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Vague medical AskMe questions
January 23, 2011 12:13 PM   Subscribe

This question seems like a really bad idea, heading into territory where AskMe advice may be worse than no advice at all.

I am really sorry the OP's financial situation is restricting access to medical professionals and I hope she's ok, but a substantial number of the responses take the line of "this is what happened to me, there's nothing to worrry about if it's the same thing". This may be true but strikes me as (a) the only bit of the advice someone will hear when they're in dire financial straits, (b) wildly irresponsible when there is so little information presented that it would be impossible for a doctor, let alone a random mefite, to make an assessment without investigating further.

I realise there have been previous MeTa threads on medical questions where mods have described a decision of advice here being better than no advice at all. Medical wild guess questions worry me in general, but the vagueness of this one makes it particularly egregious.

Is there a line, and if so, how is this post on the right side of it?
posted by carbide to Etiquette/Policy at 12:13 PM (152 comments total) 7 users marked this as a favorite

The bad advice is being offset by those who disagree and are encouraging her to get into the doctor. As we've discussed before, I don't think we can police people's level of expertise to speak to a matter.
posted by SpacemanStix at 12:19 PM on January 23, 2011


It's not supposed to be a poll.
posted by fixedgear at 12:21 PM on January 23, 2011 [3 favorites]


Unplanned medical expenses are one of the fastest ways people in the US can be shoved into crushing poverty and/or bankruptcy. If I ever have a medical issue and no insurance, the absolutely last thing I will do will be to run to a medical provider that isn't explicitly free. Instead, I'll probably do what the poster did and turn to a community I trust for advice and perspective so I can balance the known, incredibly high risks of going to a medical provider with the unknown risk of delaying care.

Shooting down questions like this only makes sense in order to reduce MeFi's liability, or if the poster is in some way mentally deficient. I hope AskMe is still around if I'm ever in a similar situation.
posted by jsturgill at 12:22 PM on January 23, 2011 [53 favorites]


shhh, stop being spatial, and let people do there thing... Here, read a magazine,
posted by clavdivs at 12:23 PM on January 23, 2011 [1 favorite]


Touch this [*] for instant healing over IP.
posted by Burhanistan at 12:25 PM on January 23, 2011 [9 favorites]


Almost all of the answers I can see are emphatically stating that the poster needs to get to a proper medical facility, and many are suggesting the most cost-effective way to do so. I really don't see how this could be worse than no advice at all.
It's hard to understand what kind of "line" you are asking about. Are you suggesting that the admins should apply their medical expertise to deciding which medical questions will get helpful answers and which will not?
posted by nowonmai at 12:30 PM on January 23, 2011 [1 favorite]


sometimes it is about the journey to the desired positive end result.
posted by clavdivs at 12:34 PM on January 23, 2011


People know what they are getting when they do an askme. Shit, some ADULT just passed out, and rather than going to get medical attention, they are asking random internetters.

What kind of response do you think the OP (and others who ask stuff like this) do you think they are expecting?

I think they are getting exactly what they asked for.

I agree that the info sucks, but they are getting what they asked for.
posted by hal_c_on at 12:37 PM on January 23, 2011 [2 favorites]


nowonmai: Are you suggesting that the admins should apply their medical expertise to deciding which medical questions will get helpful answers and which will not?

I'm guessing you're asking facetiously, but yeah, minus 'expertise' - I am wondering how a question in which the poster approximates the time unconscious, makes an error in their own medical history (blood pressure), and provides a very limited amount of information can in any way be considered as one that might be answered helpfully.

I acknowledge the many good responses about affordable medical options, and I hope one of them works out for her - the bit I object to is the danger of people pulling an anecdote out of their ass based on medical history that differs in ways totally unknown, and the poster, worried and with limited options, assuming this applies to her situation.
posted by carbide at 12:42 PM on January 23, 2011 [1 favorite]


I know the majority of users here are from the U.S., but using the infodump, is there a way to figure out how many medical advice questions originate in countries without socialized medicine? Sadly, I'll bet it's completely disproportionate. Hell, here in Toronto, my neurotic ass ends up at the doctor if my balls get itchy.
posted by gman at 12:56 PM on January 23, 2011 [7 favorites]


Really surprised the first answer, hworth's answer that encourages the receipt of medical services by fraud, has not been deleted and has been favorited.
posted by Frank Grimes at 12:56 PM on January 23, 2011 [4 favorites]


I can't see that line you're asking about.

Answers like "go ahead driving that old Pontiac with the mystery squeak" or "eat that chicken breast on the counter, I do it all the time", even instructions to make better espresso (boom), or "you'll be fine" in the recent discussion about leaving candles and goofy cats alone in the bathroom are potential death-traps. On a platform like this one, such an effect is absolutely unavoidable.

The problem here is not that the question heads towards principally new territory, but that it makes everyone squirm a little extra. On the one hand, fainting can mean anything from a momentary bad circulation and/or low sugar levels à propos nothing to imminent final disaster, and on the other hand, the question has the sickly sweet and enticing aroma of an unavoidable derail into American healthcare discussions that makes everyone secretly shiver in anticipation (like that old joke about the Viola solo "you know it's coming and you can't do anything to stop it"). Obviously, it is a rare person here who can answer that question without doing something wrong (Ideally, it ought to be the guy next door to the OP who says, hey there, I pay for the emergency room, let's just go).

Bottom line: don't flag but move on, if you aren't that guy.
posted by Namlit at 1:00 PM on January 23, 2011 [1 favorite]


The spirit of her question seems to be "Is a random black-out something that might be a symptom of a condition that will kill me if I don't rush to the hospital RIGHT NOW"? Anecdotes don't really answer the question, but neither do people being all "Go to the hospital immediately, because maybe".
posted by 23skidoo at 1:03 PM on January 23, 2011 [3 favorites]


I didn't intend to be facetious; sorry if I came across as overly snarky. I think that in this case, the preponderance of good advice the asker is getting is far better than a deletion and no advice at all, so I disagree with you there. But as a general case I think it's unrealistic to expect the admins to be able to make the kind of judgements you are asking for.
posted by nowonmai at 1:05 PM on January 23, 2011


Oh hey, I have vasovagal syncope. Maybe that's why when she described her question, I was pretty calm about the whole thing and just astounded at the number of people who were all 'ER now!' She is young, female, and has fainted in the shower before, plus she didn't eat for 10 hours and was severely dehydrated by drinking. From my perspective all of those sounds like things which trigger me to faint and my vasovagal syncope was diagnosed in the ER (which was incredibly expensive, jesus). I realize that my perspective could be totally wrong, so that's why I appreciate that she asked the question in AskMe because a lot of people did recommend going to the doctor.

She absolutely 100% no question needs to follow up with a doctor (especially because she might not have vasovagal syncope) but if her symptoms do not worsen, she doesn't faint again, and she can get someone to stay with her on Monday, she has every right to decide whether or not to go to the ER. The suggestions about how to go to the ER and avoid debt are even better, in case she does have a condition that should be checked out immediately.

So, AskMe is providing her with information from a variety of directions and she will make the best decision for her, which ideally will involve a doctor in the very near future. You can't force a person to go to the doctor, but maybe asking this question will help her gather the information she needs about how best she will be able to go to the doctor, safeguard her health, and avoid debt.
posted by librarylis at 1:06 PM on January 23, 2011 [13 favorites]


my neurotic ass ends up at the doctor if my balls get itchy.

This sounds like a perenium problem that would taint the answers of the post in question.
posted by Burhanistan at 1:10 PM on January 23, 2011 [7 favorites]


It would also be a perineum problem if I knew how to spell it.
posted by Burhanistan at 1:13 PM on January 23, 2011 [1 favorite]


spelling is a perennial problem
posted by Namlit at 1:16 PM on January 23, 2011 [3 favorites]


I appreciate the advice given in the thread. In all honesty, I am now taking my incident much more seriously than I would have. I have told people in real life about it. I have made plans to go to the clinic. If I hadn't posted the AskMe, I would have just eaten a hamburger and tried to forget about it. So the information is helpful. And I think AskMe should be a safe haven for me to ask these kinds of questions without being judged. Is that so wrong?
posted by Night_owl at 1:18 PM on January 23, 2011 [19 favorites]


Touch this [*] for instant healing over IP.

Kancho!
posted by loquacious at 1:20 PM on January 23, 2011 [7 favorites]


And I think AskMe should be a safe haven for me to ask these kinds of questions without being judged. Is that so wrong?

Potentially, yes. What if someone had a minor stroke but seemed to be feeling nominally better after and posted a similar AskMe? Advice to stay home or delay treatment while you figure out how to game the system could be fatal.
posted by Burhanistan at 1:24 PM on January 23, 2011 [3 favorites]

while you figure out how to game the system
WTF? In what way exactly do you think the OP is trying to game the system?
posted by craichead at 1:29 PM on January 23, 2011 [1 favorite]


WTF? In what way exactly do you think the OP is trying to game the system?

Calm down. It was a hypothetical supposition.
posted by Burhanistan at 1:30 PM on January 23, 2011


And you know, the system is fucked up beyond belief. The system is the reason that she's dealing with this shitty dilemma in the first place. As far as I'm concerned, she would be completely justified in trying to game the system, but she's not trying to do that. She's trying to weigh the small chance that this is something urgently life-threatening against the much larger chance that going to the emergency room would put her in an economic hole that will be hard to climb out of.
posted by craichead at 1:31 PM on January 23, 2011 [10 favorites]


Glad to hear it, Night_owl. My intention wasn't to judge you, but to raise a wider policy question - I don't think AskMe should be a safe haven for anyone to ask these kinds of questions.
posted by carbide at 1:32 PM on January 23, 2011


And I was using "you" in the generic sense and not implying anything nefarious by gaming the system.
posted by Burhanistan at 1:33 PM on January 23, 2011


Fair enough, Burhanistan.

Still, what are the chances that this other borderline (to herself) patient would get an overwhelming amount of bad advice, given that historically AskMe has been a "Doctor. Now." place?

And I'm grateful to have the community around me at this time. I've already gotten personal messages offering someone to take me to the ER, etc. If I hadn't had this... I really don't know. I think sometimes people for whom this is just a place to hang out and make snarky comments once in awhile (not an accusation of anyone) kind of don't realize that for others of us, Metafilter allows us to hold on to a sometimes tenuous grip on happiness, self-direction, and yes, health. For so much, I'm glad to be here.
posted by Night_owl at 1:33 PM on January 23, 2011 [7 favorites]


Hell, here in Toronto, my neurotic ass ends up at the doctor if my balls get itchy.

WTF, how many instructional videos do I have to send you?! Don't use %$%# crunchy peanut butter, the ingredients clearly say smooth!
posted by Brandon Blatcher at 1:36 PM on January 23, 2011 [1 favorite]


Night_owl, FWIW, I certainly wasn't judging you AT ALL, and I didn't get the sense that others were, either (but of course i only speak for myself).
posted by tristeza at 1:37 PM on January 23, 2011


Brandon Blatcher: "WTF, how many instructional videos do I have to send you?! Don't use %$%# crunchy peanut butter, the ingredients clearly say smooth!"

Yeah, thanks, but I don't appreciate those bestiality videos, dude.
posted by gman at 1:40 PM on January 23, 2011


More than spelling, I'd say my perennial problem is impatiens.
posted by pajamazon at 1:48 PM on January 23, 2011 [7 favorites]


spelling is a perennial problem

No it taint.

