Hospital Bill: Appendix Ultimatum

I have finally squared away my various hospital bills from last August's appendectomy, so what follows is a discussion of the hospital charges versus what everyone involved finally got paid. Excitement! Suspense! Thrills! Chills! Horror! It's hospital claims data!

Episode One

First things first. A hospital visit includes a bunch of stuff, so I'm going to give you the full price for the entire episode of care, but I'll also break it down so we can see the component parts. And special thanks to CIGNA, who upgraded their Web site and now allow me to get claim records from more than a year ago. I'm now with Aetna as of January, and I haven't dealt with their Web site yet...

Episode of Care:

Total Charges: $28,089.62
Total Paid: $8,324.25 (real cost)

29.6% of charges paid. In other words, my bill was three times higher than the negotiated price between those providers and my insurance company. If I had no insurance, my bill would be three times higher than the going rate for a pretty nice PPO.

This includes the emergency room, radiology, surgery, and two physician visits. Disclaimer: I was told to go back to the hospital to have my staples removed, but I elected to go to the wound care doctor who is literally next door, so he charged me for a physician visit and the "surgery" of removing the staples. I'll break it down in a minute. I added in my whopping $40 in two copays as part of the real cost.

Episode One and a Half

Also, for a giggle, I'm going to add up the whole year's worth of care. This includes:

1. Going to Hospital A, then leaving before being triaged (free!)
2. Going to Hospital B, getting the appendicitis diagnosis, then running away.
3. Seeing a gastroenterologist a week later.
4. Going to Hospital C and getting the little bugger out.
5. Doctor's office visit to have the staples removed.
6. Follow-up a couple of weeks later to get the all clear.
7. Drugs. Also free, as I never cashed in the pain killer prescription. I'm Welsh. If we're in pain, we simply punch ourselves until we can't feel it anymore.

Total Charges: $32,327.92
Total Paid: $8,898.80 (real cost)

That makes it 27.5% of charges paid.

Charge!

Let's look at just the single hospital visit, from ER to surgery to discharge, charges first then what was actually paid.

Emergency Room: $1,185.00 - $419.68
Emergency Room Physician: $1,461 - $460.60 (more info)
Cat Scan: $2,015.00 - $713.64
Operating Room: $3,250.00 - 1,151.03
Surgeon: $1,740.00 - $626.81
Anaesthetist: $1,601.00 - $787.50
Recovery Room: $3,100.00 - $1,097.91
Pathologist: $35.00 - $35.00
Semi-Private Ward: $5,000.00 - $1,770.81
X-Ray: $127.00 - $44.98
Per Diems: $5,850.70 - $5,850.70
Labs, Supplies, General Medical Services: $1,627.04 - $652.65

(Plus the New York State Service Charge: $523.64 - $523.64)

Total Hospital Charges: $22,718.70
Total Paid: $12,078.38

So the hospital visit was reimbursed at 53.2% of charges.

Hospital Versus Doctors

And finally, one more split. Let's see hospital charges versus the various physician charges:

Physicians Charges: $4,837
Physicians Received: $1,909.91
for a 39.5% reimbursement rate.

Hospital Charges: $19,342.70
Hospital Received: $10,629.07
for a 55% reimbursement rate.

Choosing A Hospital

By the by, a report card I happen to know a bit about lists this particular hospital as having an average charge for an appendectomy as just under $11,000 with a 2.4 day average length of stay.

In all fairness I didn't have a laparascopic procedure so I ended up staying a bit longer. I should also point out that I chose this hospital using the afore-mentioned report card based on the lower-than-average length of stay.

I wanted in and out as quickly as possible, so I shortlisted the three with the shortest average stay and chose from there, not wanting to be at one of them based on hearsay. That left two and I chose the one with the cheapest average charges. I'll be asking my boss for a kickback on that saving any day now...

Why Should I Care?

So many reasons...

For one thing, there's a myth that insurance companies underpay. This is based on hospitals not getting their full charges paid. However, it's important to note that these prices that are paid are negotiated business agreements between the hospital and the insurer. No-one stiffs anyone, it's a business agreement. As in, it was agreed.

The charges are based on a chargemaster list, every hospital keeps one, and those charges are so rarely used they don't really reflect the real cost of doing business. If an X-Ray was set at $25 a couple of decades ago, every year the hospital might add 4% to the chargemaster as a way of not dealing with every last line item and that X-Ray charge goes up and up.

