The below article appeared on the website of a local news station in Rock Hill SC. Some people in the community have varied opinions about this. For those of us "in the business", what do you think about this kind of policy? Do you think it will actually make a difference or is it just bad public relations or giving people a mixed message about a hospital's concern for it's community? What if a patient has no insurance and can't afford a doctor's office visit, where do they go? What do you think?
Local Hospital's New Policy Of Turning Patients Away Upsets Some
Posted: 6:28 pm EDT May 12, 2009
ROCK HILL, S.C. --
Diana Burgess of Rock Hill went to the emergency room at Piedmont Medical Center last month with severe pain in her side."The doctors came in and just basically said they weren't going to do anything for me," she said. The ER doctors determined that the pain Burgess was suffering was not an emergency and didn't require immediate care. President and CEO of Piedmont Medical Center Charlie Miller explained the policy this way: "it is an emergency room, not a primary care clinic." "We think it's had a positive impact on wait times," Miller said. "Two-hundred to 250 people a month are leaving to see their primary care doctor instead." Hospital officials also said patient care is better when they can see a doctor outside of the hospital and form a relationship, rather than using the emergency room as their doctor. However, people like Burgess, who doesn't have any health insurance, said she can't afford to see a regular doctor. "I just left there crying," she said. "I was hurting too. I was really feeling bad. "Miller said the hospital does what is required by law, which means doing a medical screening for every person who comes into the ER. Then doctors determine if their condition requires immediate emergency care.
My daughter who is 31 and has stage 4 cancer who goes to the ER for severe pain relief has been told by her oncologist to STOP going to the ER all of the time. She instructed the staff at all hospital ER's NOT to treat her when she comes in. She is told to go home and double up on her meds and go see her oncologist the next business day. The oncologoist tole my precious little daughter that all of the staff and doctor's at the local ER's around think she's crazy! Unbelievable and unacceptable! My daughter has sores in her mouth and in her navel and genitals and rectal area and when she has diarhea it sets her on fire. Yet she can't go to the ER because they will not treat her! Where are the ethics? Why does that oncologist have that right? Where are my daughters rights?
Your daughter has the right to change to a different oncologist anytime if you think her needs are not being met.
Re pain control, doubling up on the meds is a good idea to solve the immediate problem, but if she needs to do that more than once a day she may need to increase her long acting meds. Remind her when the pain gets worse not to wait until it is unbearable. She needs to stay on top of the pain or it can take hours and an ER visit to get back in control.
The ER is not the place to treat chronic conditions. If your daughters pain is frequently out of control she needs to get with her oncologist or a pain specialist to come up with a new plan. I'm not being harsh or uncaring. Your daughters illness is horrible and without a doubt painful but not an ER issue unless she is acutly ill or injured. The ER doctors don't know her. I'm sure she can tolerate more meds then the average person but most ER docs would not be comfortalbe ordering high enough doses to make her comfortable, that is a huge liability for them.
I am all for frequent flyers being directed to the care they really need, but how is a person always supposed to know whether they are having an emergency or not? Some people who go to the ER with non emergencies did so thinking they (or the person they took) are having an emergency and were not trying to "milk the system."
I apologize for my "frequent flyers" remark as it came out as being very hateful and uncaring and rude. I guess my point was that I believe if a person wants to go to the ER for something they consider as being an emergency then that should be their choice. That rule also works for the doctor on call, which is why he is there is to see the patient and make his diagnosis, whatever that might be and to his discretion. He is the doctor and has the given responsibility by the hospital administration and the acquired credentials to make such a diagnosis. If the patient is truly having an emergency however many times they go in is irrelevant, it cannot be treated as a "boy crying wolf". I mean that is what the doctor is there for to have tests ordered and decide whether he wants to order something for pain or not until he gets the results of such orders. If everything checks out, tell the patient and let him go and follow up with their main doc tomorrow or whenever. But just one case scenario with my daughter, she was sitting on the stool and when she stood up she could not feel her feet or legs and fell flat on her face in the floor. She was scared and had never experienced anything like that before. I say that would warrant an ER visit. When she has blood backwashing from her nephrostomy into her foley, that warrants a visit especially when you call the office of the oncologist and she is so busy takes my daughters name and says she will cal back. What is my daughter supposed to do when she can't feel her legs and is on the floor. I have heard that cancer pain is the most horrible pain ever and she has to endure that plus all of the added side effects from the chemo too. I know my daughter and she is not making up this horrible pain and I feel so helpless because Moma can't kiss it and make it go away this time. She is hurting. Last night she was hurting so bad and could not get a response from her oncologist and was afraid to go to the ER since the oncologist told her it would do no good to go cause they would turn here away. This is what she took tyo finally be able to get some relief. 8mg of dilaudid, Flexaril and melatonin, ativan plus all of her "night meds" which I am not sure what that consists of. h how I wish I could find a doctor who could not just treat her with chemo but to try to do everything to help the pain and give her a least a little hope. No rose colored glasses here. Thanks so muvh for all of your responses. JustaMama
I am all for frequent flyers being directed to the care they really need, but how is a person always supposed to know whether they are having an emergency or not? Some people who go to the ER with non emergencies did so thinking they (or the person they took) are having an emergency and were not trying to "milk the system."
