You want reform. I'll tell you what reform should look like.
911 dispatcher: Medic 20 respond to an unknown medical at 397 bullshit st. apt. 1297.
First Responders: Yea, he's on the 12th floor. No elevator, so you should take your stair chair.
Me: You know, they have two feet and I only have one back...
(Paramedics walking up 12 flights of stairs with a 30lb bag, 20 lb monitor, 15 lb stair chair and 10 lb oxygen bag and an unmeasurable amount of disgust.)
Patient douchbag: I can't move. I've cut my toenail to deep and it is bleeding. I need to go to- big fucking hospital 20 minutes away- because my doctor is there and he is the only person who can treat me.
Me: So, let me get this straight. You cut you toe nails tonight (2:30 A fucking M) and your big toe on your right foot is bleeding so you can't walk?
Patient: Oh yea, I can't stand because it's hurts like hell and you know I am a diabetic.
Me: Ok, is there anything else going on? Surely to God you really didn't call me because of this?
Patient: No, I just can't walk because my big toe is hurting so bad. I'm afraid that it will get infected and they will have to amputate my foot. I've seen you before and you know that I have diabetes. You know that and I've looked on the internet it says that diabetics are at a higher risk for infection.
Me (thinking): Did you notice the articles on smoking and eating like hell until you can't breath and weigh over 300 lbs could be detrimental to your health?)
Me: Ok, your toe isn't an emergency. I can clean the cut and bandage it with antibiotic ointment. If you have any signs of infection tomorrow then you should call your family doctor and make an appointment so they can evaluate you appropriately. That way you could see your doctor and wouldn't have to leave your house tonight since it's a blizzard outside and there is already six inches of snow on the road. You know there is a good chance we may not even make it to0 - big fucking hospital- tonight because of this.
Patient: I'm not sure. I have medicaid and it will pay. You have to take me to the emergency room now because I called 911 and I don't have a ride that will take me to my doctors office two blocks down the road tomorrow.
Me: Ok, you know what, I really tried to be nice. I can't believe that you would call 911 during a blizzard at 2:30 in the fucking morning because you cut your big toe with a pair of toenail clippers. I am not going to carry you down 12 flights of stairs and pray that my driver will be able to navigate unbelievable road conditions putting both of our lives in danger to take you the emergency room were they will tell you the same thing I just told you. I will bandage your foot and you will call your doctor during normal business hours and get an appointment because that is the most appropriate action that should be taken.
Patient: I knew Obama would wreck the healthcare system. I'm going to sue you, your county, your OMD, your OMD's group, the county, the state, the federal government and the president because my I should be able to go to an emergency room on any whim and get exceptional treatment anytime of the day!
Me: Well go ahead, because the new legislation says I can recommend that you should - go fuck yourself- get the most appropriate medical care. I am protected by new laws that says I won't loose my job and you can't call an ambulance chasing lawyer to defend you. Thank you for calling and I hope everything works out ok.
Fantasy I know. In reality- because this really happened to me- I carry this big stupid motherfucker down 12 flights of steps into a blizzard and drive to big fucking hospital during a blizzard at 2:30 in the morning because I can't say no.
Real reform would stop this abuse and give better training to prehospital personnel so they could triage patients and advise them of the most appropriate action. I know this is only a tiny reason the American healthcare system is broken but reform must begin somewhere.
Why does an emergency department have to absorb the cost of ignorance?