On this bill, the X-Ray was charged at $127.00, but the hospital had agreed with Cigna that $44.98 was good enough. That's because the $44.98 is based on hospital costs, not charges, and unfortunately, getting cost data is nigh impossible.

Trust me. I've tried.

The Little Guy

The person who actually gets stiffed is the person who doesn't have an insurer bargaining on their behalf like I do, that person gets a non-negotiated bill for the full amount, $127.00. (In New York last year, about 5% of discharges were uninsured.) From here, two things can happen.

One, the person pays it, and the industry quietly nods and says that uninsured people who pay are generally wealthier individuals who are propping up the underpayments they're getting from everyone else.

Two, the person doesn't pay because, as is most likely, they're poor, and the hospital sends their bill to a collection agency.

Then what happens is the hospital bills you and me, the taxpayer, for uncompensated care. They tell New York State at the end of the year that Joe Blow had an X-Ray and didn't pay, therefore they bill us the $127.00. At least we assume they do.

That $523.64 NYS Service Charge goes towards uncompensated care, in New York there's a big pool of money that gets divvied up at the end of a financial year and pays the hospitals for their "charity" care. This bugs me for three reasons:

1. Hospitals operate tax-free, on the premise that they perform community service, maybe I could call that charity care. So which is it? Tax-free or get compensation from the state? Apparently it's both. I'm sure it all works out somehow, but it just smells funky.

2. I believe that most hospitals use the full charge as the "cost" of charity care, when in fact they should use a more reasonable cost-based rate. Charging the state or writing off $127 for a $45 X-Ray just doesn't seem right to me.

(I waded through one year's worth of charity care filings once, I haven't been right since. If anyone knows more than me on the subject, please comment below.)

3. The bill possibly went to collections. Some portion of it was collected on top of the amount that was claimed as charity, does that get deducted from the claim? If a hospital sold the debt to a collection company for ten cents on the dollar, do they still claim the full amount as charity care? I don't know, but I know which way I'd bet.

4. The patient who doesn't pay possibly gets sent to collections. In return for receiving charity care, which we all paid for in some way, the poor guy has bad credit for seven years minimum. Does that make sense?

(I know that's four reasons. I just thought of number three.)

So, if I figure this right, a $45 unpaid X-Ray gets maybe $4.50 from the credit agency, some unknown portion of $127 from the uncompensated care pool, let's take a stab at 75%, and the hospital then gets a tax break for doing so, which is probably worth more than all that combined. Some credit agency further recouped, say, $20.

By my ridiculously unscientific calculations, that $45 X-Ray generates about $200 in revenue. I wish I could give a better answer, I do. Which is why I do what I do.

This stuff shouldn't be so darned complicated.

Your Paycheck

I keep saying this, but all too few people seem to get it. I could have gone to a hospital that charges three times what this one did. That would have generated a bigger bill for my insurance company. They would then have charged my company where I work. My company would then refigure it's health care expenses next year and either (a) make me pay more for my health care, (b) not have as much money hanging around to give me a raise, and or (c) change the health plan to include fewer benefits.

It's that simple.

Health System or Health Sector?

Health care, among other things, is a business. That's the goal of this blog pretty much, to stress the fact that doctors and hospitals and dentists and chiropodists, all lovely people for the most part, are in business. It's not offensive, it's not an attack, I just think we should spend a little more time paying attention to how much we pay for this stuff.

Health care gets a bad rap from a lot of angles, and most of this is based on lack of insight. What we don't know, we don't trust.

Open up your books. Simplify your billing and claims. I can see from my bill that my surgeon, a guy who cut me open, cut a bit of me out, then put me back together again, got paid $626.81. I think that's fair for three hours work. Actually, I think that's a bit low. $209 an hour seems a bit thrifty, I'd go $300. If someone asked me the value of cutting bits of me out safely, I'd say about $300 an hour.

But knowing it makes me a better consumer. Knowing it makes me understand his angle. Knowing it makes me understand my impact when I go for surgery.

And I bet knowing it would help you too.

I think I managed to get all this into OutOfPocket.com and I urge you to check them out. They store details on charges compared to actual money paid.

And if you'd like to compare the cost of your care, have a look at Consumer Health Ratings, a directory of the many report cards available in the country.‎ Full story...

And I Should Know This... How?

I still haven't blogged my bill for having my appendix removed, because I've been waiting to tie down the bill itself. The hospital I chose was in-network for my health plan, but I'm getting a bill for a little under $800 for the ER services.