I've observed this as well. Many people don't know what an emergent medical condition is and isn't, all they know is that they're having this pain they've never had before, and they think they might be really sick. This is where the medical screening exam comes in. If they're not really having a medical emergency, they don't need to be treated in the ED. They can be sent home with instructions for follow up of their non-emergent condition, and given information on what a real emergency would look like. This can be done in a way that is courteous and kind, without making the person feel stupid or like they're getting the brushoff.
A medical screening exam and stabilization of emergent medical conditions is what patients presenting to the ED are entitled to. If no emergent medical condition exists, the ED is NOT obligated to treat. This is what some people don't seem to get.
justamama, we are not allowed to give medical advice on this site. Your daughter's medical questions should be directed to her physician. If she is not satisfied with the level of care she is receiving from that physician, she is free to find another one.
I am truly sorry that your daughter is suffering. I am a mother too, and I simply cannot imagine how you must feel. However, this thread is not the appropriate place to address your concerns.
Specializes in Clinical Research, Outpt Women's Health.
My daughter who is 31 and has stage 4 cancer who goes to the ER for severe pain relief has been told by her oncologist to STOP going to the ER all of the time. She instructed the staff at all hospital ER's NOT to treat her when she comes in. She is told to go home and double up on her meds and go see her oncologist the next business day. The oncologoist tole my precious little daughter that all of the staff and doctor's at the local ER's around think she's crazy! Unbelievable and unacceptable! My daughter has sores in her mouth and in her navel and genitals and rectal area and when she has diarhea it sets her on fire. Yet she can't go to the ER because they will not treat her! Where are the ethics? Why does that oncologist have that right? Where are my daughters rights?
I can understand your need to do anything to help your daughter. However, I would agree that ER's are not equipped to deal with the complexity of your daughters issues and pain relief needs. Ask the oncologist if a pain specialist can be consulted. Also, is this a curable cancer? I know you said stage 4, but I did not see what type. If not, then hospice can help provide excellent pain relief and 24 hour on-call availablilty which can be a huge help....... I am so sorry for what both you and your daughter are enduring.
oh i am so sorry to have entered a board i was not supposed to enter. I really wasn't seeking advice. I was just upset cause she was turned away so many times. thanks so much for your responses. i promise to refrain from wrinting on here anymore. thanks again
Specializes in Spinal Cord injuries, Emergency+EMS.
just another symptom of a messed up (not a) system ... here in the evil socialist NHS we've been 'turning people away' from the ED after triage for many years and more often than not with the primary care appointment they claimed to be unable to obtain ...
1- really amazing that there is even discussion about this. An overwhelmed ER spends much of it's time dealing with non-emergent patients. This is harming the care of medical emergencies. The department prioritizes it's resources to deal with emergencies. Living up to it's name, "Emergency Department".
Is there anybody here who would like to wait an extra hour having a heart attack so that your docs and nurses could spend a bit more time with chronic and trivial issues?
2. How did the subject of insurance even come up? There is a huge misunderstanding of the relationship between insurance coverage and innapropriate use of the ER. It has very little to do with coverage, it has to do with payment. People who pay nothing for a particular service are more likely to take it for granted. An insured person with a substantial copay is unlikely to use the ER for a non emergency. An unisured person who intends to actually pay the bill is also going to think twice about whether the ER is a good choice. The most frequent misusers pay nothing- their insurance either covers completely, or they simply don't pay what ttey owe.
3. Trust me- If the doc was willing to put his license and well being on the line by turning a patient away, it was a BS visit.
The below article appeared on the website of a local news station in Rock Hill SC. Some people in the community have varied opinions about this. For those of us "in the business", what do you think about this kind of policy? Do you think it will actually make a difference or is it just bad public relations or giving people a mixed message about a hospital's concern for it's community? What if a patient has no insurance and can't afford a doctor's office visit, where do they go? What do you think?
"the hospital does what is required by law, which means doing a medical screening for every person who comes into the ER. Then doctors determine if their condition requires immediate emergency care."
I LOVE THIS!
The ER in which I work now does not MSO/MSE ANYONE! The one from which I came, where 1/2 of our pts were self-pay/medicaid, we MSO/MSE'd many. Of course, it's purely a financial decision. But this is smart move on the part of the hospital.
He was right... the majority of ER visits are for non-emergent matters. It is a shame that these people can't afford primary care doctors. This pulls at my heart-strings (esp. as a tree-hugging liberal!). But I am out of a job if my employer gives everyone free health care to every person who can't afford care.
Ultimately, this underscores a MAJOR problem with my GOVERNMENT, and it is not one that my employer should have to fix.
we've been 'turning people away' from the ED after triage for many years and more often than not with the primary care appointment they claimed to be unable to obtain ...
justamama
3 Posts
My daughter who is 31 and has stage 4 cancer who goes to the ER for severe pain relief has been told by her oncologist to STOP going to the ER all of the time. She instructed the staff at all hospital ER's NOT to treat her when she comes in. She is told to go home and double up on her meds and go see her oncologist the next business day. The oncologoist tole my precious little daughter that all of the staff and doctor's at the local ER's around think she's crazy! Unbelievable and unacceptable! My daughter has sores in her mouth and in her navel and genitals and rectal area and when she has diarhea it sets her on fire. Yet she can't go to the ER because they will not treat her! Where are the ethics? Why does that oncologist have that right? Where are my daughters rights?