[Parents' and medical employees' accuracy in the estimation of fees for consultations and frequent medical procedures]. / Estimation par le personnel soignant et les parents des tarifs de consultations et actes les plus fréquents.

PURPOSE: To analyze the accuracy of estimates made by medical staff and parents regarding fees for consultations and frequently prescribed medical exams. PATIENTS AND METHODS: The questionnaire focused on the value in euros for the following: day and night consultation in the pediatric emergency department, blood and urine analysis, electrocardiogram, chest and abdominal x-ray, abdominal ultrasound, upper digestive endoscopy, CT scan, cerebral MRI (without anesthesia), an arm cast, and superficial wound repair. Medical staff belonged to different units of the childrens' hospital. The parents interviewed had consulted at the pediatric emergency unit. Neither of the two investigators was familiar with the fee structure. To avoid inducing a gradation in estimates, questions were asked with no pre-established order. To limit the possibility of participants discussing the questionnaire with their colleagues or searching for the real value, all medical staff members were assessed within a 48-h period. RESULTS: The responses of 185 medical employees (23 pediatricians, 28 interns, 81 nurses, 45 childcare assistants, seven nurse supervisors) and 187 parents were analyzed and compared. Less than 25% of the population gave an answer with an accepted error of ± 30%. Parents and hospital staff overestimated costs, parents and childcare assistants overestimated more than other medical employees. Radiological exams were the most overestimated procedures with the largest proportion of the average deviation from normal value: CT scan 850 ± 1100%, cerebral MRI 370 ± 590%, abdominal x-ray 240 ± 390%, and chest x-ray 190 ± 320%. COMMENT: Part of our societal culture and now a requirement, the right to healthcare has a cost. This cost is often overestimated by caregivers and the general population. CONCLUSION: Global understanding of the costs related to medical care requires educating the population and medical professionals. Medical staff should be informed of the real costs of treatment to enable them to manage unnecessary costs. There is a balance between justifying the costs of essential medical treatment and not using economic constraints as a pretext for denial of treatment.

Intrapartum, intranasal cocaine use and acute fetal distress. A case report.

Intrapartum, intranasal cocaine was used for relief of labor pains by a healthy woman with an uncomplicated pregnancy. Fetal hypoxemia and distress followed the event. A causal relationship between the intrapartum use of cocaine and the fetal distress was postulated. Cocaine abusers could benefit from hospitalization early in labor for close surveillance and monitoring, thus avoiding exposure to cocaine and its unpredictable systemic effects.