Jack Coulehan is a physician and senior fellow at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University in Stony Brook, NY. He describes himself as “not only an experienced physician, but also an advocate—in fact, a teacher—of standard-of-care practice.”
But he was no match for the vagaries of the hospital emergency room.
In the most recent issue of Health Affairs, Coulehan writes about hearing tales from friends about being “caught in a web of excessive and unnecessary medical testing” when they went to their doctors for seemingly routine problems. Although sympathetic, he couldn't really relate.
He goes on to say, “Many of the tales also included delays in receiving their test results, frequent referrals to specialists, and poor coordination among health professionals. Naturally, I’d express sympathy or outrage, whichever the speaker seemed to expect, but internally I’d pat myself on the back. I felt fortunate that there was absolutely no way I’d ever be stuck in such a scenario.”
Well, it turns out that Coulehan was wrong. A bout with self-diagnosed shingles on Easter Sunday sent him to the emergency room “to confirm the diagnosis and get my prescriptions.” Instead, Coulehan ended up spending all day in the ER, seeing an ophthalmologist and neurologist, having two MRIs and a CT scan and racking up $9,000 in medical charges.
The tale he tells of “the Great ER Caper,” provides a clear example of the “unnecessary testing, inappropriate consultation, and uncoordinated care” that are rampant in hospital ERs and throughout the health care system. Chastened by this experience of winding up as “a poster boy for excessive medicine,” Coulehan asks;
“How can we make stories like mine less common? The only way is an approach to health care reform that encourages well-coordinated, standard-of-care practice and one that simultaneously discourages the irrational shotgun approach to medicine.”