So, it turns out that while the hospital is in-network, the doctor in the Emergency Room is not. The doc is not employed by the hospital, but instead is essentially a consultant.

How I'm supposed to figure that out I have no idea. How I'm supposed to find an in-network ER doctor during an emergency I have even less of an idea.

Back when I was a consultant, tax law requires that if I work a certain number of hours for one employer I cannot claim self-employment or consultant status as that would essentially allow corporations to evade employment costs. I wonder if this applies to ER doctors?

Do ER docs work at multiple hospitals, multiple employers?

But still, my main point is that I chose a hospital that is in my health plan's network, but the ER doctor is not being paid by my health plan because she's not in their network. Hence, I have a bill for $900.

How the heck am I supposed to avoid that?

It's an EMERGENCY room. I had appendicitis. I assumed once I was past the front desk and my health card had been entered into the system and approved as a method of payment, that my care was going to be provided by in-network staff. Why should I believe any different? How could I possibly choose which doctor attends to me in the ER?

And had I known or found out, what should I have done? Gone to a different hospital?

I received two bills from the generically-named billing company and I thought I was safely ignoring them, that my insurance would figure it out and kick in at some point. Now I'm getting collection threats which prompted me to follow up and find out that the health plan considers this doctor out of network.

This is the same insurance company that paid the $16,000 appendectomy bill no questions asked, but they won't pay the doctor bill that was submitted for service on the same day as the operation.

Make sense?

Nope.

And people ask me why I think it's important to bring transparency to health care...‎ Full story...

I Told You So

"Have them take it out, it's not even necessary". Amidst all the appendixotic shenanigans of this year, people kept reciting this to me. "The appendix is vestigial". "The appendix is useless". "You don't even need it".

Now, I'm not a god-fearing man. I don't subscribe to creationism and only slightly less non-subscribing to evolution. I live in the here and now, and if my body saw fit to grow an appendix then dammit it's there for a reason. I dodged having the thing removed for a long time over this.

Apparently it's where all the good germs live (Science Daily).

So, in some form of anti-Jaz spite contest, the medical community held back on letting the world know what the appendix is for until I had mine removed.

Bah.
‎ Full story...

Appendix Ultimatum

So, the old appendix flared up again, as of course it should. Same symptoms as before, it was evident what was coming. I left work, drove home, and prepared for my first hospital stay.


(Quick reminder for the uninitiated: I visited Hospital A in February with symptoms of appendicitis, waited six and a half hours in the E.R. until giving up and going home. I then visited Hospital B the next day and had the most awful day I've had in quite some time, culminating in me being seated on a gurney two corridors away from the E.R. outside the isolation room where a guy with full-blown tuberculosis and his wife were wandering in and out of isolation back and forth in front of me complaining of the heat. I've had a dodgy appendix for quite some time. Read the full story in all it's glory here.)

I gathered a book, a change of clothes, and the average length of stay for the five hospitals closest to me - not including hospitals A and B from my prior sojourns. I then had a good night's sleep in my own bed, and mentally prepared to lose myself to the system for a few days.

I saw that my hospital of choice had lower than desirable scores for infection prevention, so I made a note to bring it up when antibiotics first appeared.

My plan was to hit the 8 a.m. shift change, but my subconscious desire to not go to the hospital had me pacing the living room until nine, so I didn't get to the hospital of choice until ten. Nonetheless I was triaged within 12 minutes and was seen by a doctor within another 15.

Emergency Preparedness

The E.R. proper was impressive; clean, lots of open space, certain areas were labelled - such as the asthma section. The doctor who saw me was amazingly friendly, very informative, listened and heard the story of my history with appendicitis and it's atypicality. I drank the stuff you need before going for an MRI and was confirmed to be suffering from appendicitis by around 3 p.m.

I was told that I'd be admitted to the E.R. and therefore settled in for the wait.

It should be noted that this whole time I was in my regular clothes. No gown. Clothes. I cannot begin to describe the difference compared to sitting in Hospital B in February all day in a gown.

I was in the E.R. up until around 7 p.m. During the entire day, I felt like I was in a place that was very aware of its patients. My E.R. doc was fantastic. Checked on me every once in a while, I received regular updates about my status. Around tea-time the learner doctors began arriving one after the other to poke and prod.

