my son cut the side of his head today at work. we loaded him up and went to the local clinic, bleeding some but nothing awful. walked in the clinic and told the reseptionist we are here for some stitches. oh you'll have to go to the e.r. we dont do stiches here, i told her it wasn't an emergency we can wait, no sir we don't do stitches here you'll need to go to the e.r.
if the clinic has 18 doctors and they can't do stitches what do they do write persciptions? does the e.r.charge a lower rate? i think not. :( :( :(
doctorb please give some insight on this :)
Same thing happened here years ago to my grandpa. He cut the back of his hand on a not running chain saw. It was bad enough to need a few stitches, that was all, but not too bad. The local clinic with five doctors couldn't/wouldn't numb it a little and sew it up. Even if we paid cash. So I hauled him down the road to the emergency room where they got to send Medicare a huge bill for a half dozen stitches. And he went back to the woods that afternoon.
I have heard this many times before. I think the main reasons are liability and the specialization within medicine. Let me explain.
Inherent in both of your stories is that you assume that all doctors are trained in basic wound care. While in a generic sense, that's true, many medical docs have no intention of ever dealing with trauma or wounds in their practices. These docs may be internists, GP's, or family practice graduates, and yes, all have had rotations in the ER during their training, but none are part of a specialty that has these wounds as part of their expected curriculum or their expected post-graduation practice, i.e., none like to do it or are any good at it. Secondly, you do constitute a time consuming emergency to them. If they are crowded that day, how long do you let such things wait?
It requires the office tom have an array of sterile stuff, which they would only use infrequently at best.
Finally, and maybe most importantly, they can't deliver the full package. Many patient with head lacs need CT scans of the head. Many patients with cuts on the back of the hand have extensor tendon lacerations that require repair. They are not equipped, both physically and professionally, to make those decisions in their clinic.
So they avoid the liability of having failed to diagnose a deep structure injury with these cuts, by sending them to the ER where they accept this liability and have ER trained (and probably board certified) MD's. That's why you get so many tests in the ER, because they are deathly afraid of missing something. Tell me red oaks, did they CT your son's head?
So the old stereotype of the country doc stopping his office tom take care of some farmer's kid that comes in cut up doesn't exist anymore, except in old movies. Sorry about your frustration. It's the direction medicine has taken.
I want to second Docs comments. A country Dr. gave me my first set of about 75 stitches as a five year old when I fell on a gallon glass jug, on concrete. He was the only Doc within 25 miles to down town Memphis where the hospital were. Road and autos weren't then what they are now. A few years later, he met me at his office after hours. I'd cut my middle finger on my left hand while I was whittling out the engine compartment of gas model plane. Charged me $7.00 a stitch for three stitches. My mom had me for it. He did a good job but retired then died. By then there were a couple of hospitals with ERs out our way. I've had them sew up some holes also. One advantage is on the forehead, they called in a plastic surgeon who did a fine job with some fine thread. The Docs in the ER probably do a much better job than those in the burbs that specialize in other areas of the human body. I've been to the Med ER in Memphis. They see every kind of wound you can imagine, gunshot, knife slashed, stabbed, farm injuries and auto accidents flown in by helicopter. It's the only Level 5 ER for a good 250 miles. Good Docs in them ERs.
doctorb,
no they didn't ct or anything differerant than the local vet clinic doc would do.
i know all the cya that goes with it but, wouldn't everyone benefit($$) if our whole system wasn't so afraid of being at fault?
this may sound crude but anyone that knows me knows, from now on maybe stitches and other minor stuff will be done at home skip all the costs that go withit.
You can get stitched up in the clinics here, and I hope it stays that way...I got a few last winter when I got a finger inbetween the tail gate of the dump truck and the salt spreader...Ocuh... Didn't even consider going to the er.... Tim
Yes, it's not the same everywhere, but the trend in medicine is to specialize, i.e., control your practice.
