If an ER patient is Not Sick, are we still supposed to treat?

is doc #1 familiar with the term "insurance fraud"?.....

Hi all, interesting posts here.

Here's my take...
#1) NEWS FLASH - unless you were under a rock for the last 10 years, the ED has become a walk-in clinic for a lot of things. Obviously lots of what we do is not "emergency".
#2) That being said, everyone currently working in an ED should KNOW that we are doing walk-in/urgent care most often and thus, I believe, inherited an obligation to treat everybody.
#3) If you don't agree with treating everybody and doing some real compassionate care for those who "have not" - then you need to get out of EM
#4) If you're still clinging to the idea that "I only signed on to treat emergencies", then you need to get out of this business
#5) Hospitals have now realized that a LARGE percent of it's visibility and community reputation is garnered through it's ED. A hospital's reputation for excellence and competency is often linked to it's community perception of their ED - so guess what, now hospitals are shifting their customer service focus to the ED
#6) While trying to "tweak up" the ED perspective to those customers, does it mean that we will be asked to do a lot of "non-Emergency" stuff for pt's - YES!
#7) Do you realize that with on the national average, over 60% of your ED patients have insurance and are "paying customers"? Remember this includes: medicare, medicaid, auto liability insurance, victim's insurance AND of course blue cross and the others. That means 6 out of 10 patients have a third party plan that pays our bills and keeps us employed!
#8) Your hospital WANTS that business! So they're going to do what they can to drive you to provide good customer service which "may" include sometimes, giving more treatment than you would normally expect for simple problems.

is this right? I don't know.
I guess you have to put yourself in your patient's shoes and figure what they "perceive" as "good care"...remember it's all about perceptions!

I can see, treat and discharge a patient with no IV's,/tests or meds and no Rx's and if I take the time to explain to them their condition,t reament and explain why no workup is needed and answer all their questions - they will still likely rate me VERY HIGH on the cusomer satisfaction surveys. It's all how you present it. If you just BRUSH them off with 'go home, take tylenol and res' AND make them feel stupid or belittled - no matter how competent or hi-tech the care, they will have a higher chance of rating you unfavorably.

Some MD/NP/PAs who don't know how to talk to their patients and explain things will act more like Dr #1 thus the pt believes you did "everything". those MD/NP/PAs that are good "people" persons and who can sit down and talk with their pt's, will not have to to labs and tx's just to prove they know what they are doing....

My 2 cents.

Back to the question"

What if after the Medical Sceening Exam it's determined that the patient is NOT SICK? Are we in terms of Civil and Ethical Practice basis required to provide care for them?

Short answer- No.

The examples you give are pretty black and white. I frequently find myself in the same situation, but much grayer areas. For example, narcs to a drug seeker, oe abx for a cold. Neither is in the pt's best interest, and both are in fact detrimental.

I have considered refusing to do it, but just don't feel like dealing with the hassle.

But, if I give a medication I know is not indicated, I am doing the wrong thing. Legally, morally, and ethically. I'll probably do it on my next shift.