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

Altra, BSN, RN · Jul 27, 2013

Have said essentially this for years ...

Even for those with "good" insurance -- for one copay of $100-$200 the ER can be a convenient one-stop shop. I have had patients who had insurance, financial means, and good relationships with their PCPs tell me the same thing.

Anna Flaxis, BSN, RN · Jul 27, 2013

The only flaw in this logic is that there is Urgent Care, so if you can't get in to see your PCP, the ED is not really the next logical step.

And, it's not necessarily true that Urgent Care demands payment up front. The handful of times I have used UC, they took a copy of my insurance card and billed me for my share later.

allnurses Guide · Jul 27, 2013

Urgent Care doesn't work here as we are rural. You'd have to drive about 80 miles to get to an Urgent Care.

Our small town ER sees patients like this all the time. Of course.

The local docs do have Saturday hours (9-1300) but that isn't enough.

Sometimes though, the things that bring folks in could definitely wait.

Anna Flaxis, BSN, RN · Jul 27, 2013

Well, of course, some places don't have a UC, but a lot do!

S.G. · Jul 27, 2013

It can depend on your insurance as well. For instance, I have Tricare. With sequestration, many of our primary care clinics are closed on Fridays with limited availability other days. In order to get a same day appointment, you need to call the appointment line at 630am. If you call at 640am, all available appointments are always booked.

So, if my child wakes up at 8am with something urgent but not emergent that would require a same day checkup, we go to the ER. I always call first but get told their next available appointment is 3 weeks from now (not a good fix for something like pink eye). In order to make use of an urgent care facility, I need to call Tricare and get a preapproved referral. It's not a fun process. Given the way our insurance is built we are often told by the nurse advice line, the appointment line, and our insurance company to go to the ER.

It's an obnoxious and vicious cycle that, as a nurse, makes me cringe. But what is the alternative when you have a problem that needs attention but cannot go to primary care or urgent care regardless of the fact that this could easily be solved there? I know that Tricare leads to non emergent patients overcrowding the ER. It will continue until there is a change in the delivery of healthcare to military family members.

allnurses Guide · Jul 27, 2013

I'm not sure what the answer is but I've had those occasions happen to me as well. Acute issues that cannot wait for 3 weeks. We make use ofwonderful NP's a lot here to help but still, it is difficult to get an appointment.

I was at work one day in the med room when I heard a knock on the window and saw my teenage son standing there with his forehead on the window and tears in his eyes. He'd had ear pain for a few days and I'm the kind of mom/nurse who doesn't run to the doctor quickly. His eardrum had burst, he had copious amts of fluid coming out, a fever and was in a lot of pain. I was lucky that one of the local docs happened by and asked what happened and took him aside, looked in his ear and saw a raging infection, gave me an Rx for antibiotic and pain pills.

But that can't happen all the time. I'm just lucky in that one instance that it did or he would have ended up in the ER.

SweetMelissaRN · Jul 27, 2013

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.)

Dude.... When you put it like that, how can you argue with that logic? I mean really? But at least they gave a logical well thought answer, I'm frustrated with people who come in because "I don't have to for the ER it's free!" Or, "if I bought Tylenol OTC I'd have to pay for it".... :facepalm:

Guest219794 · Jul 27, 2013

The only flaw in this logic is that there is Urgent Care, so if you can't get in to see your PCP, the ED is not really the next logical step.
And, it's not necessarily true that Urgent Care demands payment up front. The handful of times I have used UC, they took a copy of my insurance card and billed me for my share later.

Even if I could get into my PCP, why would I? No matter how fast they get me in, it won't be as fast as the ER. No chance of IV narcotics. Then, I'll have to go to the hospital anyway for labs, ct, etc. Then wait for them to get the results and call me. Or, I can go to the ER and be done in a few hours.

PCP is a waste of my time.

Urgent Care is also a waste of my time.

I am going to the ER. And, if I don't get what I think is best for me, I am filling out a survey. Then going to another ER.

Anna Flaxis, BSN, RN · Jul 27, 2013

Even if I could get into my PCP, why would I? No matter how fast they get me in, it won't be as fast as the ER. No chance of IV narcotics. Then, I'll have to go to the hospital anyway for labs, ct, etc. Then wait for them to get the results and call me. Or, I can go to the ER and be done in a few hours.
PCP is a waste of my time.
Urgent Care is also a waste of my time.
I am going to the ER. And, if I don't get what I think is best for me, I am filling out a survey. Then going to another ER.

In my neck of the woods, we have several UCs in the area that are open late. It's true you might not get IV narcotics at UC, but IV narcotics are not clinically indicated for every complaint.

Clearly it is different wherever you are located, but here, that story wouldn't fly too well because of the easy availability of Urgent Care clinics. That's all I was saying.

Rhi007 · Jul 27, 2013

I hate going to the ED, on the other hand after ringing 6 different PCPs and they were all booked out and the nearest hospital to me is shonky and the other you don't see a doctor unless you're dying I will stay at home and pray the pain passes or wait til someone can drive me into the city and drop me off. I live an hour from the CBD

ezgreazin · Aug 9, 2013

This situation is an unfortunate reality, as ER nurses we'll always see this type of pt. Hopefully you've got a good doc on shift who is going to set the pt straight and not order any narcotics.