Monday, March 13, 2017

What's the ICD-10 for "Fucked-up healthcare system"?

Details changed, it's all fiction, I'm really a 400 pound Ukrainian hacker, etc.:

Differential diagnosis includes [but is not limited to] fracture, laceration, abrasion, contusion, hematoma, ligamentous injury, vascular injury, nerve injury

In summary, this is a 29-year-old male who has done his utmost to follow the plan laid down for him when this tibial plateau fracture was dx a week ago. He has followed up with his primary. He elicited a list of possible surgeons directly from his insurance company. He called ALL surgeons listed as accepting his insurance. Five would take him, but have no appts in the next month. He then appropriately returned to his primary, who then referred him back to our ED.

I spoke at length regarding this case to Dr. It’s-2a. Not only would he not see or treat the patient, he was emphatic that the consultation itself was inappropriate and that it was a social work issue. Despite that his expertise was of benefit in that he set the maximum time the surgery, ideally obtained btw 7-10 days, could be delayed (two weeks from the injury, leaving four business days for Mr XXX to overcome the hurdle of not having a orthopedic doctor who would see him within a month, obtain a consult with them, and be scheduled for and obtain surgery) and advising that Mr XXX's coldness/swelling, in the setting of normal pulses and sensation, likely reflected a need to keep the leg elevated more consistently to reduce edema. Appreciate his consultation.

As the initial trauma was caused by a motorcycle accident, OSH YYY trauma service agreed to accept Mr XXX in transfer and, in their words, "work something out." Very grateful to them for their help with this extraordinarily frustrating case of an insured patient who seemingly "did everything right" but nevertheless was not able to obtain critical time-sensitive follow-up care.

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