This week I worked 3 12's, I only had 2 patients who were actually sick, even out of the dozens who were admitted, basically because we have to watch them even though we know nothing is wrong for fear of being sued by the one who really does have something wrong.
It seems like half of my patients this week said they called thier PCP and they told them to come to the ED (with BS complaints).
It seems like the vast majority of my patients are seeking drugs or attention or a combination, or they can't see a doctor because they don't have insurance, so our taxes will pay for a $14,000 work up for the WORST HEADACHE OF THEIR LIVES, when they just drank too much last night and ate too many tacos for breakfast (not that I have anything against tacos).
If there has to be a place for these people to go, why does it have to be the emergency room, and why do we have to be so afraid of a law suit that we do a $14,000 work up on everyone when we all know that there is nothing wrong with them. How is that the greedy have taken away all of the power that Doctors have to make a financially intelligent decision. How many tests do we do on a daily basis based purely off of fear of being sued, really think about it. Is there a way to fix it? We have these great facilities in place in order to save lives, but we rarely ever actually do that, all or our resources are spent on the "others." Sometimes it feels like a fruitless waste of effort, and like I am contributing to the further degradation of society as people become more helpless and pathetic every day. It's not that I don't love being a part of the times when we really do help someone that is sick, I just don't understand why we have to spend so much time, energy, effort, and money on people who are NOT SICK.
Thank you for this great post. I can't tell you how many times I've had to take a child screaming in pain to the ER for something "minor" because the PMD couldn't fit us in. Remember, you might call at 9 AM, but not get a call back from the office until noon, if not later. I'd try OTC meds while waiting for an appointment, but could not let my child stay that way until the PMD's nurse could call with an appointment time.
For instance, the above situation happened to me once when my son (around 2 y/o at the time) had a fever, was crying in pain and pulling at his ear. Called the doc's office, they can't fit him in until noon the next day. I called later in the day and asked if they could call something in for his ear infection. Nope. Wait til we see you tomorrow. NSAIDs were doing nothing for my child and I called again at about 9 PM begging for pain relief. The answer: "Just go to the ER." I sat in the ER until 2AM getting scoffed at "for coming to the ER d/t an ear infection." When the ER doc saw my son, he put a hook-like device into his ear and pulled out a large ball of pus and said it was one of the worst ear infections he'd ever seen. Thanks to the ER, my little guy got some pain relief and antibiotics.
I guess the point of my story is that, sometimes, the patient HAS tried other routes of care before finally resorting to the ER.
Yes, I completely agree, which is why I call it the dumping place, your PMD dumped you to the ED, this is absolutely not your fault, this is the fault of the PMDs, and someone already made the point that PMDs are forced to fill up their schedules and not allow room for cal ins. It is a system problem, although there are a majority of people who do abuse the system and won't even attempt a PMD because they have to pay if they go there. People like you are not part of the problem.
Just an additional thought. Along with what everyone else has said, we a now are a society of quick fixes. It seems like people have no patience for nonurgent illnesses. Everyone wants a pill for this and a pill for that. Some of the most demanding ER pt's are between the age of 18 and 30 and have had a sore throat since this morning, a cold for 2 days, diarrhea x 2, N/V x 2 or 3, a 24hr rash, I could go on and on. These are normal healthy young people with no patience for being sick for 1 minute. These are the people that aggravate me the most.
You guys are so right about the appointment problem. It is so hard to get a sameday, or even next day appointment. I had a bad sore throat and had to wait an entire week to get in! On top of that, my doc has no office hours Fri, Sat, or Sun.
The other big factor that is playing a part in all this is health insurance. With my plan, If I go to the doc, I have to pay out of pocket. If I go to the ED, it's all paid. Doesn't make any sense, does it?
My local hospital just set up a 24-7 clinic for non-emergencies, but it is connected to the ED, so they can shuffle patients back and forth depending on the situation. Not only that, but for billing purposes and insurance, the clinic is considered an ED visit. I don't know how it is working for them, but it has got to be an improvement.
The situation in my area has improved within the past few years. There is now an urgent care center, a free clinic for low income uninsured patients, and an office of doctors who take walk-in patients.
As far as the ED treating people differently based on income or insurance, I saw no evidence of that. I was brought in naked (except for the blanket the squad had put on me), dried blood and fecal matter on my body, unshaven, hair uncombed, teeth unbrushed. The only thing in my favor was the teeth:tattoo ratio (32:0). The trauma team did not ask for my name or insurance until they had finished treating me. Providing proof of insurance at that point did not change how I was treated.
Granted, this was a bad GI bleed, rather than a request for Demerol for a "bad headache".
Unpaid treatment is a problem, though. It was mentioned in the newspaper recently that millions of dollars in unreimbursed services are provided each year by this hospital.
All those people who come in to ER with bogus or frivolous or attention getting complaints are just what I call "Inbetweens' Because they are inbetween the real patients.
ND MOM, I think your story indicates the need to take all ER patients seriously. Had your husband died, it would not be the girl-in-the-waiting-room-with-the-hangover's fault, it would be the doctor's fault. The doctor who has decided people who come to the emergency room aren't really sick.
