I don't need a PCP- I have the ER.

[Guest219794]

We all seem to get frustrated by the use of the ER for problems best dealt with by primary care. More to the point, we get frustrated with the patients. But, look at it from the pt's point of view.

Devil's Advocate- I'll look at it from the point of view from one of my pt's yesterday:

I have had back pain off and on for years. I was in a few days ago, and you told me to follow up, but I haven't made an appointment yet. Now my back really hurts, and I have trouble moving.

I come into the ER, get IV morphine, and and MRI. I leave with a percocet prescription. Immediate pain relief, an expensive test done on the spot, and some kick ass narcotics for home.

If I strike out at one ER, I can always go a few blocks to the next one. They don't communicate, and are in direct competition for market share and high customer ratings.

Compare that to the process, had I made a PCP appointment. A long wait for an appointment, no immediate pain relief, a long wait fr an MRI (if any is done) and who knows what I might get for a prescription.

Why on earth should I go to my PCP? I pay the exact same price for either service, and one is far superior to the other.

Can any of you nurses convince me to use my PCP?

(BTW- as this pt's nurse, I did use our system to actually get her a PCP, and and appointment. I gave an earnest explanation as to why it would be in her best interests to use a PCP.)

[ArthriticRN]

Hello-just joined so just chiming in. I work in a rural UC. Its a young one, only 4 years old. Its staffed by all seasoned ER Nurses and Pas. It $188 up front if there insurance is not accepted. The community is a retirement and vacation community. People come to us for everything. We are higher functioning, lab, CT, US, MRI 3days weekly. People roll through the door with all sorts of inappropriate/ grisly things. But the nearest ER is 45 minutes away. They don't want the ambulance bill, or they can't/ wont make the the drive, or they are simply unaware the difference. In our situation, "Urgent Care" is a inappropriate word. It's confusing to them, they don't know. So alls we can do is try to educate them. We need to be an immediate care or something like that.

[aaox0]

Yes, this is all true and logically it makes sense for a person to do this. I think the only way for this issue to improve is for ability for hospitals to hold outside establishments accountable for sending patients under non-emergent circumstances. I have had countless patients sent by pcps for routine blood work/scans and nursing homes sending asymptomatic patients with slightly abnormal labs/vitals (with a hr that got up to 115 with EMS reporting that the home called in a "cardiac arrest" lol), with the thought that "oh well everything gets done faster in the ER." Yeah, well, since every order from the ED is stat, one patient's CBC for sniffles are run as "stat" next to a trop for chest pain. When everything is stat, nothing is stat.

[Melleeboo1]

In Kansas, there is one hospital in our area that has something similar to a UC right there in the ER waiting area. It's a small walled off area with chairs that recline in each room, they only see minor complaints. Then in the back is the main ER and the fast track. IMO it's the best ER as far as wait times go. I have never waited more than 15 mins before going to the back, even on a Saturday night... They also place the people who they think are drug seeking back there. I remember getting injured sledding with my son and niece, I went to the ER in horrific pain (real for once) and they put me in the UC area. After a x-ray and finding out I fractured 3 vertebra in my back, I got transferred back into the main ER for IV pain meds and admission..

[ERnursebyday]

What's frustrating is when patients make no attempt to establish a PCP. I advocate that patients need to call their PCP when they are NOT sick and establish themselves as a patient. Yes it might take some time, but the process of making a doctors appointment will be easier in the long run. The ER is not a doctors office, dentist, pediatricians office or a chronic pain clinic. This abuse of the system has got to stop.