Those kinds of questions make me squirm, but I think they tend to work out alright, at least for medical issues. I mostly avoid the mental health ones because some of the things I see people write bothers me too much, and there's enough botheration in my life without seeking out more on the internet.
posted by Forktine at 1:48 PM on January 23, 2011 [1 favorite]


When I see this type of question, with the kinds of answers it provokes, I always think the poster actually knows the answer but is getting reassurance that they are correct. So in this case, the poster actually knows they need to see a doctor, but hates the idea, so they go to AskMe where they are told by 95% of the answerers that yes, in fact, it is very important that they get to a doctor. So I like the idea that this type of question is allowed.
posted by ThatCanadianGirl at 2:09 PM on January 23, 2011 [2 favorites]


Yeah, thanks, but I don't appreciate those bestiality videos, dude.

You said you wanted a lustrous coat!

As the this call out and these sort of AskMe questions. Most people asking them realize it's a hit and miss and that they're stabbing around in the dark. Plenty of answerers note that medical advice is the best option, despite the cost. The system works, despite a bit of sand in the gears at times.
posted by Brandon Blatcher at 2:10 PM on January 23, 2011


And Night_owl, I'm glad you're acting on all the advice. I hope everything works out okay.
posted by ThatCanadianGirl at 2:12 PM on January 23, 2011


it's a hit and miss and that they're stabbing around in the dark. [. . .] The system works, despite a bit of sand in the gears at times.

Block that metaphor!

But I agree with everything you said ;-)
posted by toodleydoodley at 2:16 PM on January 23, 2011


Block that metaphor!

What, why?
posted by Brandon Blatcher at 2:20 PM on January 23, 2011


I am now taking my incident much more seriously than I would have.

And yet you are still not at the doctor because you're being given terrible advice from people who have no idea what they're talking about. Did you even ring the hospital and ask them what they think? Getting real medical advice, not stupid internet advice, is the absolute least amount of taking this seriously you should do given that there is a non-zero chance that this could kill you.

"Go to the hospital immediately, because maybe".

Um, what else exactly where you expecting? Because that actually is the answer. None of us can say for sure if it will kill them or not but, in this case, there is a possibility. We can't even say what kind of possibility (beyond 'significant enough that you need this checked out today') because we're not a medical doctor examining this patient in person, and anyone who expects otherwise needs to readjust their ideas of how magical the internet is.

People talk about a trusted community or whatever like ask.me is full of the smartest, bestest, most mindreading-est diagnosing people ever. It's not. It's just a bunch of random idiots like you find anywhere (myself included). I think that the level of trust people have needs to be dialled down, particularly after seeing some of the really irresponsible advice given in threads like that one.
posted by shelleycat at 2:24 PM on January 23, 2011 [5 favorites]


So in this case, the poster actually knows they need to see a doctor, but hates the idea, so they go to AskMe where they are told by 95% of the answerers that yes, in fact, it is very important that they get to a doctor.

And then the asker decides not to go to the doctor for several days. This is not actually a good outcome.
posted by shelleycat at 2:27 PM on January 23, 2011 [1 favorite]


so they go to AskMe where they are told by 95% of the answerers that yes, in fact, it is very important that they get to a doctor. So I like the idea that this type of question is allowed.

That's what I meant when I said unthread that it's not a poll. So 51% gets you the ER? I get the sense that people post questions of this type hoping to hear "Lupus? Getouttahere."
posted by fixedgear at 2:27 PM on January 23, 2011 [1 favorite]


None of us can say for sure if it will kill them or not but, in this case, there is a possibility.

There's a possibility you'll slip and die in the shower tomorrow. There's a possibility you'll get hit by a truck crossing the street.

People who have insurance or public healthcare and feel entitled to berate people who don't for trying to avoid instant lifelong, unpayable, non-dischargeable debt and the unemployability and homelessness that accompany it in a society where a credit check is a routine part of employment and rental screening, do you also go around telling starving people to eat cake? What the fuck is the matter with you?
posted by enn at 2:34 PM on January 23, 2011 [71 favorites]


I'm doing what I can with what I have. I'm sorry I can't put myself into more debt. I'm sorry to have caused such a stir.

Shelleycat, it seems you think I'm an idiot. I'm sorry about that. I'm sorry that this situation so upsets you. I'm sorry I can't make the decision you think I should make. But isn't it better that I get some medical help rather than none? Maybe you think it's too little too late. I don't know.
posted by Night_owl at 2:41 PM on January 23, 2011 [11 favorites]


Plenty of answerers note that medical advice is the best option, despite the cost. The system works, despite a bit of sand in the gears at times.

No, it doesn't it really doesn't (in the US) and eventually it will get fucked up enough for you to experience it first hand.

And yet you are , still not at the doctor because you're being given terrible advice from people who have no idea what they're talking about.

No, she's not at the doctor because it could cost anywhere from $100 to thousands of dollars to see one. Have you ever been to a doctor? Here's what they do if you have some problem they can't visually identify: they order tests. Does the doctor know how much the test is going to cost? NO! Does the doctor know how much just talking to them is going to cost? If it's at an institution probably not. So, now you are talking to the doctor and you don't know how much this conversation is going to cost and the doctor wants to perform a test and neither the doctor nor you know how much it is going to cost. So, now you are talking to the doctor about just how necessary this test is. Except that you are not a doctor and you don't really know, and doctors aren't trained to weigh being a debt to whether a given test is necessary or not.
posted by ennui.bz at 2:43 PM on January 23, 2011 [15 favorites]


Hell, here in Toronto, my neurotic ass ends up at the doctor if my balls get itchy.

Hmm...you should see a psychiatrist about that.
posted by hal_c_on at 2:44 PM on January 23, 2011 [1 favorite]


And then the asker decides not to go to the doctor for several days. This is not actually a good outcome.

The OP knows a doctor is her best bet at finding out what happened, and preventing it from happening again. Saying "go see a doctor! i told you go see a doctor! for the fifth time go see a doctor!" doesn't do any good. In fact I go so far as to call it condescending. People have shared their thoughts, and it's up to her to decide what to do with it. Really - I'm sure it's registered for Night_Owl that this what happened to her could potentially be serious. No need to make her feel awful or stupid about waiting a few days, based on her own analysis of her circumstance. You have no idea what her outcome may be - no more than those suggesting it might be dehydration. Let her take it from there.

FWIW I posted this anon YANMD uninsured question a couple of months ago about mild-ish chest pains. And while I appreciate the few calls to go to the doc/ER, it turns out that for 3 days (one day after asking the question, two days it took for the anonymous question to go through the queue) I had a bit of trapped air. Gallons of peppermint tea, a few antacids, lots of forcing myself to burp, and the air eventually cleared out. I'm personally very glad that this community exists, and thankful for the anecdotal experiences from "a bunch of random idiots" that saved me shitload of money by not going to the ER.

Obviously people mean well when they say "omfg go to the doctor!!!!!11" and that advice should not be glossed over. Sometimes things are serious. Sometimes they can wait a little bit. Responding with major concern is to be expected, but let's not chastise people for dealing or "justifying" their situations in ways that they see fit, after you've already shared your thoughts.
posted by raztaj at 2:48 PM on January 23, 2011 [5 favorites]


but let's not chastise people for dealing or "justifying" their situations in ways that they see fit, after you've already shared your thoughts.

people not in the US have trouble understanding just how expensive a visit to the ER/urgent care/etc can be in the US.
posted by ennui.bz at 2:51 PM on January 23, 2011 [3 favorites]


I've been in this type of situation more times than I care to think about. And by "this type of situation," I mean I have some sort of issue or episode like getting dizzy for no apparent reason or coughing nonstop for more than a few days or these excruciating headaches I get in my right eye every once in a while or what have you, nothing obviously and immediately life-threatening like a broken bone or gaping wound, and people around me are like, "You really need to see a doctor about this! It could be serious! Just go!" Lately I've taken to responding to these people by asking if they're offering to pay my doctor bill for me, since I'm uninsured and can't afford it myself, at which point they always clam up with surprising abruptness.

It's a very real concern. When you have to choose between paying a doctor (for what might turn out to be nothing) or paying your utilities or your rent (about which there's no doubt), a lot of times the choice is to pay the bill you KNOW you have to pay.
posted by Gator at 2:55 PM on January 23, 2011 [3 favorites]


people not in the US have trouble understanding just how expensive a visit to the ER/urgent care/etc can be in the US

Do they now.
posted by Namlit at 2:58 PM on January 23, 2011


Night_owl, I'm not angry and don't think you're an idiot. I think you're in a bad situation which really suck, and it's one that is sadly very common. You're still doing the wrong thing (even ringing the hospital to ask their advice is going to put you in debt?), but nothing like as wrong as the people giving you medical advice and diagnoses without even meeting you in person.

Also just to be clear also: falling unconscious is not in the league of having a headache or weird pains or feeling dizzy. It's a clear medical emergency.
posted by shelleycat at 3:01 PM on January 23, 2011


hal_c_on: "Hmm...you should see a psychiatrist about that."

Yeah, sorry, my hyperbole-to-get-a-point-acrossitis isn't covered here in Canada.
posted by gman at 3:01 PM on January 23, 2011 [1 favorite]


shelleycat, what is the hospital going to say over the phone except, "Come on in and let the doctor examine you." $$$$$
posted by ThatCanadianGirl at 3:07 PM on January 23, 2011 [4 favorites]


"Go to the hospital immediately, because maybe".

Um, what else exactly where you expecting? Because that actually is the answer. None of us can say for sure if it will kill them or not but, in this case, there is a possibility.

I didn't say it was unexpected, I said it was a crap answer. If one is going to be all "Go to the ER immediately" at least provide some IANAD guess as to the fatal condition that it might be, otherwise there's absolutely no reason for someone to believe that one blackout could be a symptom of something that could kill you tonight.
posted by 23skidoo at 3:07 PM on January 23, 2011 [1 favorite]


Seriously shellycat, if you think an ER visit will only cost $100 or that the OP can just ring up the hospital for some advice, maybe you're just not familiar enough with the health care situation in the US to be berating poor Night_Owl for doing the wrong thing.
posted by Mavri at 3:14 PM on January 23, 2011 [25 favorites]


Hell, here in Toronto, my neurotic ass ends up at the doctor if my balls get itchy.

Hmm...you should see a psychiatrist about that.


Or a proctologist.
posted by ellenaim at 3:16 PM on January 23, 2011


I had a very similar thing happen to me in California about three years ago, Night_owl, and I did go to the ER almost immediately. After the 5 hour wait in which my dizziness and muscle weakness mostly improved, I was seen.
You know what I got? A pregnancy test that cost me $50 even though I had not had sex in months and months and had regular periods and swore that to the nurse. A battery of drug tests totaling over $100 even though I told them I was not on drugs of any kind. A CT scan that I was in fact happy to have, but it showed nothing. EKG, blood, etc. They were ready to spinal tap me to start looking for an infection or something, and that was the point where I said hell no. I walked out without a diagnosis and with a bill over $3000, and to this day I don't know what happened but I've been pretty much fine since. I followed up with a few regular physician appointments once I had insurance again, and still nothing.