I was given a form to sign that acknowledged I had received various forms and information. I asked for the said forms and information, but was told I would receive it the next day. After a brief exchange of dry sarcasm, I elected to shut up and sign the release, making a mental note to see when the information actually arrived.

It was given to me two days later.

As the reality of surgery became more and more present, I asked the learner doctor surgery chap who was taking all my details down about how I could remove my appendix home with me. While it may seem odd to some, I am part of a large group of people who actually want to keep their hands on the bits that come out of us. I asked earnestly about my ownership of my slated-for-removal organ, and even offered to go halvsies on it so that pathology could have something to look at. I asked two different surgery doctors to check on this for me, I never got an answer nor did I see those doctors again.

Slowly, as my status was swinging from profitable E.R. visitor to run-of-the-mill appendectomy last thing on a Friday night, I became less of a customer and more a vocal cadaver.

Special Ops

Looking back, the thing that really peeves me is that no-one ever told me what was going to happen *after* the surgery. I did not know I was going to be shaved "down there".

I did not know I was going to wake up with tubes up my nose and another down my throat into my stomach. I did not know there would be metal staples in me. I did not know I would spend the night in a recovery room full of other people.

None of this was impossible to deal with, but knowing it beforehand would've made waking up after surgery a whole lot easier.

Seems to me that pre-op I should be given a one-page handout along the lines of "Appendectomy for Dummies" that covers what they're about to do and what things will be like after.

One page. A couple of paragraphs. That's all I'm asking. I don't want half an hour with a very busy surgeon stroking my hand and reassuring me. Just give me the handout.

So I woke sans appendix. The operation took longer than expected as my appendix was reluctant to leave, for which I feel proud in a silly way. The surgeon chap, when trying to impress upon me how aberrant my appendix was, exclaimed "that was one ugly appendix", at which I was offended in a silly way. It was twisted around and clinging on, he described it as having to "peel it off out of there".

The first 24 hours were simply uncomfortable as I had this pipe down my neck. I finally made it to a room, where I experienced my first real time in a hospital bed.

Overall, the stay was great, everyone was polite and friendly. The only real grumble I have is that the surgeon was very obviously agreeing to anything I asked like "please take this pipe out of my stomach" or "let me eat some ice chips" but he had no intention of doing so, which he could have just said so instead of trying to placate me.

For example, he told me the pipe could come out within the hour, left the room and gave no such order. This happened three times, all the while he actually wanted the thing in there about 36 hours. He told me this after it was removed, along with why it had to be in there for so long in the first place.

Information I could have really used, say, 36 hours ago.

Feed Me

Due to my atypical presentation, the guy wanted me in hospital for four or five more days. I worked really hard on walking around, looking healthy, and passing gas "back there". Given that I chose the hospital based on their apparent ability to kick people out relatively quickly, I felt I should give it the old college try. The surgeon really wanted me to stay in, but after talking to the resident who was visiting me, the surgeon came by eventually and checked me out. Again, I really felt listened to, like what I was saying was relevant, that I knew my limits and capabilities, I knew my body, and I felt like I would recover better at home. I was passing gas "back there", I was walking around unaided, I was peeing like a racehorse. The guy let me go home, albeit reluctantly and with many cautions about when to come back if such and such happened, but the point is they listened to me and let me go home.

Either that or someone googled me and figured they should let me go before I caused a scene

By the by, why is the no Internet in hospitals? I worked every day checking E-mails, I would have loved to do some research on recovery from appendix surgery, check the rugby. I was reduced to working on my phone which is mind-numbing after any decent amount of time. Get some wi-fi people! We'll pay for it, don't worry, you can bill it to the room just like the TV.

Three days later, when I was becoming ready to kill the next passing orderly for a tub of strawberry jelly, the senior resident for the day, after having asked me about 15 times if I was passing gas "back there" agreed to let me get some "clears", code talk for jelly, stock and tea - which in American means Jello, broth and... tea.

UK jam, US jelly
UK jelly, US jello
UK stock, US broth
UK broth, US chunky soup


I was so concerned that these orders wouldn't be passed on I ninja'ed the "Nil P O" (no food by mouth) sign above my head and removed it to the wastepaper basket.

That lunch time I received a tray with two jellies, a bowl of beef stock, a cup of tea and a bread roll which certainly doesn't seem clear to me but I wasn't about to give it back.

Never has a bowl of beef-flavoured water tasted so good. Three days without food is cruel and unusual in my book.

