Patients should be allowed admission to the center with the greatest expertise
After reading the article in Sunday’s paper about the insurance networks, it seems to me that there is an assumption on the part of everybody that one size fits all when it comes to hospital caregivers ["Policies’ limits shock shopper,” page one, Dec. 1].
This is simply not the case. During the 25 years I worked in one of the major Seattle hospitals, my area of expertise involved urology, nephrology, diabetes and organ transplantation. I had no experience in caring for burn patients, patients with severe trauma or patients undergoing chemotherapy.
Physicians depend on nurses to detect subtle changes in a patient’s condition and to report those changes back to the physician. Whether a patient lives or dies can depend on these observations. A nurse who has no experience with that patient’s particular problem is less likely to detect these changes.
If a patient comes in to an emergency room with trauma or burns that the insurance company deems minor enough that I can care for him or her, rather than allow admission to the center in which the greatest expertise exists, everybody loses. I lose, because I am expected to give superior care to a patient whose problem is one with which I am unfamiliar. The hospitalist physician loses for the same reason. The patient certainly loses, because he or she has sat in the emergency room in pain while the insurance company and the emergency-room doctors argue about whether to admit him or her to a hospital that really doesn’t deal extensively with the type of problem — or to admit him to one that is “out of network” that does.
— Clydia Pappenfus, Shoreline