I am NOT trying to dissuade you from seeing a doctor, but rather to point out that even if you went in immediately like all these people are telling you to do, you would still be unlikely to be seen immediately and even less likely to get good care leading to a firm diagnosis, because that's what happens when you don't have a regular physician and you land in the ER with a nebulous symptom set. When you do go in, give extensive details to your providers, and ask them to clear EVERY test with you. They might give you push back, but don't bear the burden of being unnecessarily tested for meth just because you're low income like I did.
posted by slow graffiti at 3:18 PM on January 23, 2011 [24 favorites]


Personally I think people here are way overreacting with the "get to the ER stat" advice. People faint some times. Night owl mentioned she was hungover, probably dehydrated, had had very little to eat and felt nauseous. She didn't injure herself in the fall. It was a singular event and my advice would be for her to have a nutritious meal, get plenty of liquids, and to see how she feels as the night progresses. If her symptoms worsen, or if she has another episode, then it would be time to bite the bullet and see a doctor.

There is also a nasty stomach flu going around where I live, so the nausea and shivering comments make me wonder if she is possibly feeling early symptoms from that.
posted by puny human at 3:36 PM on January 23, 2011 [1 favorite]


I'm betting postural hypotension,anemia or pregnancy. Anyone want to take my action?

If I was the op I would wait till the second or third time I passed out, as long as I didn't injure myself hitting the floor.
posted by Ad hominem at 3:40 PM on January 23, 2011


Just for information - Something that Canada (and UK?) has, which in my experience the US does not have, is a reasonable phone nurse line. In Ontario, you can call up for free and a nurse will answer and give you real advice about how serious your issue is, and whether you should come to the hospital. In the US you can't do this (again in my experience) in most cases. Some insurers offer a help line like this, I think. But there's no free easy way to get authoritative medical advice by phone - they will really just tell everyone "you should probably come in".
posted by LobsterMitten at 3:42 PM on January 23, 2011


I'd say my perennial problem is impatiens.

That's because they're annuals!

And, Night_owl, I hope you're ok, and don't think you deserve to be critiqued like this for trying to make the best of a bad situation.

I think that though there is a point to discuss regarding giving medical advice on askme, people using your personal, particular life situation as a battlegound for this is so not cool.
posted by 5_13_23_42_69_666 at 3:51 PM on January 23, 2011 [5 favorites]


This is one of those situations where site policy should be discussed independently of a question.

At what point is asking medical advice from strangers on the internet unacceptable?

That question is a lot more apt to produce acceptable discussion than, "Should this poster be allowed to ask this question instead of going to the ER?"

It's just like the time when I was trying to make the case for metafileter not being the best case for medical fundraising. And people were all, "But this person needs it!"

If you have the discussion in the abstract people are going to be much more willing to be unemotional and logical about it, but as soon as you bring in actual cases it, "Why are you calling her an idiot and what happened to you to make you feel that giving is a bad ideas?"

In the case of medical questions I think you have to ask, what will the person do in the absence of the ability to ask the question? I doubt if the outcome of this particular example will be different.

Also, it may have some bearing to discuss US healthcare as it stands, but I don't see how that has a bearing on the site policies. The discussion of whether or not this type of question should stand should be the same even if medical attention were free. Is this the type of thing someone needs to see a doctor for? The answer is the same whether or not the price is. the price might change whether or not you do it, but the need remains the same.
posted by cjorgensen at 4:17 PM on January 23, 2011 [2 favorites]


(even ringing the hospital to ask their advice is going to put you in debt?)

Given the OP's symptoms, and given the liability borne by medical professionals, it's pretty likely that someone on a nurse advice line is not going to diagnose her over the phone as being dehydrated and having low blood sugar, and that she should drink plenty of fluids, eat regularly, and get some rest. The nurse advice line person is going to tell the OP to get a medical evaluation sooner rather than later. And that will cost money.

Also, I can't find out if the general hospital half a block from my house even has an advice line. The Kaiser Permanente facility does, but you have to have their insurance to use it. The website for St. Mary's Hospital has a list of symptoms for which you should come into the ER if you can't reach your doctor, and a list of symptoms for which you should go to the ER ASAP. As far as I can tell, there is no advice line listed. They probably have one, but the number is likely only available to people who have insurance that St. Mary's accepts.

I see from your profile that you're in NZ. Things don't work the same way in the U.S. At all. Random people cannot just "ring the hospital" to ask for advice.
posted by rtha at 4:25 PM on January 23, 2011 [5 favorites]


it's a hit and miss and that they're stabbing around in the dark. [. . .] The system works, despite a bit of sand in the gears at times.

Block that metaphor!

What, why?


It's a common witticism in response to too many mixed metaphors (hit and miss, stabbing in the dark, sand in the gears).
posted by John Cohen at 4:29 PM on January 23, 2011 [1 favorite]


I didn't read the thread because the spread of answers, the handwringing and this Meta are so predictable. This is a rerun of a rerun of a dilemma; which shouldn't be taken for my dismissal of the potential seriousness of the situation.

Maybe questions that come under the medical category should have a short statement advising that there may be risk in following strangers' advice and that nothing can replace a consultation with a medical provider - and have that appear in bold below each question. I'm not sure if that affects any liability potentially faced by the site (big if as to whether there is or could be any) but it might be the smart PR thing to do, particularly in relation to closed Askme questions in the archives.
Just a thought (which has undoubtedly been expressed before).
posted by peacay at 4:32 PM on January 23, 2011 [1 favorite]


This kind of thing makes me so angry I could scream. Obviously people wouldn't feel the need to go online and ask strangers for medical advice if there was even a modicum of professional diagnosis available to them. The poster is reluctant to risk financial catastrophe for what might be (and probably is) a minor problem, and the conservative observers recommending an abundance of caution are appalled that the asker would take the slimmest of chances that the situation isn't treated as a code blue event by default. In between these parameters is where the rest of the modern world has settled, precisely because this is what makes the most sense. Demonstrably, there is no way of resolving this issue reasonably, as the American health-provision system is so badly broken. This irreconcilable disparity simply will not change until Americans get their health act together, and all the gnashing of teeth here about how to remotely treat possible illnesses online can never find a reasonable solution, given such a completely unreasonable situation. Sadly, access to health care without the fear that it will bankrupt you works almost everywhere else in the developed world, but a loud minority of influencers in America have managed to obscure this fact with their vicious agenda. This will only be addressed once Americans stop letting the corporate interests screw them over in this outrageous manner.
posted by PareidoliaticBoy at 4:43 PM on January 23, 2011 [16 favorites]


Underneath each answer? Well just the visual noise alone will shut down the whole thread, which may be what you're after.
posted by ThatCanadianGirl at 4:45 PM on January 23, 2011


Oh! Under each question, you said. Sorry!

But I can still see a continuum of health questions that will or won't be serious enough to require that disclaimer, and disclaimers/waivers can be shot down in court anyway, if that is what you are aiming to protect the site from. And a PR statement takes us back the visual noise thing.
posted by ThatCanadianGirl at 4:50 PM on January 23, 2011


Seriously shellycat, if you think an ER visit will only cost $100 or that the OP can just ring up the hospital for some advice, maybe you're just not familiar enough with the health care situation in the US to be berating poor Night_Owl for doing the wrong thing.

This.

I really wish people unfamiliar with the massive clusterfuck that is the U.S. healthcare system would take a giant step back before judging posters and answerers. The idea that an uninsured person would escape a visit to the ER with a $100 bill would be quaintly adorable if it wasn't so wrong.

Like slow graffiti, last year I went to the ER for dizziness and loss of balance. I forgot my insurance card, so they sent me the bill personally. Turns out it was mild dehydration, and for an hour with an IV and a couple tests the total cost was close to $2,000.

I am extremely sympathetic to concerns about medical questions and answers in AskMe, but it's important to understand that many of the posts are, at their core, asking for a risk analysis of a situation in which acquiring crippling debt and ruined credit is not an unlikely outcome. It sucks and it's an unconscionable travesty, but here we are.
posted by lalex at 4:52 PM on January 23, 2011 [17 favorites]


Ok, so I called a friend who is a doctor, and he said pretty much the exact same thing I did. Most likely dehydration from the alcohol. He did suggest that you have someone sit with you tonight if possible and that if you have any other symptoms or episodes then definitely see a doctor.
posted by puny human at 4:53 PM on January 23, 2011 [1 favorite]


shelleycat writes "Also just to be clear also: falling unconscious is not in the league of having a headache or weird pains or feeling dizzy. It's a clear medical emergency."

It's not so clear actually. Not like say a compound fracture or the symptoms of stroke or heart attack for example. Several people have posted things that can cause fainting and not be even a medical concern. I've fainted twice and in neither case was it caused by something that was an emergency and in fact I didn't visit the ER either time despite having good Canadian health care. If I was facing a potential multi thousand dollar medical bill I'd most likely wait until I could get into a clinic or other low/no cost option.

peacay writes "Maybe questions that come under the medical category should have a short statement advising that there may be risk in following strangers' advice and that nothing can replace a consultation with a medical provider - and have that appear in bold below each question."

There are dozens if not dozens of dozens of potential topics that should have the same warnings. Better to have the system we have now.
posted by Mitheral at 4:58 PM on January 23, 2011


Touch this [*] for instant healing over IP.

Why would touching your asshole help?
posted by chrisamiller at 5:04 PM on January 23, 2011 [5 favorites]


--There are dozens if not dozens of dozens of potential topics that should have the same warnings.--

This is true, as is the potential for visual noise, neither of which should be a barrier to improving functionality and safety where appropriate.

Actually, the real hole in my thought comes from the category being 'Health & Fitness' as I see now, rather than 'medical' as I had believed it to be.
posted by peacay at 5:08 PM on January 23, 2011


I really wish people unfamiliar with the massive clusterfuck that is the U.S. healthcare system would take a giant step back before judging posters and answerers. The idea that an uninsured person would escape a visit to the ER with a $100 bill would be quaintly adorable if it wasn't so wrong.

Last year, I had three trips to the ER and one hospital visit in the space of two months. Without insurance I would have had been in debt to the tune of $26K. Looking at the statements that came back, administering a single bag of IV fluids cost $600. A dose of dilaudid was another $500. A CT scan and contrast solution was $4K. Etc.

Most people's access to the American healthcare system is limited greatly by its exorbitant costs. The presence of medical questions on Ask Metafilter is therefore no surprise. Unless the goal is to limit the liability of the site's owners, my opinion is that the questions probably do less harm and, on the whole, provide more benefit to people who need medical advice and must make difficult decisions about affording it.
posted by Blazecock Pileon at 5:56 PM on January 23, 2011 [11 favorites]


The flipside of this is that those without insurance rarely pay the same prices as those with insurance. There are "cash discounts" to be had. A trip to an immediate care clinic a couple of years ago cost me $400 for the visit and two IVs of saline.
posted by proj at 6:00 PM on January 23, 2011 [1 favorite]


Seriously shellycat, if you think an ER visit will only cost $100 or that the OP can just ring up the hospital for some advice, maybe you're just not familiar enough with the health care situation in the US to be berating poor Night_Owl for doing the wrong thing.


The only thing worse than the state of health insurance in the US is the state of malpractice insurance. No one will say anything on the phone that could ever even sound like a diagnosis, let alone advice, without telling you to come in and get examined. Hell, I can't get antibiotics for documented recurring UTIs without going in to the doctor's office and paying a co-pay for a visit and lab fees, even though my doctor and I both knew when I called that the whole thing would end with a prescription for Bactrim. But if she'd just given me the scrip when I called... and it hadn't been an infection... and then I'd sued...

The ass-covering just drives up the price of care. Even WITH health insurance, for a simple UTI, I can expect to pay $120 for co-pays, lab fees, and then finally the $2 for the antibiotics.

