"Dumping"

[Celiac Plexus]

During my intern year I learned about the fine art of "dumping". This term refers to the transfer of an uninsured patient for the sole reason that he/she is uninsured. A lot of the times the report over the phone describes a surgical problem that cannot be handled by the local surgeons for... any number of reasons. When the patient arrives, usually the only thing "wrong" with the patient is the lack of insurance. Only when we finish admitting the patient, and finish reading all of the transfer notes, do we realize that we have been "dumped" on.

My personal view on "dumping" is mixed. I feel that every patient is a learning experience, and as such I welcome any admissions/transfers. The residents don't complain at all if they get to operate. Sometimes, I get pissed because the transfer comes in just as I am trying to get out of the hospital, but otherwise if I'm already there then what does it matter?

From a professional standpoint, I think that it's bad medical practice to transfer sick patients long distances just because you know you're not going to get paid for taking care of them. Their morbidity is increased, and the overall cost of caring for the patient is increased. Also, as a physician I believe that you have a duty to help people out regardless of their ability to pay. Granted, we all have to make a living, but I find the thought of transferring a patient for financial reasons distasteful.

Finally, I was just wondering if any other residents at academic centers experience this, and if so, what are your feelings on the matter.

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[rotty1021]

It's lucky that we get dumped with patients that are operable, thus making the learning experience fun in that we go to the OR, unlike our IM counterparts. Imagine being dumped with a whole smorgasboard of incurable medical problems...

 

[Paulista]

I don't think dumping of patient who are uninsured is necessarily without profit. In many states, patients without insurance get emergency medicaid which covers most of their treatments. In some states, this same medicaid pays really nicely, specially in SouthWest.

In East Coast, Surgeons get like 200 bucks to take out a appy under medicaid, but in southwest they get close to private insurance rates.

Plus, you get paid for consult portion as well.

From the trainee's perspective, what we call service patient is good.
Attending do not hesitate in giving the case.
I had attendings first assisting while the resident do the case. Only way to learn to operate in my opinion.

At the end, Dumping does not seem so bad.

Now, I do disagree in shipping patient out unless it can't be taken care of in house. Like one hand amputation case, I was forced to send patient to Bellevue/NYU Hand Transplant Team.

I think making the right decision on who to transfer or not is also part of the surgical training.

 

[neutropeniaboy]

These have been my favorite dumps:

1. Patients with epistaxis while on Coumadin. They're an automatic stay of at least 5 days. But, in many we get to do IMAX ligations, so there is some light at the end of the tunnel.

2. Big head and neck whacks that develop fistulas or wound infections. Got HBO? Sure we do...30 days.

3. Somehow, we only get the UNinsured facial fractures.

4. Patient with renal failure, CHF with an EF of 20%, DM, intracranial bleed, intubated, and...oh, neck mass.

5. Intubated patient that needs to be trached.

6. Distal esophageal stenosis. Does "Ear, Nose, and THROAT" mean anything to you? Or, were we confused with gastroenterologists?

 

[maxheadroom]

Friday afternoon always seems to be the peak time for transfers. It's like we sent out an email: "Got a patient with an extended post-op ileus? Planning on leaving town for the weekend? Transfer your patient to _______ Medical Center and we'll continue to watch the high NG outputs and write TPN."

I was sitting next to the Gen Surg PD on the night before Thanksgiving last year when he got a page for a transfer. It was from a place 200 miles away (everybody else had said "no") that wanted to send a LOL with an ileus. She'd been in house at the other place for two weeks. The PD asked straight up, "So, you don't want to take care of your patient over the holidays?" I heard a fast answer. The PD then said, "Yeah, I can't accept that. One of the residents is sitting right here and he'd kill me if I accepted that kind of a dump on a holiday."

Needless to say, I gained a whole lot of respect for the PD that night . . .

 

[kinetic]

Needless to say, I gained a whole lot of respect for the PD that night . . .

*puts on some Barry White*