Have you guys considered the amount of trust we placed in those country docs who did everything? It was incredible. Childbirth, trauma, chronic disease, mental illness, pediatrics. What a list! there was less to know then, and there was a grateful populous surrounding them who respected his/her judgment. It was not a litiginous time, and he often got paid in chickens or farm work done. He also served as the presider over end of life decisions, which were much easier then. He knew all his patients by their first names, and never turned anyone away.
Now, we're specialized and sub-specialized, including me. Shame, really a shame.
Not gonna start a thread on it. My total hip is tomorrow morning, so I'll be less attentive to the FF for a short spell. I'm glad a country doc is not performing the procedure!
A number of hospitals in our area now have urgent care facilities. Most are in a clinic setting away from the main hospital. It is much cheaper than emergency room care, and just as good. I have had very good luck with them with injuries.
Faron - you're right. Lot's of what we call "Doc-In-The-Box" clinics to take care of small emergencies have cropped up. Shorter wait time as well. these have tried to bridge the gap discussed here.
Oh, and Red Oaks-
I think the whole country and culture would be better off if we could purge our belief, when someone tries to help you with something, that there's a guarantee that nothing will go wrong. This isn't just about medicine, either. We look for fault at the drop of a hat. I could not agree with your sentiments more. And it is the avoidance of fault (risk) that has changed the way we practice medicine.
doctorb
thanks for the insight as always and good luck with your procedure hope all goes well, you'll be in our prayers :)
Glad to hear your son is alright
In 1996 my then 4yr old son fell off the top bunk and hit the back of his head on the fireplace, it was a glancing blow with not much swelling but the wound was an inch long and bleeding a lot. It was 2 am and we were a long way from town. I called the Doc and he asked how long was Tims hair. He said, "Tie knots across the wound and close together. 5 days later I cut the knots out and the wound had healed.
I got scalped by a German Shepherd ex- airforce dog and the local country Doc put 169 stitches in 5 wounds. He did a good job but in all the mess missed a 2inch cut above my right ear and punctures through my hand where I had covered up.
Fingers crossed for a quick recovery Doctorb, and remeber "be a good patient and do as your Doctor says"
This makes me think of the great work that our military combat medics and navy submarine corpsmen do when there is no medical doctor readily available.
Nurse practicioners are also very active in our VA clinics and do a great job.
I know all the medical pros are gonna jump all over me for this, but I used to get sewed up sorta regularly. Haven't had stitches for several years now since I watched a vet super glue our dog back together. I just clean it up now and get out the super glue. I do leave a little drain hole usually. Of course most of these repairs are the "just a few stitches" category. The only wound I have had for the last few years that didn't qualify for super glue would have required darning instead of stitching. :D
I use to watch a guy at work use super glue when his fingers would split in the winter time.
i use the super glue trick all the time. trick is to know when not to use it, if you use super glue when it really needs stitches the docs will have to remove the super glue before they can do anything for you.
on a side note: i have a buddy that got a job years ago, first day out he was running a chainsaw without chaps... cut his knee pretty good. scared to tell anyone, it was close to quittin time he hid it from the boss and made it home.
no money to go to doctor so he just set down cleaned the wound and sewed his knee up.
two days later the employer finds out, they come out and pick him up and take him to the ER. the doctor and the PA both look at it and tell the boss, "we aint gonna touch that"..." it looks better than our work"
he told them he had sewn up lots of dogs before and they healed up without scars too.
Good story ely.
But too often, chainsaw cuts are about 1/4" wide and if more than just skin then there is more to do than just stitch it back.
Have used the super glue as well, but had the stitches once too.
The country doc that delivered me was the only one that touched me till he passed when I was 17. He put more stitches in me than I can count. By the way he died at his office and was close to 80 years old.
my mom had a friend when I was a kid that grew up in the deep backwoods of WV. This ladies brother was seriously cut once doing some sort of farm work. The "family doc" (being the family member with the best hands), took a hair from a horse's tail and proceeded to sew the wound up.