Without insurance? It's monstrous.

So, really, to understand the whole problem you have to understand that there are no back-channels and absolutely no way to get anything resolved quickly over the phone. Even WITH insurance. You will receive every single diagnostic test, necessary or not, and you will be charged for it because the doctor needs to justify him/herself to the hospital's lawyers. I know plenty of places in the world where you can call your doctor and get advice on the phone - the US is not one of those places. You call, and the only way you can get answers to get an appointment and go in and pay for it.

System is truly fucked.

I can totally understand the impulse to AskMetaFilter or even a Magic 8 ball before going in to an ER for someone without insurance. Even WITH insurance, I almost always weigh the price of my co-pay with the gravity of my problem before going in.

(PS: I've gone in to the ER uninsured for minor problems. LOWEST bill I ever ended up with was $800. For, as you may have guessed from my previous examples, a UTI. Any loss of consciousness is going to require a CAT scan in an ER and that's at least $1000 out of pocket. This isn't a financial decision that someone without insurance CAN make lightly. Unfortunately.)
posted by sonika at 6:07 PM on January 23, 2011 [12 favorites]


You will receive every single diagnostic test, necessary or not, and you will be charged for it because the doctor needs to justify him/herself to the hospital's lawyers.

What, you suppose we should have a system where doctors would be immune from any responsibility if they fail to meet the standard of care, or where consequences of medical negligence (or worse!) were borne by individual, unlucky patients rather than spread across the population?

Tort reform is a red herring. It isn't the existence of insurance and liability that's the problem -- somebody bears the cost of mistakes, one way or another -- but how that insurance is provided.
posted by Marty Marx at 6:35 PM on January 23, 2011 [1 favorite]


The thing about medical questions on Ask is that they are always answered by the Go To The ER Right Now! people. I'm always kind of surprised by this because, you know, who are these people who just go to the ER or the doctor every time they feel woozy? There was a question a few months ago from a college student with a vomiting hangover and everyone told her to go to the ER, which frankly I thought was ridiculous. The ER isn't going to do anything for a hangover except give you shit and charge you thousands of dollars. Hell, I've taken children who've been vomiting for longer than that to the doctor and been told to go home, they'll get over it. That's the flip side of this: if you're a regularly healthy person, most of the doctors I've met aren't particularly interested. They doubt there's anything much wrong with you and they figure you'll get better.

They might run tests, which, yes, cost thousands upon thousands of dollars (often even if you have insurance.) Here's the thing: if you can't pay for the tests they won't run them. There's a woman in my town who has started a lobbying group; her son died because he couldn't afford colonoscopies. Welcome to the USA. I'm hoping a witch doctor or herbwife moves in down the street, because then maybe I could get some help for the various ailments I have on and off. Otherwise, I'll just have to either get over it or die.

I actually decided never to ask another medical question myself because like the OP, I don't have insurance and I don't have any money and no, I'm not going to the ER. I'd have to be spouting blood from a major artery before I would even consider an ER visit. Even then I'd probably try to sew it shut myself because I don't have that kind of money and I don't want to lose my house. It took me a year to pay off the CT scan that AskMe recommended a couple of years ago; it turned out to show nothing, which was fortunate, but even though I had insurance then, it still cost me $750 out of pocket.
posted by mygothlaundry at 6:39 PM on January 23, 2011 [25 favorites]


FWIW, I have some of the best non-Cadillac insurance you can get in the US. I was involved in a 3 car accident yesterday and had to go to the hospital. Despite the fact that I have insurance, that I was not at fault for the accident, and that I have a decent job, I am still expecting to see a medical bill for 4 figures before this is over with... in addition to having my car totaled.

Anyone in a country with national health care that wants to sponsor and hire an engineer turned chef turned economist and a personal trainer - let me know - because seriously this place is stupid when it comes to medicine.... and politics... and yes, I say this in jest, but I'm also dead serious - if you've got connections as such - I'm serious enough that I would be interested. My wife is this close to agreeing with me that we should head to Canada.
posted by Nanukthedog at 6:44 PM on January 23, 2011


Ok, let me get this straight:

People think the only possible correct answer to questions like this is, "GO TO THE HOSPITAL RIGHT NOW!!" But yet they think this type of question should not be allowed.

The fact that someone is asking the question or sitting there thinking about the question clearly indicates they are not ALREADY GOING TO THE HOSPITAL RIGHT NOW. So the options are either a) they ask the question and maybe get convinced to GO TO THE HOSPITAL RIGHT NOW, or b) they are for some reason not allowed to ask the question, and therefore definitely do not get convinced.
posted by drjimmy11 at 6:48 PM on January 23, 2011 [3 favorites]


Last time I hit the emergency room was when I was working in a bakery. The knife slipped just right and got the tip of my little finger -- it was really kind of nothing. If I'd been in control, I'd have simply finished my shift and not sought help whether I'd had insurance or not. I mean really, you don't need the tip of your pinkie to bench dough. Who cares! However, the law required that I drop what I was doing and seek immediate medical attention, so I hopped into a cab.

I shit you not when I say that the bill was just over $700 for an intern to deal with my cut finger. What racks up a $700 debt in the ER? Glad you asked. I'll tell ya.

Two (count 'em: two) Band-Aid brand band-aids, warm soapy water, the little sponge they used to clean the (very, very clean) wound -- over and over and over, which made it hurt far worse than the original quick, clean slice -- a consult between guy-washing-my-finger and Dr.-pffft-nah-that-won't-require-stitches, and two Tylenol tablets. Who the hell takes only two Tylenols? Seven hundred dollars. Best country in the world!!! Yay!
posted by heyho at 6:54 PM on January 23, 2011 [15 favorites]


Mitheral: "If I was facing a potential multi thousand dollar medical bill I'd most likely wait until I could get into a clinic or other low/no cost option"

But that's JUST IT. Night_Owl said she could go to urgent care for $100. I went to the ER when I thought I was having a heart attack and got into $6000 debt and I can't exactly afford it either. They're getting $20 a month from me. The billing department's liaison called me up and helped me apply for Medicaid. They practically did it all for me. They asked me questions and filled out the form over the phone, so no initial paperwork for me. They went to my appointment at the Medicaid office as my representative so I didn't have to show up. All I had to do was answer a questionnaire from Medicaid and mail back a photocopy of my license and birth certificate. I was denied but luckily I work for a lawyer* and he's getting another attorney to help me out, and not for free either.

If I could get an initial urgent care appt for $100 for a basic checkup, and ask the doctors what any other tests would cost before they were done as well as the reasoning behind the tests, boy would I be in a damned good place. Or you could look at it the way my mom does: $6000 for a hospital visit is probably cheaper than a funeral. And I'm still alive.

*Before you think I must be rich, I make about $50 a week.
posted by IndigoRain at 7:04 PM on January 23, 2011 [1 favorite]


I know it is accepted, but I can't stand when questions get non-answers, especially when the poster makes it clear what they don't want. What part of I really, seriously, really can't afford to go to a hospital is unclear to make people say "go to a hospital"?

I just don't get it.
posted by cashman at 7:20 PM on January 23, 2011 [2 favorites]


But why did Franny pass out?
posted by jfuller at 7:20 PM on January 23, 2011 [2 favorites]


To shelleycat and others who are wondering why you can't just ring the hospital: because they won't answer the phone. Or if they do, the certainly, positively, absolutely will not provide medical advice, no way no how.

We do have phone-in consult lines here, but they're inevitably run by insurance companies. And if you don't have their particular insurance, they won't talk to you. They'll tell you to call 911 or schedule a visit with your primary care doctor, and hang up the phone.

Until this month, I had the cadillac plan. Not even cadillac; rolls-royce. Health care for me was simply free at the point of service, no co-pays, no coinsurance, no nothing. My husband lost the job that came with the cadillac plan last August; as I was 7 months pregnant, we elected to continue to pay the $1700 a month (no typo) to continue the coverage until my son was born.

The kids are still on the cadillac plan, and will be for as long as they can or until my husband gets another job with health insurance. But the rates this month went up to $1955 for the four of us, so my husband and I went with a completely standard plan, one very similar to the ones many people are offered with their employment; it's actually literally the exact same plan my DOCTOR is offered through her employer. I have a $2500 deductible, after which my insurance pays for 75% of allowed costs, minus copays. I have a $5000 coinsurance maximum out of pocket, which means that after the 25% adds up to $5000, they start paying 100% of allowed costs. Not all costs are allowed; physical therapy, for example, has a limit on how many visits they'll pay for. For this, the two of us pay $365 a month, a number that has been drastically reduced by the health care reform legislation. To keep the kids on the cadillac plan costs us $312 a month.

So, for those of you following along at home, I pay $4380 per year -- or the cost of a reasonable laptop every month -- for the privilege of not having to pay much more than twelve or fifteen thousand dollars PER YEAR if I get critically ill or hit by a bus or something. Even if I've hit my deductible, an ER visit for me costs $150 + 25% of whatever they bill me. An emergent ct scan can easily bill out at over ten grand.
posted by KathrynT at 7:22 PM on January 23, 2011 [10 favorites]


The flipside of this is that those without insurance rarely pay the same prices as those with insurance. There are "cash discounts" to be had. A trip to an immediate care clinic a couple of years ago cost me $400 for the visit and two IVs of saline.

Well, for starters, these "cash discounts" are not available everywhere, and often are limited to clinics, almost never hospitals. Also, tests are rarely discounted, as they are usually not administered by the clinic but by specialized departments or even entirely different buildings.

If you got out for $400, you got out easy. But then, an immediate care clinic is not the same as an emergency room.
posted by hippybear at 7:48 PM on January 23, 2011


Tort reform is a red herring. It isn't the existence of insurance and liability that's the problem -- somebody bears the cost of mistakes, one way or another -- but how that insurance is provided.

I suppose. I'll admit to being pretty personally fed up with the red-tape surrounding medical care w/r/t how doctors have to cover their asses to lawyers just from having dealt with it in my own life. So, I suppose I'm letting a bit of personal bile seep in here, but really, so much of what constitutes treatment in the US is decided by what needs to be done to satisfy the lawyers and the insurance companies so the doctor can cover his/her ass if sued that, as a patient, it's absolutely maddening to deal with.

My personal rant on this: I have epilepsy and am also concurrently pregnant. Believe me, I planned the latter around the constraints of the former. I knew what risk existed for my pregnancy (none, if my seizures were under control, which they are) and for my future child of inheriting the condition (the odds come down to "bad luck" on that one). I was cleared by my neurologist AND my family doctor to get pregnant in the first place. And yet. The second I got knocked up, I had to see a genetic counselor (NOT covered by insurance, ps) AND get a Level II ultrasound to assess the "risk" level my "condition" poses to the fetus. A risk level that is, by the way, none whatsoever. The whole thing was not only a colossal waste of time, but a huge waste of money for EVERYONE involved. Sure, some people absolutely need perinatologist consults during pregnancy. I'm not one of those people. And yet, I had to do it anyway so that my OB could sign a form telling their insurance company that I was fully aware of all of the risks.

It's. A. Mess.

People are sent for unnecessary testing all the time for the sake of the doctor ruling something out that they already KNOW isn't the problem, but they have to provide PROOF for the insurance companies. It gets redonkulously expensive. I'm not sure how it works in other places, but in the US, you walk into an ER and you're going to be bombarded with each and every test that's even relevant to what you've got going on so that the doctor, if sued later on, can say "Yes, we did that." It's just how it is. And that combined with the high cost of health care (even WITH insurance) drives up the cost of any visit from "reasonably expensive" to "you're effin' joking."
posted by sonika at 8:16 PM on January 23, 2011 [2 favorites]


Emergency physician here, whom people in this thread seem to think is either price-gouging for evaluating patients who might be having an emergency or whom everyone wants to send said patient to.

Let me just say this upfront: I've dramatically reduced the number of responses I write on Ask Metafilter (I lurk on the health and fitness category daily) because I don't want to be construed as providing medical advice to anyone (only general education) because of malpractice issues or I have no idea the health education of the person I'm responding to. I frequently have a full response typed in, and then I close the tab because it's just not worth the possible liability. I have seen my colleagues sued for the most bogus of bogusness, and sorry, I'm already in over $100k of debt, thankyouverymuch.

#1: Emergency Departments are expensive places to go. They cost you a lot of time and a lot of expense, because we have to do a lot of things very quickly (and can do lots of tests very quickly), work with very limited information (you don't know the names of your medicines or past medical history, or the name of the surgery you had, and you expect me to just figure it all out? Sure thing.), and work in a high-risk environment with many critically ill patients. We also have a huge number of uninsured patients, and to keep from running in the red, yes, a Tylenol costs 20 bucks -- because many of the patients just don't pay the bill or use a fake name (as was suggested by one poster already in the thread). As in the above link, you're also supporting the hospital facility (IV, rooms, nurses, techs, transporters, business associates, housekeepers) as well as the Emergency Physician, so you get more charges than you would from your primary care doctor, where everything is bundled together as one cost.

#2: It sucks that they're expensive, it sucks that we don't have a better health care system in the United States, and it sucks that people have no better alternative. Trust me, I agree, I know it, I was a Health Policy major in undergrad and spent a year of my life working to change it. But like others have said here, there should be no other answer in questions like this on Ask Metafilter besides "You need to see a physician soon," or in other cases, "Get thee to an Emergency Department, now." (What the poster does with that information is his or her own business, god bless America.)

People are right. I don't answer questions over the phone. My ED's phone number is publicly available, and calls frequently get routed to me, but I don't care how simple the question is: I don't. Give information. Over the phone. I'm happy to see anyone for any reason at any hour. That's one of the reasons I chose to specialize in emergency care. But I can't hear part of your story, without getting your vital signs and doing a focused physical exam and occasionally some routine testing to give my opinion and recommendations. Should a car mechanic be able to figure out your problem by only your layman description?

I get that people just want to be reassured that "it's nothing," and go on their way, but so far, medicine doesn't work that way. I can give you some numbers (evidence-based medicine self-link), but can I say that you're not the 1 in 250? Or 1 in 2500, or 1 in 25000? Nope.

#3: One of the other reasons I've stopped posting to these threads is the amount of incorrect information and noise in the threads with people's N = 1 experience. It's seriously frightening. "My boss had that" is not accurate or relevant information to the poster, at all. Similarly, "the same thing happened to me and it was nothing" is not relevant, either. Both answers are wrong. There is no way to know what is wrong without evaluating the patient. There are literally 50 different reasons someone may pass out.

#4: It's easy for me to speculate the cause of say, passing out -- in a young, otherwise healthy woman. I evaluate it every day. I could certainly give the very most likely causes (percentage-wise, in a population, for example). That's easy. (Almost every woman is fine, statistically speaking.) But those percentages change dramatically if it's an otherwise healthy woman who has an abnormal EKG or a positive pregnancy test or didn't think to tell you that her brother drowned unexpectedly when he was 12 until you ask her; she didn't think it was relevant. That's pretty much the crux of why no physician or medical professional in their right mind would say "It's probably nothing," and why many Advice Nurse algorithms frequently end in, "You should go the Emergency Department immediately or call 911." I'm looking for a needle in a haystack. But the patient decided to come to the Emergency Department for evaluation, so as an Emergency Physician, am I going to just say "Well, odds are, you're fine," or am I going to get an EKG, and a urine pregnancy test, and see if anything turns up? Which would you want a doctor to do for you?

#5: For the record, loss of consciousness does not directly buy you a CT scan -- unless, like I said -- you story or your exam is a little bit different.

#6: Emergency physician pet peeve: we're a Department, not a Room. We're actually a real medical specialty, which no one seems to realize, either. /snark
posted by gramcracker at 8:26 PM on January 23, 2011 [93 favorites]


I wish I knew how to do legal research. I would love to know if a doctor in the United States has ever been sued over "bad medical advice" in an online forum, and, if so, what percentage of the suits were immediately dismissed and which were not, the average damages, the average costs, etc.
posted by adipocere at 8:34 PM on January 23, 2011


It'd be a really bad idea if Americans of all income levels had access to health care.

We do not, and even a "simple" trip to the ER to rule out a real problem can cost thousands of dollars. Which can lead to years of bad credit, the inability to get a job because of bad credit, etc.

While the "right" answer is "go to the ER", it understandable that someone who isn't rivh may feel that it's financial due diligence to ask the intarwebs first.
posted by orthogonality at 8:57 PM on January 23, 2011 [1 favorite]


Late last year, I started having symptoms of detached retina- which can cause permanent blindness. Having no health coverage, and literally living paycheck to paycheck I tried:

a) to schedule an appointment with an eye doctor ("See you in a week" "Um, anything sooner?"
b) to call the hospital to ask if it qualified as a medical emergency, like, go in now, or wait a few days to see an eye doctor ("You have to come in. We can't tell you anything."
c) to call a free health line, which apparently, would only accept me IF I happened to be a college student

Finally, I googled "Retina Specialist" and found a clinic not far and called them. They took my symptoms over the phone, set me up to come in 2 days.

I went through the exams, the doctor asked me who referred me and I said, "I googled you guys".
"Smart! If you went into the ER, they would have billed you a few thousand then sent you to us anyway."

He told me if I actually did have a detached retina, to give them a call, but it was a "within 24 hours kind of emergency, not a 'run in for an operation at 3 in the morning' kind of emergency".

Luckily my eye issues resolved without further problems. And the exam and follow up only ate up ONE of my checks for the month.

Luckily.
posted by yeloson at 9:05 PM on January 23, 2011


cashman: "What part of I really, seriously, really can't afford to go to a hospital is unclear to make people say "go to a hospital"?
"

What part of "you could have a serious medical problem that could kill you" is unclear? Look at the link gramcracker provided to "50 causes of syncope." I'd say at least half of those look like serious problems, and certainly a few look immediately life threatening. If you're willing to gamble with your life/health, don't go to the hospital. At this point I don't even know why Night_owl posted the AskMe... according to her, she can't afford to spend even $100 on her health, and the only thing she's going to get here is be told to go to the ER, so what's the point of the AskMe?

Gramcracker, I apologize, I understand it's a department and not a room, but I think the abbreviation "ER" is pretty trenched in the language... and the TV show ER didn't help matters.

adipocere: "I would love to know if a doctor in the United States has ever been sued over "bad medical advice" in an online forum, and, if so, what percentage of the suits were immediately dismissed and which were not, the average damages, the average costs, etc."

There's a first time for everything and I doubt anyone wants to be the first one to have to pay damages in such a suit.

orthogonality: "It'd be a really bad idea if Americans of all income levels had access to health care.

We do not, and even a "simple" trip to the ER to rule out a real problem can cost thousands of dollars. Which can lead to years of bad credit, the inability to get a job because of bad credit, etc.

While the "right" answer is "go to the ER", it understandable that someone who isn't rivh may feel that it's financial due diligence to ask the intarwebs first.
"

You are the first person I've heard in this thread make a good point about bad credit. However, not all jobs check your credit score.

I don't understand, why do you think it would be a bad idea for all Americans to have access to health care? Because it would be a huge waste of money? Well, that's why something needs to happen to change it.
posted by IndigoRain at 9:41 PM on January 23, 2011


IndigoRain, I think orthogonality is saying "Keeping AskMe open to questions like these WOULD be a bad idea if all Americans had equal access to health care. As they don't, however, AskMe meets a need so unbelievable it's pathetic that it even exists."
posted by KathrynT at 9:51 PM on January 23, 2011 [2 favorites]


Here's the conundrum we face in the developed world: we have access to labs and studies and technologies to try to figure out what ails you early in the process, but they won't always give you an answer ("Well, we've at least ruled out all the bad stuff!"), and they cost a lot of money. But if they get the right answer, we can catch it early, and because we catch it early, we theorize that our people do better with earlier treatment/intervention (this is not always the case). Hell, in my biased view sometimes people won't even wait long enough to give things a chance to sort themselves out (my recent "Chief Complaint: Sore Throat for 20 Minutes" patient eating a sandwich comes to mind).

The flip side: I worked in an ED in Haiti, 3 months post-quake. There, you don't need a lab or an x-ray or a scan to tell you that the patient is sick, because the disease is so far advanced at that point, it's staring you in the face. People don't see a doctor there when they pass out once, or twice. Or if they have a fever for a day, or a week. They see a doctor when they've tried everything else, and they're so terribly ill (or dead) from passing out so much from their critical heart valve disorder or so septic and febrile from their cerebral malaria that they're seizing in front of you, and then it's already too late for them.

There's a happy medium in there somewhere between the two extremes, but barring fortune telling or predicting the future, I don't know how we get there. It's a Goldilocks conundrum that we'll probably never have an answer to: how long is too long to wait, and how soon is too soon to be evaluated? It all depends on the disease process, which, paradoxically, requires someone to make a diagnosis in the first place.
posted by gramcracker at 10:04 PM on January 23, 2011 [7 favorites]


Thanks KathrynT, I couldn't get that.

I walked away and took a shower. I'd like to apologize if I upset anyone.

I admit to being touchy on this issue. In early 2010, my uncle had a cold for 3 weeks that wouldn't go away. He didn't go to the doctor. My aunt found he had died in his sleep on Valentine's morning. In May, a different aunt had chest and jaw pain for a week. She didn't want to go to the doctor. She collapsed in her kitchen 2 days before Mother's Day, with a ruptured aortic aneurysm. She was dead before the paramedics arrived. In the space of 3 months, my dad lost his oldest and youngest siblings from what might have been preventable causes. I just don't want to see anyone else lose that gamble.

Night_owl, I sincerely hope you're okay.
posted by IndigoRain at 10:29 PM on January 23, 2011


You are the first person I've heard in this thread make a good point about bad credit. However, not all jobs check your credit score.

I don't understand, why do you think it would be a bad idea for all Americans to have access to health care? Because it would be a huge waste of money? Well, that's why something needs to happen to change it.


What KathrynT said.

I should have punctuated better: "It would be a bad idea to have these questions, if all Americans had access to affordable health care...

For the record, enn and lalex mentioned bad credit/credit scores before I did.
posted by orthogonality at 11:15 PM on January 23, 2011


There's a happy medium in there somewhere between the two extremes, but barring fortune telling or predicting the future, I don't know how we get there. It's a Goldilocks conundrum that we'll probably never have an answer to: how long is too long to wait, and how soon is too soon to be evaluated? It all depends on the disease process, which, paradoxically, requires someone to make a diagnosis in the first place.

Thanks for that gramcracker! It is one of those "first world problems" brought up in the Pentalobe Screw thread--though I don't dismiss it the way five fresh fish does, I think it is a critical problem of our times. Like, do you need tamper resistent screws on stuff so that only the professionals can get in? For me it goes further into safety standards, and rules about who can change the ceiling fixture in the dining room. Safety and standards and professionalisation are all critical to making our complicated world manageable. At the same time they add complicated bureaucracy that makes living in the world unmanageable.
posted by Chuckles at 12:19 AM on January 24, 2011


I appreciate the advice given in the thread. In all honesty, I am now taking my incident much more seriously than I would have. I have told people in real life about it.

Comments like that blow my mind.
posted by phaedon at 12:34 AM on January 24, 2011


I didn't go to the hospital, though my neighbor insisted I should; I'd called to him as he was walking to his car, headed to his work. I told him I didn't have insurance, and couldn't afford to go, I didn't have the bread. Before he'd leave for work, he insisted I call someone to come over he wouldn't to leave me alone. I called Bob, friend of mine, he came over, found me disoriented, in pain, sick, sitting outside my condo door in my underpants, not something I normally would do, for sure.
Metafilter: Sitting outside my condo door in my underpants.

Again and again, Bob insisted I had to go to the hospital; again and again I said no, I can't afford it, and I don't have insurance, and I'll be okay. He finally told me "Look, either you go into your condo, put on some clothes and get in my truck and I'll take you to the hospital, or I'm leaving right now." I told him "Well, have a nice day -- I'm not going anywhere." So then he says "I'm not leaving." even though he'd said he would, the lying bastard. So eventually I put on some clothes, hop into his pickup, we head toward the hospital, a couple minutes into the ride, I keel over and die, finally die from the dang heart attack I've been in for over twelve hours.

I'm one of the people we all hear about who would die because our health care system is so messed up, because they can't get help. Except I'm not just some shadow image who 'could' die, who 'might' die -- I *did* die, and was dead a long, long time on the way to the hospital -- morning rush hour, I'm dead in his truck and we're in stop and go traffic.

I've timed that ride at that time of day any number of times; the very best time I've made that trip was eight minutes. So we can pretty much assume that's how long I was without oxygen, and I was absolutely very, very compromised even before that, my cardiac artery almost completely blocked off. We got to the ER (ED for you, Dr. gramcracker), they jerked me out of that pickup, cut off my jeans (my favorite jeans, the bastards!) and t-shirt and set to work on me right there outside the hospital; they didn't even take the time to wheel me inside, every second counts, July in Austin and these guys are working outside. I like these guys.

I've seen the paperwork, talked to the guys who did it, in fact I've got a copy of the paperwork which states that they started working on me at 8:18am, didn't get a heartbeat until 8:31am, another thirteen minutes dead, on top of the eight prior, though they had oxygen on me for that thirteen minutes, so it was just a heck of a lot better.

Once they got my heart going, the cardiologist (luck of the draw, I got the head of the cardiology dept; I just LOVE this guy, he's younger than I am, I bust his ass all the time, call him a kid and whatnot, we really have a time) shows up, and they shot dye into me, stood me up, took a picture to see where the blockage was, cut open my femoral and shoved a stent up into my cardiac artery, took another picture to make sure all was well, and that was that, all better.

Except of course I wasn't all better, because I'd been dead so long without oxygen.

I died twice more that day, once in the ER, then that night in ICU, and that one they *really* had to work on me, I *really* didn't want to come back it seems -- a friend of mine was in the room when it came down and saw what they did, he says it was really a trip to watch. When I came out of the coma, I had burns all over my chest, from where they slammed me again and again with those dang paddles.

I don't remember exactly what I owed the hospital, over a quarter million by the time I got out of there. I got onto disability -- SSDI -- and they paid for it, most of it anyways; had that not happened, the hospital had told me that they would waive it, they insisted I not worry about that, to concentrate on my healing. So I'm one of the lucky ones I guess, though I had to die to get SSDI -- I knew it was hard, we've all heard stories, but this just seems a bit over the top, right?

Had I have gone right to the hospital, and got there before dying, they'd have shot the dye into me, put that stent in, sent me home a day or two later, all sewed up, snicker-snack, on my way. Might have cost me five grand, or ten -- I don't know. I know now that the hospital would have waived it had I needed it waived, but I didn't know that then.

I lost my sense of smell, totally. It took me a while to realize that, took me a while to realize most anything at all, I was pretty weak, and plenty confused, stayed that way for a while. I noticed when I picked a rosemary branch and pulled all the needles down into my hand -- a smell I really love(d) -- and put my nose to it and smelled nothing. At all. Zero. Zip. Nada. I figured I must have some allergy thing going on, but that's not what it was of course.

So I lost my sense of smell but it could as easily have been vision, or hearing, or the ability to walk or talk or just about anything else -- brains don't like to go without oxygen, especially not for eight dang minutes. They told my family that I was dead, just a matter of time, and if I did live -- they insisted I wouldn't, but if I did -- if I lived I'd be totally vegged, dumber than Bush even. The speech therapist I worked with told me that the reason I am lucid and able to think/walk/talk/etc is Freecell, to which I was addicted at that time; up until they heard about that, they could not get their head around what I am able to do, considering what had happened to me.

One section of my heart has dead tissue, and that will never, ever come back; dead from no oxygen. I've seen it in real time on the ultra-sound scanner, the tech showed me that part of the muscle that is unable to flex, stiff, unable to help pump out blood.

I'm not sure if the memory problems I have are from being dead so long or not; I'm 56, it's possible that these are just senior moments, and fact is that I'd had them prior to dying. I suffer worse confusions though, that I know, lots of circuitous thinking, and I often have those "tip of the tongue" moments, cannot find words, and am even more socially inept than I was beforehand -- I know these things because I've asked friends I trust and also family members to tell me, to lay it on the line, and they have done so. Probably all the drugs I've taken these long years for manic depression and panic disorder haven't helped either, plus I did do all kinds of drinking and drugging when I was young, might have melted a few brain cells then, lots of car wrecks and other shots to the head, too, construction accidents, on and on, etc and etc, you name it. A few bad electrical shocks, too, that might have jello'd my gourd, no telling...

ANYWAYS....... Ask me if I think that you should go to the ER and I'll tell you to go. Not for a hang-nail, no. But if you're seriously in doubt, go. Go. This whole life thing, it's really beautiful, I can't recommend it highly enough. I'm not afraid of death or anything but I want to hang around here as long as I can -- I was 49 when I died, and I'm pretty goddamned determined, insistent that I get another 49 before I head on out of here, if even then. So I'm gonna be here if I can, and I want all you mefites to hang around, too, so's we can mock each others taste, or lack thereof, tell one another that your favorite band sucks and all, and that you can't punctuate and stuff.

I'm the guy you want to think of when you have these conversations about how people could literally frickin' *die* because of our health-care system -- yep, people absolutely can. I'm here to report that to you. And maybe, given some of the tackiness of some of my responses here -- not to mention my inability to punctuate correctly -- maybe you wish that I *had* gone on and died, but I guess you'll just have to wait for that part.

Go to the hospital. You're worth it. Your country is willing to pay these piece of shit banks more than you and I will ever see in our lifetimes, one tomahawk missile -- of which our military has thrown thousands, literally thousands into Iraq and Afghanistan -- the cost of one of those missiles alone would pay for my medical care four times over, and yours, too. Our country has the money to do that, they have the money to help you and I; it's just not a priority, that's all. Well, I'm here to tell you that you'd best make it *your* priority, don't make the mistake I made.

I have a friend who had lymphoma, he almost died from it, and he had to fight bureaucracies the whole goddamn time of his treatment, every goddamn step of the way -- he's so sick he can't walk, he's puking and shitting himself and can't eat, the last thing he needs is these people to fight him, but they *do* fight him, and they'll fight you, too. He's cleared it now, he's on the other side, all his hair grown back, we're running buddies, to look at us you'd not know where we've been or what we've suffered, we both of us are willing to help anyone else negotiate this jive-ass bullshit system...

I'm going on. Sorry. That whole circuitous thinking thing probably, round and round I go, where I stop, nobody knows. Jesus. This thing has gotten way. too. long. so I'd best stop.

tl;dr -- go to the damn doctor; you're worth it

Have fun!
posted by dancestoblue at 1:53 AM on January 24, 2011 [744 favorites]


Every time it comes up on here the USA health care system amazes me.

I don't know why it should amaze me every time, because the stories (and $ amounts) are always the same or worse.

Almost $2000 a month for a family's health insurance sounds absolutely crazy.
posted by selton at 3:26 AM on January 24, 2011


dancestoblue, that story is CRAZY. Thanks for putting all that down.
posted by lauranesson at 3:43 AM on January 24, 2011 [1 favorite]


Holy god, dancestoblue.

I work for a health policy think-tank sort of place, and I see/edit/proofread/post to the internets truckloads of surveys, reports, briefs, testimonies-before-House-committees etc. that are all about health care in these fine United States. I see the facts and figures - pretty much all of them depressing and discouraging - on a daily basis, and I sort of have to numb myself to what the reports and such mean.

Anyway. I'm glad you're okay, dancestoblue.
posted by rtha at 6:44 AM on January 24, 2011 [2 favorites]


Blazecock Pileon: "Looking at the statements that came back, administering a single bag of IV fluids cost $600. A dose of dilaudid was another $500. A CT scan and contrast solution was $4K. Etc."

Having followed a few health care threads in my time, I'm under the distinct impression that these bills are more like the opening gambit in a potentially protracted negotiation; the insurance companies don't pay the sticker price, and neither does anyone else if they're willing to play the game.

Of course, I'm in the UK and benefit from the warm embrace of our admittedly flawed but nevertheless lovely NHS, so thankfully I don't have to worry about such things.

On the other hand roughly 20% of the cost of my employment to my employer goes on health care (well, a bit of that goes on unemployment insurance and social security, so nearly 20%).
posted by pharm at 7:01 AM on January 24, 2011


the insurance companies don't pay the sticker price, and neither does anyone else if they're willing to play the game.

The problem is that insurance companies have entire departments devoted to negotiating this stuff. When you, an individual, are sick with a heart attack or cancer, you are magically expected to pay attention not only to your own treatment, but to the reams of paperwork that come along with it, to have enough wherewithall to challenge any hinky looking diagnostic codes or costs, and to keep track of the fact that Billing Department Person A told you one thing on Tuesday (after you spent an hour on hold), but on Thursday, Billing Department Person B contradicts Person B, and furthermore, they're missing the records you have faxed them twice.

Fucking nightmare is what it is.
posted by rtha at 7:16 AM on January 24, 2011 [13 favorites]


Great story, dancestoblue! Congratulations on picking up running (again?)! I had seen your comment about losing your sense of smell in another thread, and as I read the beginning of your story, wondered if it was you, and it is.

I think if Night_owl would have posted something incoherent, something that was the internet equivalent of "I'm not right, I'm sitting outside in my underpants", then I totally get overriding the person's fears about payment.

I love your story, and I'm glad you're here to tell it.
posted by cashman at 7:18 AM on January 24, 2011


On the other hand roughly 20% of the cost of my employment to my employer goes on health care...