Nailed To The Door

All in all I'm glad the appendix is out, I wish I had it at home, and the hospital experience was middling. The E.R. was truly great. Everything else was vanilla. Maybe it all comes down to who's on duty that day. I don't know. I know I'm writing a letter to the E.R. doc and her boss to say thank you, they really exemplified everything I want to see when I'm in the E.R., I couldn't have been happier or more pleased with the care.

The only truly awful moment came on my third night when a roaming minstrel was allowed onto the floor and he minced from room to room with his guitar taking requests and singing to the patients. It was bad in a comedic, wincing kind of way.

I half hoped he'd break a string so I could make a luthier reference, a joke I'd been crafting for just the right moment, but the chance never came.

Ah well, it was a stretch anyway.








‎ Full story...

Hospital Bill: Appendix Addendum

Well, my weekend got away from me, so I'll settle for blogging the hospital bill I just received regarding my recent day trip to the local Emergency Room, as chronicled in Appendix Addendum.

In case you missed the first post, I went to one ER, bailed, and went to a second one the next day. In all fairness, I haven't seen a claim made on my first, failed visit, which I'd be cool with if they billed for the labs they more than likely ordered before I left.

So, Hospital B.

In short summary, I had a blood and urine workup, one CAT scan, and was seen by an ER doc and a surgeon.

The bill goes like this:

Eight, count them, eight lab charges.

$101.00, $125.00, $28.20, $89.00, $89.00 again, $96.00, $50.00 and $62.00

Total lab charges: $640.20

Total amount covered by my insurance company? $62.41

All lab charges were covered to the tune of 9.75% exactly, each individual charge was paid at 9.75%.

Now, if this had been ten years ago and I was starting my little business and was scraping by uninsured - which is exactly the situation I used to be in - I would have been expected to pay $640.20, even though the hospital is perfectly willing to accept 9.75% of their bill as adequate payment.

Weird, huh?

So, what else. Ah yes. The CAT scan.

For some unfathomable reason I have two CAT scans listed. The first one was $1,022.00 and the second one was $1,043.00

I'm pretty sure I only had one CAT scan, I mean, I was there. Maybe one of these charges is a radiologist charge, which would explain the two items, but man, that's a nice paycheck for an hour's work.

Total bill for the CAT scan: $2065.00
Total covered? $201.29

There's that 9.75% again.

There's then a general Emergency Room charge of $516.00, covered at the increasingly-familiar rate of 9.75%, the hospital getting paid $50.30 of the bill.

Finally, the "service charge", $28.10, covered in its entirety. "Service Charge". It's labelled "State Claim Surcharge".

So, the entire bill was $3,249.30, the insurance company covers $342.10, of which $25.00 is apparently a copay I was supposed to cough up, which no-one asked for. Therefore, of the entire bill, the hospital received a check for $317.10, less than 10% of the billed amount.

Here's the rub. An uninsured person would be expected to pay ten times the accepted reimbursement. But of course, if an uninsured person could afford the bill, they could afford insurance.

According to various studies, medical bills account for up to half of all personal bankruptcies. These people have jobs, albeit low-paid and not offering health insurance.

29% of Brooklyn residents have no health insurance, and are not eligible for Medicaid. Those people without insurance have lower access to health care, and will put off seeing the doctor, get sicker, and end up in the Emergency Room, where they find themselves now with an unpayable bill of thousands of dollars, which the hospital has to write off, leading to higher prices etc etc.

I don't claim to have the answer, but market forces are certainly not working at this particular hospital, which filed for bankruptcy in 2006. I grew up in a single-payer society, and while we certainly don't have the best care in the world, we have better outcomes in many areas over the USA and no-one is scared to go see the doctor regularly simply because of cost.

The richest country in the world owes its citizens better than this. Whether it be government or private charity, somehow we should be providing for basic health care for all. The richest country in the world also has one of the widest wealth gaps, the haves are getting way ahead of the have-nots.

In the meantime, if you do get a hospital bill and can't afford to pay it, bear in mind that it's as negotiable as any other bill.









‎ Full story...

Appendix Addendum

This is a personal account of my recent brush with appendicitis and the fun I had getting hospital care...

I had appendicitis, but it took me a week and a half to figure it out. Couple that with my built-in fear of all things medicinal and by the time I had a CAT scan I'd actually beaten the inflammation back from whence it came.

As it turns out, I now know what that funny stomach ache that lasted a week back when I lived in France actually was. That's right. I've had appendicitis TWICE.

So seeing as how I'm this health care report card guy, I decided to put my money where my mouth is and chose a hospital based on the report card I built. Due to the nature of my work I have a better knowledge than most of the hospitals in my area, and I chose Hospital A, high scores for quality and surgical infection prevention, not to mention a nice middle-range $14,000 average charge for an appendectomy.

(Yes, I'm price sensitive. I grasp the fuzzy math that the more I spend on health care, the less my boss has to give me a raise next year.)

The Doctor is Out

I should back up a bit and mention that I called both of my doctors before going to the emergency room, I really didn't feel like I was in an emergency and I simply wanted a doctor to examine me. I'm on the books with two guys in Brooklyn, neither of whom could see me within a day and half of me calling.

I tried, damn it.

One was out for two days, the other had been paged three times in three hours with no reply. The girl at the office suggested his pager might be broken. I've only been to the guy once, in a recent effort to change from my DO to an MD. I like my DO, but no-one else does, the general theory being that DOs suck and MDs are gods. This particular MD was not at all helpful, and managed to lose my head X-rays for a week, but he has privileges at Hospital A so I figured I'd give it a whirl.

Hospital "A"

So off I trundled to Hospital A. It's a nice place, my son was born there, it's in trendy, upper-middle class Park Slope, so I anticipated good customer service also. It's a hike from Bay Ridge, but I felt the thirty minute drive and the potential three days to find a parking spot were worth it.

I got to the ER and wrote my name on a piece of paper and followed the instructions to post it through an anonymous slot. This later turned out to be the triage room.

The ER waiting room was pretty full, and no signs or clocks gave me any indication of how long I would be waiting or how many people were in front of me to see the doctor.

The deli where I buy my lunch can handle this simple task, and they only get five bucks from me. I'm in an ER waiting to spend $14,000 dollars. Come on people!

I waited about half an hour and was methodically seen by a triage person. I told him about my abdominal pain, other uncomfortable and unmentionable GI issues, the mentionable projectile vomiting, and I had my blood pressure taken. Blood was removed from my body with no indication as to why. I assume it was for tests, but still, a few words would be nice.

I was then given a plastic bracelet with a close approximation of my name handwritten on it, and was then directed to the *real* ER waiting room. Up until now I had been in the triage waiting room.

Gah.

The ER waiting room proper had many more people waiting, along with a TV. I toyed with the idea of turning it off using my universal off button, but felt that this was one audience who needed their network television.

I was registered and my billing details were taken. I then waited another three and a half hours or more until I became so uncomfortable sitting on the plastic chair I elected to leave so I could go home and lie down.

Strike one.

--

I didn't tell them I was leaving, I simply left; but here's the reason I didn't go whine about how long it was taking: health care is a service industry. My knowledge of service industries tells me that if I get seen out of order or in response to a complaint I make, my quality of service is likely to go down.

The hospital equivalent of the waiter spitting in your sandwich scares me.

If we're talking about sewing buttons on a coat I may make the value decision to be loud and demanding if I think my button sewing service is failing me, as I do not value buttons highly enough to care if the button sewer subconsciously does a crappy job because I'm annoying; however, I refuse to receive service from a health care professional who may be pissed at me.

I'm just not willing to risk it.

Hospital "B"

The next day I cheated and put my inside knowledge to work for me. I knew that Hospital B had recently filed for bankruptcy, had appeared in the infamous Berger Commission hospital closure list and was suffering a large decline in ambulance drop-offs. Plus, it's literally around the corner from me.

The down side was that, according to my report card, Hospital B scores very low on surgical infection, and had a surprisingly high average bill for appendectomies, a whopping $21,600!

However, I was still telling myself this was a bout of constipation and I really just wanted a trained medical professional to rule out appendicitis.

I trudged around the block to Hospital B and my cunning plan proved itself when I saw only one other person waiting in the ER.

Victory was mine!

I was triaged in about five minutes, and the only difference was that Hospital B also requested a urine sample, Hospital A had not done so. More surprisingly, unlike the scrawled, unreadable bracelet I received at Hospital A, I was given a computer-printed bracelet with my name, date of birth and other useful information on it.

I was begininng to be impressed.

A doctor came out within ten minutes, and guided me to the ER. I ran through the symptoms and professed my half-arsed fear that I had appendicitis, but the doctor pretty much ruled it out as I had no fever nor any other signs usually found with appendicitis. However, she recommended I get a CAT scan. I resigned myself to the three hours of Barium digestion and said yes. By now I was in a hospital gown on a wheeled bed.

