Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice.
A few days later, I get this e-mail: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking to a doctor for 5 minutes. No blood drawn, no stitches made, no X-rays, but I’m told the standard amount for the classification of my visit is $624. I called to complain and, of course, the person on the phone can’t do anything. Well, she could have sounded sympathetic. I didn’t even know that there’s a difference between an urgent care and an emergency room. Apparently, an urgent care would have been cheaper. Where is there an urgent care downtown?”
Urgent care is just 2 blocks from the ER. But why didn’t Rob just call me? He wasn’t sure. Why do so many patients like Rob end up in the emergency room with non-emergent conditions? Let’s think this through.
An emergency is a serious, unexpected, and often dangerous medical condition requiring immediate action such as a heart attack or gunshot wound. An urgent medical condition is a very important, but non-life-threatening situation that needs immediate attention such as a dislocated shoulder or kidney infection. A routine medical condition is neither urgent nor emergent such as high cholesterol or hemorrhoids.
Let’s say I’m your family doctor. It’s Saturday morning and your kitty bites you. Your hand is suddenly red, hot, and swollen.
Should you go to our 60-room, 44-bed, 30,000-square-foot emergency department and trauma center that includes a waiting area with a fireplace and a children’s playroom? Do you really need 2 psychiatric holding rooms, 2 trauma suites, and a decontamination room with a dedicated entrance for patients exposed to hazardous material? Upon arrival you may be treated by up to 4 doctors and 17 nurses, all emergency-trained and you’ll have 24-hour access to anesthesiologists, neurosurgeons, and all manner of specialists. In case you need to arrive by helicopter from the 8-county service area, expect to enter an extra wide mega-elevator that will enable your continuous care during transport from the hospital’s rooftop helipad. By the way, if you need this level of care, please call 911.
Or should you go to our 6-room, 3,000-square-foot urgent care that staffs one family doctor, a nurse, and a medical assistant? They do X-rays and labs and they’re open from 9:00 am until 9:00 pm every day with six locations in town.
Or should you call me? I work in a cozy 280-square-foot clinic. I have no staff. I handle urgent and routine conditions and perform minor surgeries. Once, I even removed metastatic lung cancer from a guy in my office. I work most afternoons, but I’m available 24/7 for urgent needs. Best part: my low overhead allows me to pass savings on to you. How can I do this? Watch my TEDx Talk.
Today Rob sends another e-mail: “In addition to my initial fee of $624 associated with my cat bite, I got a second bill for $194.70. It’s totally different looking and is from the Emergency Physicians. The bill references a nurse practitioner. I suppose I never actually saw a physician.”
The truth is: you could get treatment anywhere for your cat bite. The real question is: how much do you want to pay for it?
Emergency room: $818.70.
Urgent care: $99.
My office: $50.
Pamela Wible, M.D., is a family doc in Eugene, Oregon. She is author of Pet Goats & Pap Smears. Photo by Geve.
This sounds great and I wish you were my doctor! I hope you know that I respect and love you colleague to colleague BUT………you do not have young children and a spouse who also works round the clock and takes call etc. It sounds wonderful to patients to have a doctor be available to them all the time but I learned (the hard way) long ago that I cannot be everything to everyone, all the time. I do not appreciate anyone furthering the myth that doctors should be available to their patients 24/7. I love my patients and I love medicine but I need time off in order to renew myself and to be able to continue that focus on excellent medical care and patient relationships.
What I would love to see you write is an article on how patients can empower themselves and have even better health by utilizing their medical resources (including doctors) wisely. I bet they could even save some $$$$!!
Great points Dannielle and you will be glad to know that I work part time so that I have lots of time off to rejuvenate and relax. In fact, my massage therapist is coming to my house in about 30 minutes for my weekly massage! Yay! I do ask my patients to be responsible and to call me only when they truly need me after hours. I have received very few calls in the 9 years that I have been solo-solo-24-7. Life is good! 🙂
Great post and information. I’m sure there are many like Rob who do not know the difference between the ER and Urgent Care.
I’m afraid there are too many.
While I am not defending the bills this patient had, I would not recommend urgent care for a cat bite. According to a recent study, roughly one third of all patients presenting to an ED with a cat bite require admission, with 2/3 of those going to the OR for a washout. The spirit of what you present is correct, but the problem with urgent care centers is that you have to know, ahead of time, that you have little chance of having a real injury or illness. The reason EDs are so expensive is that we are focused on ruling out significant injury / illness (as opposed to directly ruling in a specific diagnosis).
Thanks Howard ~ Yes, if admission is likely than ED may be better choice. I’ve seen many cat bites in 20 years and none needed admission to the hospital. Early outpatient treatment is always best. We need to educate patients on proper use of facilities and when to seek care. Waiting till cat bites get worse can be catastrophic.
Unfortunately, the difference between an Emergency Department and an Urgent Care is that the Urgent Care forces payment. With that, plenty of patients that present to the ED for non-emergent conditions do so to pass the $818 cat bite bill onto others and avoid any responsibility for contribution to the healthcare system. Perhaps if that sort of abuse was addressed that those saving could be passed onto others presenting to the ED as well. Just last week I saw a patient who I see almost biweekly in the emergency department. We recently started publishing our ED wait times on the internet and due to her sore throat, logged on to the website and saw our two hour wait. Mind you, she logged onto the website on her iPhone but doesn’t carry health insurance. After observing the two hour wait, she called 911 stating her “throat was closing” and she thought she was having an allergic reaction. She immediately bypassed the 2 hour wait, received treatment for her viral pharyngitis and passed the buck onto everyone else.