I bet I'm as high or higher than 20%. Especially if you are going to count social security and unemployment insurance.
posted by cjorgensen at 7:24 AM on January 24, 2011 [1 favorite]


That's an incredible story dancestoblue. I'm not sure I understand this concept of hospitals waiving fees, though, or how often it's done and under what criteria. Hospitals willing to forgive $250K of debt? What the hell?
posted by empyrean at 7:41 AM on January 24, 2011

I see the facts and figures - pretty much all of them depressing and discouraging - on a daily basis, and I sort of have to numb myself to what the reports and such mean.
I once worked for a pharma company in a staistics group. It was a bad day when I finally realized what a "severe adverse event" was. These things look so sterile from a distance, which is why it's so easy to be against health care, because surely the numbers would be messier if it were really so bad...
posted by Karmakaze at 8:57 AM on January 24, 2011


empryream: I work for a hospital finance department and one of the things we do is review patients' financial situations in order to approve them for charity. We forgive millions of dollars in medical bills, after verifying that the patient is broke and ineligible for Medicare/Medicaid. The patient has to ask first and submit all the paperwork.
posted by Toothless Willy at 9:46 AM on January 24, 2011


(empyrean, sorry)
posted by Toothless Willy at 9:47 AM on January 24, 2011


Jumping in a bit late, but I fully agree with the OP of this thread. Not only are we not her Doctor, we are not Greg House, master diagnostician who can declare (incorrectly the first time) what it is, only to come back later after a revelation and deterioration in the patient's condition and correctly diagnose what it actually is.

All without having ever met the patient.
posted by dougrayrankin at 9:54 AM on January 24, 2011 [1 favorite]


neither does anyone else if they're willing to play the game

It would be nice for people to be able to focus on getting healthy, instead of spending physical and mental energy "playing the game", which consists mostly of negotiating layers of impersonal bureaucracy and stacks of paperwork and billing statements.
posted by Blazecock Pileon at 10:27 AM on January 24, 2011 [4 favorites]


Beautiful, dancestoblue. Really beautiful. And damn, I needed to read something like that right now. I'm gonna carry your story around with me for a few days, and use it the way you intended.
posted by nevercalm at 10:33 AM on January 24, 2011


In Ontario, the healthcare professionals are perfectly happy to give out advice over the phone - there's an official "call to see if it's serious" telephone line - Telehealth.

I called them when I had a terrible headache, was vomitting and couldn't even keep down water. Turned out that I was dehydrated, and was drinking the water too fast; I sipped a glass of water and was better within an hour. That saved me a trip to the emergency room, which is, of course, why the government started the program -- they pay for my healthcare.
posted by jb at 10:39 AM on January 24, 2011 [2 favorites]



I know it is accepted, but I can't stand when questions get non-answers, especially when the poster makes it clear what they don't want. What part of I really, seriously, really can't afford to go to a hospital is unclear to make people say "go to a hospital"?


Well, but wasn't she, at bottom, asking to find out whether people thought she should go to the hospital? I have to wonder what mix of OMG ER v. "you're prob fine" answers would have gotten the OP to the ER...judging from the ratio and the fact that she didn't, what is the point of asking?
posted by Pax at 10:42 AM on January 24, 2011


jb - what happens if they're wrong and the patient gets worse or dies as a result of erroneous advice? Can Telehealth be sued?

I can't imagine a nurse telling me anything other than "you have to come in" if I called with the scenario you described. I don't know if it's because they're afraid of malpractice suits or because healthcare is paid privately, or both.
posted by desjardins at 11:33 AM on January 24, 2011


I was watching a history TV show a couple of days ago, and they had one of those commercial-break quiz questions. It started off by saying: "Back in Victorian times, going to the doctor cost money." I did a massive double take before I remembered it was a British show.
posted by Hargrimm at 11:51 AM on January 24, 2011 [1 favorite]


Telehealth. What nice idea. So for the price of a buying a disposable cell phone in Canada I too can have free health care advice?
posted by Bonzai at 11:52 AM on January 24, 2011 [1 favorite]


The UK has NHS Direct. Sounds like the Canadian Telehealth scheme is similar.

I've called NHS direct a couple of times, the people I spoke to were both very helpful.

In the UK you can also get some advice from Pharmacists for non-serious things.
posted by selton at 12:07 PM on January 24, 2011


So for the price of a buying a disposable cell phone in Canada I too can have free health care advice?

You may need a health insurance number, though. (a personal ID code from your health insurance card)
posted by LobsterMitten at 12:44 PM on January 24, 2011


Telehealth is available to the good people of the province of Ontario. You need an OHIP card (Ontario Health Insurance Plan). I'm sure other provinces have something similar. It's enormously cost effective, keeping people out of "Emerg" and Urgent Care Clinics unless they really need to be there.
posted by ThatCanadianGirl at 1:07 PM on January 24, 2011


We have the equvalent to Telehealth in Quebec, it is called Info-Santé. You don't even need to submit some proof of insurance plan, just your name and adress. It saved us a few trips to the ER, for ourselves or the baby.
posted by ddaavviidd at 2:00 PM on January 24, 2011


We can rebuild him. We have the technology. Buuuuut... he doesn't have any health insurance.
posted by dougrayrankin at 2:07 PM on January 24, 2011 [2 favorites]


I don't remember giving my OHIP number last time I called; they probably only accept calls from within Ontario. I know that NHS direct did not ask me to proove I was eligible for the NHS when I called them; I wasn't, that's why I called (to see if I should pay to see a doctor).

As for suing: no, I don't think anyone has ever sued Telehealth or any of the others. Why would you sue a service which is trying to make your life better? They always tell you to go to the emergency if your symptoms continue/ get worse. But the point is that the vast majority of people don't need to go to the hospital, and the nurses are good at triaging over the phone. In my case, the nurse correctly worked out what was wrong and I was better within an hour; if I hadn't been better, I would have gone to emerg. But I was better -- and I saved myself so much hassle and the govt so much money. Now when I get the same symptoms (coffee addict, prone to dehydration), I do the same treatment.
posted by jb at 5:38 PM on January 24, 2011


Canadian pharmacists also give advice -- they are great at recomending over-the-counter stuff. They often direct you away from the big name stuff to what is best for your specific symptoms.
posted by jb at 5:40 PM on January 24, 2011


Why would you sue a service which is trying to make your life better?

This is a question a certain percentage of Americans bringing medical lawsuits have never, ever asked themselves.
posted by sonika at 7:38 PM on January 24, 2011 [1 favorite]


This is a question a certain percentage of Americans bringing medical lawsuits have never, ever asked themselves.

Actually, I believe that the single greatest reason most Americans bring medical lawsuits is that they are searching for any possible way to cover the hundreds of thousands, if not millions, of dollars' worth of ongoing care they or their dependents may require. It's not even greed, it's a grim necessity.
posted by KathrynT at 8:11 PM on January 24, 2011 [11 favorites]


Australia has HealthDirect which lets you call anytime to talk to a Registered Nurse. The first thing they do when you call is run through a checklist of items "are you experiencing chest pain, etc". I presume if you answer yes they call an ambulance or something.

If you answer no they discuss your symptoms, and whether you should go to the emergency department or just wait until your GP is open. They have a "no such thing as a stupid question" attitude that makes it a relief to tell them your problem. They don't diagnose, they just sort out if you need immediate care, can wait a while, or just need to drink more water or something.

It's an amazing resource that I've used several times - one time it was serious, another few times it wasn't but they told me what symptoms to look out for if things were getting worse. My sister used it when she couldn't find the number for the poisons hotline. My other sister used it when her baby was sick and she didn't know if she was being a panicky new mum or something was really wrong.

It's funded jointly by the federal and state governments.
posted by harriet vane at 10:28 PM on January 24, 2011 [3 favorites]


For-profit medical insurance is a malignant tumor growing on the United States of America. This thread is a symptom.
posted by one more dead town's last parade at 6:04 AM on January 25, 2011 [5 favorites]


Why would you sue a service which is trying to make your life better?

I laughed out loud when I read this. Oh, you naive, naive, incredibly lucky Canadian person.

Also LOL at wanting to save the government money. That's so quaint.

/sobs

Right now I'm trying to get a refill on a prescription that I'd accidentally let lapse. I'm waiting for a call back from the doctor but I expect they won't do it over the phone, I'll have to come in. I'm between insurance companies right now so this will probably cost $400 or so between the office visit and the pills themselves. When I had insurance, it was $20 copay for the visit and $10 for the meds. If I wouldn't have horrible fucking withdrawal, I'd consider going without it until I get my insurance sorted out.
posted by desjardins at 7:37 AM on January 25, 2011 [2 favorites]


One good thing to keep in mind is that even if you have to pay 45000 dollars to a hospital they are often very cool about letting you pay in installments that are very low. For example, I owe 800 dollars to a hospital here in Baltimore and I pay ten dollars a month. No interest, just ten dollars a month.
posted by josher71 at 8:08 AM on January 25, 2011 [1 favorite]


dancestoblue, you are awesome. No snark, no sarcasm, no innuendo, no overestimation, no hyperbole, no aphasia, no kidding around. Straight-up awesome.
posted by Civil_Disobedient at 9:20 AM on January 25, 2011 [1 favorite]


Actually, I believe that the single greatest reason most Americans bring medical lawsuits is that they are searching for any possible way to cover the hundreds of thousands, if not millions, of dollars' worth of ongoing care they or their dependents may require. It's not even greed, it's a grim necessity.

I agree, which is why I said "a certain percentage" and not "most" or "all." My mother was a nurse and I've heard all about medical malpractice from the very obvious "Oh yeah, mistakes were DEFINITELY made. Big. Big mistakes." to "You're suing? Over THAT?!" Most fall somewhere in the middle ground of "Yeah, I guess want to blame someone, but really that just sucks."

But there are absolutely fringe cases wherein people just sue because they *can.* And those are the ones that healthcare professionals have to really work hard to cover their asses against since there's no predicting total insanity. There's a huge amount of erring for caution and over compensating just in case this turns out to be one of those times that someone sues because they were told something over the phone and then turned around and lit themselves on fire or whatnot. While they may not be the majority of cases, they're the ones that get the most attention in terms of how hospitals operate.
posted by sonika at 9:41 AM on January 25, 2011 [2 favorites]


What these threads boil down to, always, is, "I know I should go to a doctor. But it will bankrupt me and ruin me for life if I go for anything that isn't going to kill me. Do you think this is going to kill me?" And as has been pointed out, there is no way for the poster to get any advice on this from US medical professionals before racking up thousands in debt, period. Where the hell else can they go other than to ask their relatives, neighbors, and the Internet? We're all just guessing, but there's no other option but to guess. Yeah, there could be a miraculous save for a rare "nothing" symptom a la an episode of House, but odds are a lot higher that someone goes bankrupt for a gas bubble or dehydration.

Essentially, when I read a thread like this, I want to know how bad their symptoms are before I fire off GO TO EMERGENCY DO NOT PASS GO PAY UP A BILLION DOLLARS FOR WHAT MIGHT BE NOTHING. In NightOwl's case, I'd say to wait (sounds like she's okay-ish anyway). In dancestoblue's case, clearly he(?) was badly enough off for anyone to say GO TO EMERGENCY DO NOT PASS GO.

Ask Mefi does this service. I still think it is, unfortunately, necessary. We're taking a poll on just how bad the situation might be, the OP makes their best guess, and survives/dies/goes bankrupt on their own recognizance.
posted by jenfullmoon at 3:13 PM on January 25, 2011 [3 favorites]


Essentially, when I read a thread like this, I want to know how bad their symptoms are before I fire off GO TO EMERGENCY DO NOT PASS GO PAY UP A BILLION DOLLARS FOR WHAT MIGHT BE NOTHING.