Over the course of the next three hours I was successively removed further and further from the ER as people with real injuries and worse pain came in. By the time I was sent up for the CAT scan I was at the very end of the corridor. My gut feeling (pun intended) was that most of the staff figured I was fine, I obviously didn't have appendicitis as I looked perfectly fit and healthy apart from the searing stabbing pain I felt when I poked myself in the gut.

I overheard many conversations about the hospital's recent bankruptcy filing, people's holiday pay, new jobs, that sort of thing. I probably didn't help myself much by having brought a copy of Ian Morrison's "Health Care in the New Millennium" to read.

Undaunted, I got my CAT scan and was wheeled downstairs to await the radiology report. That took about another hour, at which time we found out that yes, of course it's appendicitis, here, have some antibiotics, please wait for the surgeon.

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The best part was when they came up and just started hooking up fluids to an IV without telling me what they were doing. I had to stop them, get their attention, and have them tell me exactly what they were doing and why.

You can't just walk up to someone and start pumping stuff into them, can you?

Who do these people think they are, and who do they think *we* are? I'm sure the routine stuff gets boring after a while, but seriously, inform me.

By now I was actually down the corridor and around the corner, so I was practically outside the hospital. I sat and read and waited. And waited. And waited.

I was so invested by this point I was resigned to waiting for the surgeon to arrive. However, it turns out that I was by now parked outside the room where you put dangerous folk such as people with tuberculosis.

Of course, what are the odds of anyone turning up at a bankrupt hospital at 7 in the evening with tuberculosis?

Odds on, apparently.

A guy was brought in with full blown TB, a fact I only know because the nursing staff were discussing his dangerous-ness right around the corner from me, well out of earshot of the real patients.

Masks were handed out to the staff and the wife was briefed on her need to be tested. All of which was fine, until they left to go do other nursey things and this TB-ridden moron kept LEAVING HIS ISOLATION ROOM. RIGHT ACROSS FROM ME.

So, considering I had absolutely no intention of being operated on at Hospital B, and given the fact that a family of TB was walking past me asking how I felt, I decided to make a break for it. I wheeled myself down to the ER desk and asked to be discharged. Everyone seemed a little perturbed about that and convinced me to stay. I decided to give the surgeon a half hour, after which I would sign out against medical advice.

My antibiotics had finished a long time ago, and I was just in the middle of trying to figure out how to remove the IV from my arm without anyone noticing when magically, the surgeon arrived.

He was a bit flummoxed I think by the diagnosis, and was in no rush to whip the little bugger out. He wanted me to stay overnight but I could imagine nothing less inviting, so I sweet-talked him into letting me go home under the promise that if all hell broke loose in my abdomen I'd be back around the corner in two minutes flat.

He signed me out under "abdominal pains of unknown origin" or some such safety diagnosis, and I went home, whereupon I alternated between sleeping and eating toast for three days.

I feel gipped by this, I have appendicitis, I'm willing to sign out against medical advice, why stick me with a phony diagnosis?

Epilogue

I am now pretty much 100% better, although a bit gurgly. The pain's all gone, I have a huge new understanding of how medical care is delivered and how hospitals work from a patient's perspective, and best of all, I still own an appendix.

Now, I am not the kind of person who believes in vestigial appendages. It's in there, and it's in there for a reason. I do subscribe to the fact that it's great for digesting grass, and I also subscribe to the fact that I am evolutionally unfit to consume grass or other green leafage, being more genetically predisposed to large chunks of dripping red meat.

Therefore, I am now pronouncing that not only are appendices necessary, mine is different from most everybody else's which is why I want to throw up when I see cabbage or lettuce. Or spinach.

So there.

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My next experiment in health care will be trying to schedule an appendectomy without a diagnosis of appendicitis, as I suppose it really should be removed at some point. It's obviously not happy in there, but without a valid reason for having it taken out as part of an emergency, I'm curious to see what my options are.

Seems to me that with my history I should be able to call up a hospital and just schedule an appendectomy, but I've a funny feeling nothing is that easy.

Common sense tells me it would be better to have it removed while it's in a vegetative state (har har) as opposed to inflamed and angry, as then it could be removed laparascopically. But hey, what do I know, I'm just the owner/operator of a human body.

Stay tuned.

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