Emergency?

One of the questions my friends from away most frequently ask is what we do up here for medical services. I had a few days ago a (very minor) experience in that question. It illustrates both the problems of rural life medical care and of lack of health insurance anywhere.

Thursday evening, while fixing dinner, I cut a slice off the right-hand side of my left-hand index finger. Because it was bleeding so profusely, I couldn’t really tell how much of an injury it was, but I wrapped it tightly in a strip of muslin in order to apply adequate pressure to stop the bleeding. As long as the pressure was exerted, there was no bleeding, But the minute I stopped, it went back to bleeding. It wasn’t spurting blood; just flowing freely from the cut tissue. What to do?

I am in Canada at the moment, and there is a nearby hospital with an E.R. open at night if I need it. If this had happened when I lived in L.A., I would have thought nothing of driving over to my HMO ER to get their view of what, if anything, needed to be done (specifically, suturing). And they would probably have put in a few stitches because, since I’m already there, why not? But I have no HMO to go to now. But if I go to the Canadian ER, they will charge me around $500 for treatment. I know this because Ed had a similarly-placed but more obviously–in-need-of-suturing injury a couple of years ago and that was the price, plus $400 for a bandage change the next day. What to do?

I got out my book of home care (provided to me by my former HMO) which is very helpful in such instances. On the relevant page, it gave me about 6 indications for seeking medical care with cutting injuries and I was okay on 5 of the 6, I thought (although I really didn’t know the depth of the cut), but not so okay with #6, getting the bleeding stopped. What to do? I thought about the $500. Medicare of course won’t pay for out of country treatment. (Medicare’s view is that if you are old, you should stay inside the country.) My secondary insurer would cover 80% of the cost, but of course I would have to get them to do it, which is likely to be an unhappy though eventually successful piece of work. But it isn’t just the money; or it is, but not my paying for it. It is that I feel very strongly about not using medical care if it’s not really necessary. And I don’t know whether it’s necessary in this case. But I do know that the research shows that when patients judge whether care is necessary, they’re as likely to go without care they need as without care they don’t need.

Had I been in Point Roberts, it would have been much the same problem. If stitches are to be effective, they must be done within 8 hours, says the home care book. And I had no access to anyone in P.R. at that time of night+8 hours. (During three days of the week during the daytime, there is a clinic that would have been a simple answer, however. Lesson? Use knives only during daylight hours on the days the clinic is open.) I could go over the border (a 15-minute drive at most) to the E.R. there, but that solves no problem, because I’d be back at the Canadian ER charges for non-Canadians. I would have had to drive an hour each way to a Bellingham (U.S.) hospital and wait several hours once there probably but, because I’d be a Medicare patient, they would be likely to tell me I didn’t need stitches if that were marginally the case, because the Medicare reimbursement is very low.

Left on my own (and with Ed, of course) to decide, I went for more dedicated efforts to stop the bleeding and was, eventually, more or less successful. Enough to decide to let the rest of the 8 hours lapse, which ended the decision period. So that’s how we deal with health care up here. I think that my mother (born in 1911) and my grandmother (born in 1888) would both have known right away what to do and, if it needed stitches, could probably have done the sewing themselves. But we’ve lost that kind of knowledge now. And that’s one of the reasons our health care costs so much.