Those horsetail hairs should be sterile enough. ::) ::) :) :)
These are Homelite XL12 tracks. :-\
(https://forestryforum.com/gallery/albums/userpics/20011/2410/DSCN0568.JPG)
They got stitched.
Here if you go to the hospital 2 things are about to happen. Your just minorly injured, or your gonna die. Da was having a light heart attack about 5 years ago. I took him to the ER and we got a DR that didnt speak English well not real good English. He immediatley tried to send dad home saying it was indigestion without chhecking him out. We hauled tail to Corinth and found out dad was having a heart attack.
Two years ago I had a staph infection come up on my wrist from a fiberglass splinter. I just showed up. Went to the family DR and all I could get was a Nurse Practioner. She didnt have a clue they took a sample and reffered me to a specialist in Corinth. I went there and got it lanced and meds. THe next 3 days the NP called wanting me to come back so they could veiw it at my cost. They cant even figure out the rules on giving a DOT physical.
The glue issue is interesting. While I am sure superglue works, we use fibrin glue, which gets absorbed into to skin over time. Many small lacs can be pulled together with steri-strips. If too much tension is present at the wound edges, whether closed with glue or steri-strips, the wound will gap. In such cases, sutures are mandatory.
An emergency room physician wrote a article for Fine WoodWorking on how to put together and use a first aid kit meant for woodworkers. Would work for the majority of us. Some of the items in the kit were Steri-Strips, Corban tape, special bandages, and Super Glue. I've used super glue before, but now I got instructions along with pictures from the article.
Cutting-Edge First Aid (http://www.finewoodworking.com/Workshop/WorkshopPDF.aspx?id=33750) is the url. Unfortunately it looks like ya have to pay something to read the article. For us low tech guys it is issue 216 which came out maybe last December or so.
I was planing to put the kit together but forgot until this thread...got a second chance now.
We used to have a first aid kit for our fly in Canadian trips. It was put together by a Doc to cover some pretty bad emergencies as we were completely on our own for a week. Them fillet knives are dangerous and ya never know when you might hurt your finger pulling pop-tops. :)
update... got the bill from the emergeny room. any one want to guess how much? refresh everyones memory my son only needed 3 stichtes they didn't clean the wound or xray to see about concussion or any thing just 3 stitches . i was are you sitting down for this one...$978.82
this is what is wrong with our country, greed ,gouging ,bending over what ever you want to call it this stuff is killing our country and its citizens faster than any deaise or illness ever will.
doctorb, i don't think you can explain this one in aany way that will make me believe that this is any thing other than i was robbed!
Doesn't surprise me, in fact would have guessed more.
The amount of expensive paraphernalia that they roll out that is all disposable will add up in a hurry, plus the number of hours of Dr.'s, nurses, and other paper shufflers along with the reports that must be filed....all adds up in a hurry. Then add on the overhead of the ER, and then add on the overhead just from the patients who can't/won't pay anything. Almost makes the bill sound cheap. I don't agree with it at all, but it is real.
IMO, get rid of the suing lawyers (or reduce their take to less than 15% of any settlement) and the liability hanging over everyone's head, along with the Gov't requirements and the HMO's and the cost may come down. We are choking on our own spittle.
Don't get too excited about getting a bill for such a small amount, Red Oaks. You ain't got the one from the Doctor yet.
With all the crap going on today...medical, politics, economy...costa rica and nicaragua are looking better all the time...
minor cuts less than a 1/4 in deep.. good ol 3/4 wide electrical tape! done and done i have a roll in my car ( in with my propane soldering iron..lol)
it sticks to itself wet or dry. bandaids dont stick to my skin/ fall off, with exception to the rule , the 3m ducktape bandaids.
I'm afraid it's gonna get worse before it gets better. My son is 9 and I dread what he has to look forward to. Geeeee!