Sunday, November 18, 2007

T/T ratio

I have to admit that I am a big fan of competition and a fair market when it comes to most things. It hurts me to think that we may need some king of national healthcare. The reason I am so concerned is this. If we can deregulate the insurance industry similarly to deregulating the airline industry, we might lose a few insurance companies, but in the end we might get lower fares and better benefits for our ER frequent fliers. The problem though is that no matter what we do, some of those who come to the ER won't get insurance if it was the cost of a pack of smokes or even free. (I really do think we need to deregulate the insurance industry, but i digress.)

These patient's who would never get insurance are the one's who tend to come it when the bar closes after they have wrecked their car and taken all the meth they can. They can usually be rapidly identified by their T/t ratio > 1.0. Where T=tattoos, t=teeth. As luck would have it, a T/t ratio > 1.o seems to confer temporary immortality for all but the most horrendous major traumas. Other factors that seem to help identify this group and that confer temporary immortality are the following: postitive for over 3 illicit drugs on their tox screen, facial tattoos*, blood alcohol of 0.3 or greater, being readily recognized by the ER staff, transferred from jail*, allergic to all pain medications except OXYCODONE, had last bath 2 weeks ago*, colostomy from prior gunshot wound, homemade tattoo especially if it is spelled wrong, and lastly if they are pushed out of a car that leaves the Er at high speed. (*original composer of this trauma scale unknown, immortalized by Rip Pfeiffer M.D.)

Interestingly, the same patients with a high T/t ratio also are the ones who seem to know "a good lawyer" and threaten to sue. Anyway, they are not the ones that are going to take the time to fill out forms for health insurnace even if it was free.


Chrysalis Angel said...

I wondered what the heck a T/T ratio was. Interesting observation. It's great to see you posting again. It helps to get some of all this daily "stuff" out, and we enjoy reading you.

SeaSpray said...

Hi Throckmorton- I am not familiar with this deregulation that you speak of. I really never paid attention to any of it. They did it with the phone and electric companies too..yes? So it gets rid of a monopoly thus forcing fair competition? forgive me but economics not my strong suit. I know our health system is in a crisis. I have read through a lot of med blogs in which this topic has been discussed although don't recall anything about deregulation but I could have missed it. It is all mind boggling to me but interesting. I saw the sicko film and was disturbed by it. I immediately got up and started posting about it and expressed my questions/concerns. i an in no way a fan of michael Moore but he did get me thinking about it. I knew he would present from his biased perspective but still if it drew attention to the issue then kudos to him. I did think the scene where they were in the boat approaching Cuba was funny.

So, I did a post about the pros and cons of socialized medicine. I don't have the knowledge that you docs have and so my post was from a lay person' perspective although I did put a lot of doctor links in there and want to add some new ones Scalpel did fairly recently. I get more hits on my stat counter from people using search engines looking up info on socialized health care. The questions come in from around the world but mostly the u.S. and so I would say that it is a concern to many Americans. The only other post on my seaspray blog that gets equal or more hits is the one I did on Kidney stones. I am guessing that kidney stones must be the urologist' bread and butter or pay for their child's college education and must be very common. oh and one other post gets hits. I posted a funny e-mail that was sent about why guys pee outside. Well, again..people are looking up peeing outside and all kinds of things involving peeing. Who knew? So i am currently collecting the search requests on peeing because some of them are hilarious and may try to do a funny post using them. But i digress.

I've heard about the t/t ratio before and you are right that they probably wouldn't care about insurance although some would. some have MDCD so maybe they would go for it. On the other hand I often gave out the financial assistance forms (charity care) with careful instructions on who to contact and when they came in they never did it and so they were still without coverage.

It is tough for the doctors too and also for pts with insurance although obviously worse for the uninsured.

It seems to me that you docs need to come to an agreement and then present a united front. It doesn't seem right that ins companies make money with denials. But that is how they keep their money.