A standard medical exam is made up of multiple parts, only one of which is the subjective information provided by the patient, and most of that information is gained by specific questions asked by the care providers either in person or on standard health history form. Most people are not qualified to properly quantify their symptoms, much less know enough to actually describe the symptoms without prompting.

So basically my point is, we aren't in a position to actually know how bad the symptoms are for anything that isn't obviously minor (and we're going to wrong then too sometimes). When someone talks about passing out, the amount of very serious differential diagnoses is enough that the only sane advice is forget the bill, go check it out. Or as dancestotheblue said it better, "Go to the damn doctor; you're worth it."
posted by Apoch at 7:25 PM on January 25, 2011 [1 favorite]


the insurance companies don't pay the sticker price, and neither does anyone else if they're willing to play the game.

But when you get to the hospital (disoriented by your medical emergency) you have to sign a piece of paper that says you're on the hook for the cost of treatment before they work on you.

The part where you can negotiate the sticker price is not explained. How on earth is anyone supposed to know this is even theoretically possible?
posted by desuetude at 10:59 PM on January 25, 2011 [1 favorite]


How on earth is anyone supposed to know this is even theoretically possible?

Everything is negotiable, even when someone says that it's not. Usually the latter just means that the avenues of negotiation are elsewhere. Even when something is negotiable, that doesn't mean that you're going to like the terms on offer.

This is one of those truths that nobody teaches you in school. Perhaps they should?
posted by pharm at 4:40 AM on January 26, 2011


But when you get to the hospital (disoriented by your medical emergency) you have to sign a piece of paper that says you're on the hook for the cost of treatment before they work on you.

The part where you can negotiate the sticker price is not explained. How on earth is anyone supposed to know this is even theoretically possible?


I've never arrived to an ER in an ambulance, so I don't know what that intake procedure is like. But at my local hospital, here's what happens from the user's perspective when you show up at the ER front door:

They do a fast triage (chest pain? trouble breathing?) and if things look grim you skip the paperwork until later and are rushed in. Above the triage desk are big signs saying that no one is refused for lack of money and that financial help for people in need is available.

When you do the paperwork (on admittance if you aren't dying on the spot, or later if you are in bad shape), they sit you down with the bilingual intake person, at a quiet desk off to the side, where they do the insurance and financial paperwork. Again, there are big signs above this desk, too, advertising the availability of care, financial assistance, and so on. The function is not to screen out the poor people -- they are finding out if you can pay the bill yourself, if you will need help, maybe a payment plan, or an appointment with one of their people who can hook you up with state and federal assistance. I certainly have never had to sign something saying I am on the hook for the cost of treatment -- exactly the opposite, I think.

As far as I know, this is just sort of a regular community hospital -- it's hardly nationally-ranked or special in any way I know about. And when I've spent time in the ER, it's clear that they are picking up all the slack from a dysfunctional health care system, with tons of poor people coming to the ER for basic care that should have been provided at a community clinic. But even at my regular local hospital, if you came in to the ER complaining of fainting, you would be seen by the medical staff regardless of your ability to pay, and all of the options for assistance would be explained to you.
posted by Forktine at 5:46 AM on January 26, 2011 [1 favorite]


The speech therapist I worked with told me that the reason I am lucid and able to think/walk/talk/etc is Freecell, to which I was addicted at that time; up until they heard about that, they could not get their head around what I am able to do, considering what had happened to me.

I feel dumb that I don't understand this part, since no one else has questioned it. Can you give us more details about that?
posted by peep at 8:33 AM on January 26, 2011



As far as I know, this is just sort of a regular community hospital -- it's hardly nationally-ranked or special in any way I know about. And when I've spent time in the ER, it's clear that they are picking up all the slack from a dysfunctional health care system, with tons of poor people coming to the ER for basic care that should have been provided at a community clinic. But even at my regular local hospital, if you came in to the ER complaining of fainting, you would be seen by the medical staff regardless of your ability to pay, and all of the options for assistance would be explained to you.



My mom's an ER doctor in DC, and this. Exactly this. They get a ton of people who are poor and sometimes just poor and lonely, and they get seen without being billed for a million unnecessary things. The doctors know the health care system is broken, but they are really stuck in the middle. They've taken an oath and made a lifetime commitment to help the sick and needy, regardless of insurance/payment plan etc. If you go to the ER you will get quality care. You may have to advocate for yourself to manage the payments, but you should be doing that anyway. Yes, the insurance system isn't great but if you advocate for yourself you should be able to manage things.
posted by sweetkid at 9:10 AM on January 26, 2011


Just as an aside, it occurred to me today that it might be easier and cheaper for an American to purchase a holiday to the UK with travel insurance and then whilst there pop into one of our hospitals.
posted by dougrayrankin at 9:58 AM on January 26, 2011


I bet that would still result in coming home with a "pre-existing condition" the U.S. insurance companies could use against you, assuming you received a diagnosis while overseas.
posted by Gator at 10:00 AM on January 26, 2011


If you go to the ER you will get quality care.

That depends on the hospital. Last November I had a nasty nasty sprained back with muscle spasms, and I went to the hospital after about six hours of sucking down advils and having to furniture-walk my way to the bathroom. Once I was there I was examined, and told that since it wasn't life-threatening and I have no insurance, I'd have to pony up two hundred dollars before I was given so much as a painkiller.

It wasn't going to kill me, sure. It'd go away on its own. Meanwhile I at the tender age of twenty-eight (when a week ago I was playing bodyslam tag with the dog and climbing things) needed a cane and another person's elbow to walk anywhere, couldn't get into or out of the building without a wheelchair, and I couldn't sit up on the hospital bed without help. They told me ice and ibuprofen - I tried that, it didn't work, I couldn't take a deep breath without setting off a muscle spasm, that's why I came in.

The second hospital I went to gave me industrial-strength muscle relaxers, painkillers, and here, have some Valium too, just in case all that other stuff doesn't work. When the nurse took my vitals I asked if they were going to kick me out too. She needed a moment to recover before answering that - it's hard to shock an ER nurse on a Saturday night, but I managed it.

All of which is to say: if you don't have health insurance, find out now which hospitals will treat you when you need it. Don't wait until you have to beg them to push your wheelchair back out to the car, because you're not profitable enough to treat.
posted by cmyk at 12:17 PM on January 26, 2011 [3 favorites]


Well, we got lucky.

My dad had a melanoma break out on his shoulder, and, on the advice of a long-distance friend, who had recently dealt with melanoma, pursued medical attention.

A few days ago, we finally got the lymph node biopsies, post removal, and found out the melanoma, rated a 4 (of 5 on the scale for aggressiveness), had not spread.

The only reason that anyone can tell it didn't spread any further was due to early detection and treatment.
posted by Samizdata at 1:05 PM on January 26, 2011


I certainly have never had to sign something saying I am on the hook for the cost of treatment -- exactly the opposite, I think.

How is it possible that we're in the same country and I have had to sign something to this effect every single time I've been to the hospital? It basically goes like this "if your insurance company refuses any of the charges, you agree to be liable." And boy do they hold you liable, they call me every other day.
posted by desjardins at 1:07 PM on January 26, 2011 [1 favorite]


Just as an aside, it occurred to me today that it might be easier and cheaper for an American to purchase a holiday to the UK with travel insurance and then whilst there pop into one of our hospitals.
I bet that would still result in coming home with a "pre-existing condition" the U.S. insurance companies could use against you, assuming you received a diagnosis while overseas.


I don't know of any travel insurance that covers pre-existing conditions, which would preclude you getting coverage for this sort of thing.
posted by one more dead town's last parade at 3:33 PM on January 26, 2011


How is it possible that we're in the same country and I have had to sign something to this effect every single time I've been to the hospital? It basically goes like this "if your insurance company refuses any of the charges, you agree to be liable." And boy do they hold you liable, they call me every other day.

I don't know, honestly. Maybe it's because my local hospital is run by the Catholics, so the charity part of its mission is put front and center? Or maybe it's seriously not representative of hospitals and I am just lucky?

But in all honesty, each time we have been through the ER there, the emphasis is on "how can we help you pay for this," not "how can we fuck up your life with big bills mwah ha ha." They always emphasize that if my insurance won't cover the treatment, that then we will work things out, depending on the situation. It's not some utopia of perfect care and equitable treatment, but I would have absolutely no reservations about showing up there broke and expecting to receive ok treatment.
posted by Forktine at 5:43 PM on January 26, 2011


They always emphasize that if my insurance won't cover the treatment, that then we will work things out, depending on the situation.

Yeah, that's the Catholic part of it. I've been to Urgent Care centers at Catholic hospitals and they've always been wonderful about payment plans and options for the uninsured. The same standard does not exist in "traditional" (for lack of a better word) emergency departments where, indeed, you're asked to provide insurance - and agree to pay if you don't have it - before anyone has even finished taking your vital signs.
posted by sonika at 6:17 PM on January 26, 2011


Hm, well, next time I have to go to the hospital I guess I'll choose St. So-and-so over Aurora Healthcare, who is an especially huge bag of assholes.
posted by desjardins at 9:22 AM on January 27, 2011


desjardins: Double check and make sure they're run by a Catholic mission, but yeah, while it's not as technologically fancy as some of its competitors, St. Joseph's in PVD has been excellent with the payment plans for simple emergencies.

(Which is to say, if I lost my insurance and cut my finger? There in a heartbeat. Found a possible malignant tumor on my own head? Hmmm... not so much.)
posted by sonika at 9:40 AM on January 27, 2011


There's another MeTa thread highlighting a great post from herrdoktor that led me to this medical AskMe.

The conversation here seems to have died and/or moved on in a different direction from the initial post, but for posterity's sake, I thought it might be good to point this out. There is at least one concrete example of good coming from a medical AskMe. All but one response said "ER now" with varying degrees of forcefulness and explanation. Those responses were the push the OP needed to decide to go to the ER.

I'd really be curious to know if there has ever been a medical askme thread with a similarly documented or known bad outcome. (Not that this one had a good outcome, since it proved serious, but at least the right action was taken.)
posted by jsturgill at 1:07 PM on January 27, 2011


Well, there was this.
posted by Night_owl at 1:31 PM on January 27, 2011


I don't see from her AskMe history where it is shown the community did her harm. As far as I can tell, she both engaged with Metafilter and was persuing medical help. I couldn't find an obit, so I don't know the circumstances of her death at all. I don't know that Ikkuyu's characterization of the site's effect on her life and death is accurate. There certainly isn't a figurative smoking gun in her last few AskMe questions. I don't think it's comparable.

I also think I'm a bit of an ass to talk about her death in those terms. She was a real person, and her death, like all deaths, diminishes us all. I don't think there's a good way to incorporate her into this discussion that is also respectful.
posted by jsturgill at 2:06 PM on January 27, 2011 [2 favorites]


empyrean wrote: "Hospitals willing to forgive $250K of debt? What the hell?"

I'm late to the "party," but I can tell you that hospitals often lose lots of money because they can't/won't collect debts. Which is ironic, given how many stories you hear of people drowning under medical debt.

desjardins wrote: "How is it possible that we're in the same country and I have had to sign something to this effect every single time I've been to the hospital? It basically goes like this "if your insurance company refuses any of the charges, you agree to be liable." And boy do they hold you liable, they call me every other day."

There was a Frontline episode that touched on how certain for-profit hospital companies have been buying up hospitals that are treading water and turning up the volume on collections and otherwise attempting to squeeze more money out of people who can't afford to pay.
posted by wierdo at 11:09 PM on January 30, 2011


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