The Emergency: A Year of Healing and Heartbreak in a Chicago ER by Thomas Fisher

Author:Thomas Fisher [Fisher, Thomas]
Language: eng
Format: epub
Published: 2022-03-22T00:00:00+00:00

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Dear Dania,

We worked together in your first week as a doctor. It was July 4, and the ER swirled around you during a violent period of the year. As patient volume began to rebound from its COVID lows, the city’s violence was peaking. You had new systems to learn and colleagues to meet. Everything was new. One of your first patients was an older gentleman with a mysterious and complicated condition that caused his hand to swell. We sorted through a treatment plan, but the test he needed wasn’t available because of the holiday. Without that test, you became frustrated by your patient’s clinical uncertainty and the lack of available options. Soon you’ll see more of this: waiting rooms crammed with people waiting eight or ten hours before they see you, and tests and specialists just beyond their reach. You might think that if you just work faster and harder, you’ll be able see everyone who waits, cajole specialists to care for your patients, and maneuver cases toward more timely testing. Sometimes you can, but these issues will usually remain beyond your control. While you didn’t know it at the time, today you glimpsed the way money shapes our clinical systems. I know medical school teaches you very little about how money flows in health care, but maybe I can help you understand why your patient couldn’t get his ultrasound. It was not because you weren’t working hard enough.

I don’t have to tell you this, but money shapes America, and health care is not separate from its influence. In fact, the health-care industry is a cornerstone of the American economy. It is the largest employer in the country. From the engineers who keep our hospital in good shape to the laboratory technicians in the companies that make medications, more than twenty million American workers are employed in health care. In many smaller towns, health care is the economic engine that has replaced factory work. As our economy booms and recedes, people continue to use the system, and the system keeps growing. At this point, about one in eight Americans works in the field. All these people, along with the drugs and technologies that treat illness, cost a lot. In 2018 we spent $1.2 trillion on hospitals, $726 billion on doctors, and $335 billion on prescription drugs, which still only accounted for 62 percent of the $3.6 trillion spent on health care. Taken together, health care makes up 17 percent of all the goods and services America produces in a year. This mountain of money is equal to each American spending $11,172 per person every year.

We know that those health-care expenditures are not evenly distributed. While most people account for very little of this outlay, a few people spend millions of dollars, mostly at the beginning and end of life. Costly and heroic interventions give us more hours or years at the end of our lives, and expensive technologies save preemies as early as twenty-four weeks. In between, most people spend

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