Harry Lambert, MD

PGY-2 Physician 👨‍⚕️ | Travel Agent 🌍 | Avgeek ✈ | EMT 🚑

All views/tweets my own

[Harry Lambert, MD @AirBrit]

@aribindi @DrDiGiorgio EMTALA doesn't work in isolation. EDs aren't fully compensated for uninsured care. Sure, to cope with Medicaid cuts, there's definitely bloat that can be removed. But ultimately access to emergency care will worsen, a pattern already seen in states that did not expand Medicaid.

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio @MaxJordan_N Profit is helpful when patients have choice and the information required to decide where to give their business. Before we can harness profit, we need to improve information availability to patients.

[Harry Lambert, MD @AirBrit]

@jasmine_nisar Or perhaps I'm trying to understand how you'd answer a critical question. If you're going to stand for a reasoned position, you should be able to reason through the entire argument without resorting to generic comments that are not relevant. Best of luck to you!

[Harry Lambert, MD @AirBrit]

@jasmine_nisar You haven't answered the question. In your scenario, what happens when someone having a heart attack presents to a hospital without ability to pay, no charity, no family to help them? Should they be left on the curb? Should the hospital delay their care to collect payment?

[Harry Lambert, MD @AirBrit]

@jasmine_nisar And what if that non-sacrificial generosity doesn't exist for an individual?

The difficulty with health care is that it is deeply tied to life itself. If you are going to advocate for a system where no guarantee exists, then there are trade-offs.

[Harry Lambert, MD @AirBrit]

@jasmine_nisar Sure, and health care is integral to all of those things. At a base level, an inability to access health care prevents life and potentially the pursuit of happiness.

[Harry Lambert, MD @AirBrit]

@jasmine_nisar What individual rights are you specifically referring to?

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio Ah, I must have misunderstood your argument. What is the role of Medicaid in your proposed system?

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio Pre-ACA, 19% of the population was uninsured - 50 million people. Sure, we can reduce some of that by reducing the cost of insurance. But I don't think nearly a fifth of the population represents an edge case.

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio I disagree. Charity care relies on the goodwill of others/systems to donate that care. It's not a reliable mechanism to cover the cost of care.

Collections/wage garnishing requires that an individual be able to work and have assets that can be collected.

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio With a low-cost, private insurance market, you still have to account for free riders.

What happens when that patient with a subdural has elected not to have insurance? And if they don't have the means to pay (whatever the cash price may be?)

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio I take your point and agree that there is a role for market efficiency in elastic situations (and there are many of them)

But we still need a system that provides for those inelastic cases. I think this is the best argument for a universal basic insurance scheme.

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio The altered patient with an epidural hematoma coming in at 2am? That patient needs care now. It's a completely inelastic market.

In this situation, health care is much closer to a public good. While it can be optimized, I doubt a private market would adequate provide it.

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio Equally well, I don't see how capitalism can really be applied to entire segments of health care.

Elective spine surgery? Sure, you can introduce more competition, increase consumer power - ultimately create a market.

[Harry Lambert, MD @AirBrit]

I still don't understand why we can't agree that improving physician rest is a good goal to work towards.

It's not a binary and there will be situations where a tired surgeon must operate. But shouldn't we try to minimize them?

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Would I get on a plane with a tired pilot?

If it was life or death, yes. If my child needed urgent care, yes. If there was literally no other option and time was critical, absolutely.

Same goes for doctors.
Would I want a rested surgeon? Of course.
But if it’s the only surgeon available for a brain bleed? For a tumor that can’t wait 3 months? For the one surgeon I trust?

I’ll take tired and skilled over rested and unavailable any day.

Painting this as a binary (tired = unsafe, rested = safe) ignores the real-world tradeoffs patients and doctors face every day.

[Harry Lambert, MD @AirBrit]

@DutchRojas It's easy to be critical of the system. How would you reform our emergency care system given EMTALA? EDs are the most inelastic form of care around...when you have a medical emergency, you go to the nearest ED. More competition and less regulation would not solve this.

[Harry Lambert, MD @AirBrit]

We're an evidence based profession and we have evidence that humans do not perform as well when exhausted.

Duty hours exist because an exhausted resident seriously harmed a patient.

We may not have the capacity for better rest right now, but why can't we work towards it?

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Do pilots get called in for surprise 2am flights with a life on the line?

How many people are going to die if the Little Rock–Topeka flight is delayed?

Surgeons are not commercial airline pilots.

[Harry Lambert, MD @AirBrit]

@DrDiGiorgio I'd pay close attention to the secondary analysis. It's not surprising that errors increased if there were more patients per resident. That's more data to track and less time to "know" your patients. I wouldn't fault the schedule, but the system that led to a higher patient load.

[Harry Lambert, MD @AirBrit]

@braindoc69 @DrDiGiorgio Perhaps, but if they at least have insurance, there is some level of reimbursement for that ED visit. With the phase out of direct grants for uninsured care, EDs are far more exposed to increases in uninsured patients.