In a world where it is unlawful not to carry car insurance, which I’ve been paying into for 40 years and haven’t used once, but health insurance is optional when I use the system multiple time annually is beyond me.
Obviously disrespectful behavior on the part of the patient. Our sick medical system will never be healed if patients do not start taking an active role in creating a more ideal model. Our behavior and attitude count. There is a ripple effect to all of our decisions. Her more critical medical condition was manipulation, not pharyngitis.
This was helpful to me – I had no clue.
Thanks for the heads up.
Ironically enough, i too went to the e.r. once for a severe cat bite, I could barely crawl out of the house, and left my car out front with the lights on. I didn’t need antibiotics, but I did need 3 rounds of nebulizer and a couple inhaled meds. And I didn’t pay the bill, my state apparently thinks only people with kids need medicaid. Have you seen the multimillion dollar insurance administration office parks? Car insurance for my old truck is about $400 a year, and that is more than the health care I consume on average, so why should we pay hundreds a month? What we want is medicare for all for catstrophic coverage and prevention, and we’ll pay out of pocket to the provider of choice for routine visits. Working to reduce expense is needed, but we need some straight talk about why we’re the only country that expects those seeking care to enrich shareholders. Paramedics can come to the house, put on a 12 lead, give o2 and nitro, and never send a bill if you don’t go to the hospital, because they can’t make people regret calling for help. Some physician comments about the uninsured make me hesitate to ask them for help though.
Oh, also to other commenters… professionals complaining about frequent flyers and labelling patients as e.r. malingerers means you’ve already lost the battle. Every patient you come into contact with is a privilege, that you should want to earn every day, that’s just the way it has to be.
I had to go to urgent care two days in a row for an infected cat bite after a cat drove its tooth sideways under the skin of my thumb and I couldn’t get the bacteria flushed out even with a thorough hand washing. It happened late in the afternoon and within a few hours my hand was like a hot red balloon and the red was traveling rapidly up my arm. One of the techs at the local vet hospital told me that when she got bitten and the vet sent her to the same urgent care, the PA refused to provide treatment with antibiotics for a cat bite, so the tech had the veterinarian call the urgent care clinic to explain to the PA that within a couple of hours that bite would develop into a serious infection. Fortunately, the PA I saw knew about Pastuerella and warned me I could lose my hand if the infection wasn’t brought under control quickly. I got an injection plus oral antibiotics and was told to return the next day for a second injection. I had no insurance (couldn’t get insurance then, due to multiple pre-existing conditions) so I paid $300 for the two visits (after a 15% cash discount).
According to the Mayo Clinic, cat bites can be serious injuries. A new study by researchers at the Mayo Clinic has found that of 193 patients who came in for cat bites on their hands over a three-year period, 30% had to be hospitalized for an average stay of 3.2 days. Most of those admitted, like Ms. Briske, needed their wounds surgically cleaned to eliminate infections, according to the study, published this month in the Journal of Hand Surgery.
“Cat bites can be very serious, and when you do get an infection, it can be very difficult to treat,” said Brian T. Carlsen, a Mayo surgeon who was an author of the study. That’s particularly true with a hand injury because of the structure of the tendons and joints, he said.
Absolutely correct, Corey. If you wait too long, you may need to be hospitalized for a cat bite. Moral of the story: Call your family doc or be seen at urgent care to prevent needing the ER or worse.
Hi Pamela, it is always a pleasure to hear you weigh in on questions with practical, no-nonsense non-ideological and non-hysterical answers. A couple weeks ago I went to see a dermatologist for a wart removal from the tip of my index finger. I had been treating it with a $2.00 bottle of OTC Cornex corn remover and it was more than half gone, but my wife thought maybe I should have a doctor look at it. I was in the doctor’s office 18 minutes. For the first 8 minutes he sat at his desk, staring at his screen and typing my answers to his questions furiously, checking off the usual “denials”: Patient denies smoking, drinking, contemplating suicide, depression, etc. He never looked at me once during this time. Then he got up, checked my torso for suspicious signs of cancerous growths, I presume, and then he shot a short burst of liquid nitrogen on my wart, and told me to go home and continue putting my Cornex on it for another month. So far, so good. The bill was just under $600. Because I have a high insurance deductible, my share will be about $200. It was all very efficient and businesslike. Just before I left he shook my hand and said, you’re my neighbor, aren’t you? I smiled and said, yes, you live two doors down the hall on my floor. He said, well you don’t have to call me Dr. Just use my first name. Perhaps he added to my patient notes “Patient denies being my neighbor.” 🙂 We are all so anesthetized by our ridiculous system that we resign ourselves to this kind of thing as our new normal. We eat industrial food, and we all submit to industrialized, and dehumanizing health care, with outrage by some, and resignation by most.
Duct tape also works for warts. Cheap. Painless.