All operating rooms are subject to strict quality controls and must have constant checks on sterility and equipment, and the quality control is often a point for competitiveness among the hospital suppliers. If suture material is breaking or stapling machines for intestines are not working well, a competitor will immediately fill in the void with a better instrument or suture. Competition often breeds better quality. Hospitals and surgical centers have committees overseeing every aspect of medical care to bring the possibility of error or malfunction as close to zero as possible. True, mistakes are occasionally made, but most of the time they are very minor and do not impact patient health or safety. In choosing your site for surgery, you can check out its safety record and its relative scoring with an agency called The Joint Commission on the Accreditation of Hospitals. If the facility to which you have been recommended has scored poorly or has a problem with accreditation...go elsewhere. There are many fine institutions. Go where you feel safe and comfortable!
Chapter 7
OUTPATIENT SURGICAL CENTER
Hey, you need a surgery and want it done real quick
Like takin’ out a bullet or a knife that made ya sick?
Well, come on over to my place, behind Gilhooly's bar
My private surgicenter is a souped up ragtop car.
I wantcha to be paying for the service with small bills
And I can get ya any kind a mainline stuff or pills
I use a knife that's pretty clean, I cut you while I drive,
And I can vouch, some of my patients, dey is still alive.
Over the past decade surgical centers have been popping up all over the United States. They are the alternative to inhospital operating rooms when a patient needs more than a minor procedure and will require general anesthesia or anesthesia standby. The operating rooms are much the same as those found in hospitals, offering full nursing facilities and pre-operative, intra-operative, and post-operative care. The patients usually stay for only a few hours and then have a relative or friend take them home since they will have been sedated to some degree. Some surgical centers actually have facilities to keep patients overnight for observation. Frequently, the outpatient surgical center is near a hospital, so that patients who have problems during surgery or the recovery phase can be transferred to the hospital for overnight observation or more specialized care.
In today's world of cost control, many insurance companies prefer to have less serious surgeries done in the outpatient center because the cost is less and the greater requirements for hospitalization do not have to be met or are less stringent. Still, history and physical exams are required, and sometimes basic laboratory work, chest xrays, and EKGs may be needed. Most surgical centers can arrange for a pathologist to be on hand for doing frozen sections (quick stains for evaluating tissue) when a surgeon wants to remove a skin cancer and needs pathological confirmation that all the margins are clear of tumor!
The typical outpatient center has a waiting room for family, a dressing room, and a preoperative area where a nurse takes a brief history, an intravenous line is started, and you have a consultation with the anesthesiologist. (He may call you at home the night before and answer your questions and remind you not to eat anything after midnight). You are then taken to the operating room, your procedure is done, and then you go to a recovery area where you remain at least an hour or until you are stable enough to go home. A nurse will usually help you into the vehicle and give care instructions to your family or friends who are driving.
All in all, the outpatient surgical center is often more convenient for patients because there are not as many patients in the admitting area as in a hospital, and you probably receive more individual attention, purely on the basis of numbers; fewer patients allow the nurses to spend more time with you both before and after surgery. Also, because the acuity and seriousness of the procedures are often much less than in a hospital, the atmosphere is usually more relaxed and thereby more comfortable.
If you are in need of minor surgery such as hernia repair, breast biopsy, removal of small skin problems, or minor orthopedic or podiatric (foot surgery) procedures, you may want to consider an outpatient surgical center.
Chapter 8
THE EMERGENCY ROOM
If you have a touch of plague or meet up with a missile,
Or if your two-year-old has swallowed his brand new plastic whistle,
There is a place that's waiting for your rendezvous with doom...
It's your friendly, local, understaffed... Emergency Room.
The physicians are all dedicated to serve and save humanity
With nurses who are unafraid of squalor and profanity.
And if you have a mother-in-law who's getting on your nerves,
Give her a dose of poison and then call up the reserves.
As long as you can show the world you cared to send for aid,
No one will even ask you why the old bag swallowed Raid.
Just tell the friendly E.R. Doc, old mum was suicidal,
Give him one hundred bucks and he won't call it homicidal!
As recently as twenty years ago anyone with an M.D. degree could apply for and usually get a job working in an emergency room. It was generally a low-paying, thankless job that few physicians wanted, and it was often manned by licensed physicians who were in the residency training and needed the extra money. Now, most of these physicians were adequate, but there was also a whole host of physicians and “new M.D.” graduates who worked in the Emergency Room to augment their income and sometimes these physicians were not well enough trained to manage the more severe problems that presented themselves at the E.R. doors.
Today we are in a new century and emergency rooms have kept pace with all other areas of medicine. For the most part, physicians, working there, are highly trained specialists who have taken an accredited three or four year residency in emergency medicine where most of the programs have trauma center experience. When you arrive at a major emergency room, you can be assured that the staff can expertly handle all types of medical problems, including pediatric emergencies, heart attacks, trauma, lacerations, and gunshot wounds as well as colds, asthma, flu, back aches, and broken bones. It's a whole different world today, and the quality of care has taken a giant step forward.
All major emergency rooms are required to have an on-call panel of specialists who can take over in their specialty after the patient has been seen, evaluated and at least temporarily stabilized by the E.R. physician. These usually include primary care physicians, pediatricians, general and vascular surgeons, cardiologists and cardiac surgeons, neurologists and neurosurgeons, psychiatrists, ear, nose and throat specialists, eye doctors, and orthopedists. These physicians usually have to be available to arrive at the hospital within thirty minutes of being called. Frequently, the emergency patient may be uninsured or minimally insured, and the physicians who take “all comers” are usually donating a significant amount of their time and service “gratis” to the indigent and needy, and should be commended for this.
It is important for the public to realize that the emergency room is not a clinic to be used because it is convenient. If patients