Rabies Exposure & The Healthcare System
You’ve been bitten or scratched or licked by an animal that is not your pet, is a stray, or is wild. Or, you found a bat in the house within which you sleep. The animal seemed ok, but, after a restless or troubled night, you call your primary care physician. He/she is overloaded dealing with an over-busy schedule of the usual problems. He/she has no idea what your rabies risk is- what the prevalence of rabies is in the animals in the community, whether the particular animal is an “high-risk” species for rabies, and whether other details of your story (bite location, time passed since contact, etc.) impact the medical necessity and timing for rabies immunization. He/she has no idea on potential the risks, cost, accessibility, and availability of the vaccine and HRIG (rabies immune globulin). The problem just does not come up so much in the general medical community and your doctor probably last read about rabies in medical school 25 years ago- and it was not focused on as a priority to learn with only 1-2 rabies deaths per year in the U.S.
So, the best thing to do is to send you to the local hospital Emergency Department- offload it onto them. You go there, waiting for 6-10 hours only to run into the same level of inexperience with this problem in the ER doctor as in the PCP. Every hour of every day that physician is dealing with critically ill folks with out of control diabetes, evolving strokes and heart attacks, septic infections, and severe traumatic injuries, etc. You are walking in as a clinically well patient, at worst very anxious. In general, preventive medicine, like vaccinations, is one of the least “sexy” areas of medicine. So, you get apathy, confusion, uncertainty, and/or misinformation.
The U.S. healthcare system is not set-up to timely provide expertise and proper clinical decision-making on potential rabies exposure. To compound the problem, both the vaccine and HRIG are very costly-and so keeping sufficient amounts of inventory is not justifiable unless there is steady traffic in such cases.
So, now you know why this is a situation of terrific confusion and anxiety and desperation and operational chaos for patients.
We saw the problem and decided that our community needed a center of excellence for animal exposure cases. By distributing information on our facility, services, and expertise to Animal Control/ Public Health officials, the local Urgent Care centers, and hospital Emergency Departments across Harris County, as well as adjacent counties, and publishing the most reliable content on all aspects of rabies and preventive measures at rensimer.com, traveldoc.com, and rabiesdoc.com, we have provided the answer in our region of Texas to our healthcare system’s failure to respond to the problem of rabies exposure which exists across the United States.
When you come to us, you will,
Know we have HRIG and vaccine available same-day, on-site.
Establish medical necessity (or not) for rabies immunization.
Have answered all your questions about rabies and post-exposure treatment at or above the U.S. standard of care.
Be informed, within 2-3 hrs of your call, of the cost of treatment to you (based upon personal insurance benefits) and whether we are in or out of your insurer’s network and what that means. (no billing surprises down the line)
Find we can work the vaccination schedule with some flexibility around the necessities of your personal life.
All of this adds up to an unparalleled experience of efficiency, effectiveness, professionalism, and patient satisfaction- pretty much 180 degrees opposite the state of affairs anywhere else in this healthcare system regarding animal exposure issues.
Edward R. Rensimer, MD, FACP
Two important news stories: