a blessing if I could count on the doctor during the high stress hours of an ER visit when my thinking is not always its most limber to make reasonable medical decisions.

My fear (annoyance) of unnecessary medical tests comes from a past experience of losing my health insurance coverage due to excessive testing, too large a medical history. Living without health insurance is doable, but it introduces a low level stress to daily life, knowing anything that goes wrong medically will hurt personal finances and may bankrupt a person.

The hospital did not do its customary phone call check the day after. I assume this is because I signed an AMA and left their care. The hospital did send a customer service survey for me to fill out—which I did fill out and return.

My answer to the health care issues of the U.S. are to have universal health care and reform doctor liability. I would also insist that a doctor who loses license to practice in in one state has lost it for all states.

I wish hospitals, especially the ER, had to post prices of procedures like McDonalds posts the prices of burgers and shakes. The idea that a hospital is part of the free market economy is stupid from every angle.

I am happy to report I have been doing well since the ER visit. The bill has not yet shown up in the mail, so that may elicit a howl audible across the continent, but we’ll see.

Love & Light

Kenneth

 

2 thoughts on “AMA

  1. In the week following the ER visit I had an appointment with my emotion therapist and a second appointment with my physical therapist. I told each the story of the ER visit. Both supported my decision to avoid the faraway hospital.

    My emotional therapist brought up the toxic environment of the current political administration (Mr. Trump) and how that type of environment jars traumas loose to affect the psyche and body. So a severe panic attack most likely hit me as I struggled with our government and the family separation policy at the border and how that brought up my own old stuff. In the past I have had panic attacks so severe as to leave me unconscious or numb on my entire left side. (I do not understand why it is only the left side, but that is how it affects me.)

    My physical therapist immediately examined my spine. My T5 vertebrae was rotated out of place. It turns out when the T5 is rotated it can cause heart palpitations. Since the therapist returned my T5 to is proper position I have had no heart palpitations.

    So, I am returned to regular meetings with my emotional therapist and my monthly meetings with my physical therapist.

    We will see how things go over the coming weeks, then months.

    Like

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