I like this statement and agree with you.
I'm afraid that becoming jaded might just make me miss something important. Even junkies get kidney stones.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
I think the best solution for this problem is to have free, or income-based, clinics. If a non-emergent person comes to the ER for treatment they would be sent to the clinic. Of course, then you'd have the ones nobody thought were emergent who died on the way to the clinic. Perhaps it's just best to make sure everybody stays alive and worry about the money later. Considering potential lawsuits, it seems the most practical way to go. However, the clinics for routine care would definitely take a load off the ER and the budget.
It's my understanding that the ER can't send folks to the clinic, even down the hall, unless through some wizardry they can call it an ER visit. Anything else is considered dumping a patient and illegal.
I work in a primary care clinic that provides income-based care. An amazing number of our patients will still go to the ER for all kinds of things, like sore throats. Some go in for very high blood sugars or blood pressures which wouldn't be that high if they would come in to see us and do what we tell them to do.
We don't commonly send our patients to the ER, but you can bet that if they are telling us that they have symptoms consistent with heart attack, stroke, or other life-threatening conditions, we'll send them. We can't afford to be wrong about those things, either. I realize that what you see in the ER may not look emergent to you, but what it sounded like on the telephone and what you see walking in the door may bear little resemblance to one another.
Someone else said: Along with what everyone else has said, we a now are a society of quick fixes. It seems like people have no patience for nonurgent illnesses. Everyone wants a pill for this and a pill for that. Some of the most demanding ER pt's are between the age of 18 and 30 and have had a sore throat since this morning, a cold for 2 days, diarrhea x 2, N/V x 2 or 3, a 24hr rash, I could go on and on. These are normal healthy young people with no patience for being sick for 1 minute.
This, too, is very true. These are the same people who take their children to the ER for runny noses and pinkeye and diaper rashes. They don't go to the ER because they have no PCP, they go because they don't want to wait until tomorrow. Payment in either place is often not an issue, because they have Medicaid.
I worked in another clinic which is committed to keeping open same-day appointments, and which has someone on call after hours/weekends/holidays. A consistent effort is made to be sure that parents know that they have someone on call and when to call. They take the kids to the ER anyway, frequently without calling first. Or they call and say something like "My baby has a fever of 101, can I take her to the ER??" (Not talking about newborns here but older babies and children.) They are frequently not in the least interested in hearing what they can do to help the kid. They want an instant cure.
I would really prefer my patients not go to the ER, especially not for things I need to handle in the clinic. I'd prefer the ER be for things like chest pain, stroke, trauma, and so forth. It's frustrating for those of us in primary care too.
It's my understanding that the ER can't send folks to the clinic, even down the hall, unless through some wizardry they can call it an ER visit. Anything else is considered dumping a patient and illegal.
I work in a primary care clinic that provides income-based care. An amazing number of our patients will still go to the ER for all kinds of things, like sore throats. Some go in for very high blood sugars or blood pressures which wouldn't be that high if they would come in to see us and do what we tell them to do.
We don't commonly send our patients to the ER, but you can bet that if they are telling us that they have symptoms consistent with heart attack, stroke, or other life-threatening conditions, we'll send them. We can't afford to be wrong about those things, either. I realize that what you see in the ER may not look emergent to you, but what it sounded like on the telephone and what you see walking in the door may bear little resemblance to one another.
Someone else said: Along with what everyone else has said, we a now are a society of quick fixes. It seems like people have no patience for nonurgent illnesses. Everyone wants a pill for this and a pill for that. Some of the most demanding ER pt's are between the age of 18 and 30 and have had a sore throat since this morning, a cold for 2 days, diarrhea x 2, N/V x 2 or 3, a 24hr rash, I could go on and on. These are normal healthy young people with no patience for being sick for 1 minute.
This, too, is very true. These are the same people who take their children to the ER for runny noses and pinkeye and diaper rashes. They don't go to the ER because they have no PCP, they go because they don't want to wait until tomorrow. Payment in either place is often not an issue, because they have Medicaid.
I worked in another clinic which is committed to keeping open same-day appointments, and which has someone on call after hours/weekends/holidays. A consistent effort is made to be sure that parents know that they have someone on call and when to call. They take the kids to the ER anyway, frequently without calling first. Or they call and say something like "My baby has a fever of 101, can I take her to the ER??" (Not talking about newborns here but older babies and children.) They are frequently not in the least interested in hearing what they can do to help the kid. They want an instant cure.
I would really prefer my patients not go to the ER, especially not for things I need to handle in the clinic. I'd prefer the ER be for things like chest pain, stroke, trauma, and so forth. It's frustrating for those of us in primary care too.
Thoughtful post, santhony ... thanks for all that you do. :)
Happy-ER-RN, RN
185 Posts
Yes, I completely agree, which is why I call it the dumping place, your PMD dumped you to the ED, this is absolutely not your fault, this is the fault of the PMDs, and someone already made the point that PMDs are forced to fill up their schedules and not allow room for cal ins. It is a system problem, although there are a majority of people who do abuse the system and won't even attempt a PMD because they have to pay if they go there. People like you are not part of the problem.