A favorite topic around here. Just thought I'd share a personal experience.
In the 10 years I have been with my wife, she has been to the ER twice- Once because I insisted that a corneal abrasion get immediate care- Friday night, scratched while hiking earlier in the day- and a more recent visit.
She had a cough for just under a month, unable to sleep through the night. It seemed to start with a post nasal drip, and get worse. Tried every OTC, and several prescription meds, with no symptomatic relief. She started looking sick, and I finally talked her into going to a local clinic. I am a travel nurse-(ER) no local PCP.
While I don't have particular faith in walk in clinics, we don't go to ER's for non emergencies. Once in the clinic, we found out it was out of network, meaning expensive to us. The ER was a block away, and in network. We opted to pay at the clinic, because we don't go to ER's for non emergencies.
The doc gave her Avelox, assuming that it was a bacterial sinusitis that had migrated south.
Later that evening, she had a very brief, but complete, inability to inspire. I saw it, and it scared me. I dragged her to the ER. She did not want to go.
The ER doc was diplomatic about her opinion on the ABX for what she figured was viral in origin. Neb tx, and prescribed po steroids and inhaler. A highly competent MD, RN, and RT all provided good care.
Bottom line is we paid a lot for marginal medical care, and were well covered for the excellent care we received in the ER. I don't work in that ER, but I know it is a great work environment, and as a result, they can be very selective about staff.
It really should be no surprise to us that people use the ER for non emercencies. Great care, and no financial dis-incentive. (In our case, $150 worth of incentive)
I believe that patients do think it is easier to go to the ED for treatment instead of their PCP. You can get a CT, ultrasound, labs, Xray, EKG, and fluids all done within a few hours. Why not? Doesn't that save you time? Sure does. However, I don't agree with this. Patients will always continue to abuse the emergency system. There's the patient who comes in with abdominal pain x 3 months, and oh yeah, I have this hangnail/earache/sore toe/etc. And we will always continue to treat. I don' t know the answer to the problem.
As a college student in a town that is not home and will not be home come graduation, I have used the ER for non-emergencies. My insurance covers the ER right by my apartment and since I don't have a MD down here there really isn't much else that I can do. Obviously when I go there I bring a book or something to study while I wait because I know that what is potentially wrong with me isn't as bad as what other people may have. I am definetly willing to wait longer just to be looked at.
As a college student in a town that is not home and will not be home come graduation, I have used the ER for non-emergencies. My insurance covers the ER right by my apartment and since I don't have a MD down here there really isn't much else that I can do. Obviously when I go there I bring a book or something to study while I wait because I know that what is potentially wrong with me isn't as bad as what other people may have. I am definetly willing to wait longer just to be looked at.
This is exactly the atttitude I don't get. Why can't people get a pcp? How hard is that. It shouldn't take weeks, months, etc. If you spent at least 2 mos picking out this school, enrolling, etc, let alone graduating, that is plenty of time to get a pcp. It's just not that hard! Furthermore it must be nice to be able to afford $100 copay I am forced to pay for ED visits in my own ED for runny noses.
As a former travel nurse...I do know the difficulty in finding a PCP. I dont know if it is regional or not, but sometimes here it is very very difficult to get in to a PCP. Many are not taking new patients and the ones that are will give you an apt. that is a month out. Now, to establish myself as a pt I do take the next available apt. even if it is 2 mos from now. I have asked if they have any emergency spots or urgent care spots that they hold for their pts. They say they can sometimes work you in if you are already one of their patients otherwise....They tell me then to go to the ER if a month is to long to wait. It took me 5 clinics and about 15 phone calls to find one that had anything earlier than that. My point is that sometimes depending on where you are and who you see...you dont have much choice. the urgent cares here close at 7 pm and dont open til 9 am. If you go in to them with lacerations, sob, severe headache...they send you to ER. I envy the people who have urgent cares that actually take care of urgent issues and have them open for more hours than we do.
I think our healthcare is in very serious trouble. ERs cannot continue to pick up the slack of clinic and urgent cares and not have it affect their care. The nurses get burned out, not because they dont care about Aunt Emme with UTI for 2 months...but they cant take care of their acute pts without sacrificing somewhere...there is a finite amt of nurses and energy and too many places that need it. I dont know what are answer will be but we need one sooner rather than later..before our system is gone beyond repair.
but if everyone went to the ER...it wouldn't be as fast. There are days that you wait hours and hours to be seen. It is not first come first serve. we get all sorts of people in our ER that just didn't want to wait and get an appointment with the Doc for something that has been going on for months.
Then it is time to fix the system, go for Universal Health Coverage. Go Obama, Go Kennedy
Blame part of it on the insurance companies, that very, very rarely refuse to pay an ER visit.
My insurance company will NOT pay for the local Urgent Care clinic. My kid's pediatrician doesn't have Saturday clinic and docs around here won't call you in a prescription for anything without seeing you...even if you were there at their office the day before.
So, if me or one of my children has a very high fever, throwing up profusely, or something else we won't die of on the weekend or a holiday...when the urgent care clinic is open.
To the ER we go.
I would gladly go to urgent care...if the insurance paid for it.
PAERRN20
660 Posts
I believe that patients do think it is easier to go to the ED for treatment instead of their PCP. You can get a CT, ultrasound, labs, Xray, EKG, and fluids all done within a few hours. Why not? Doesn't that save you time? Sure does. However, I don't agree with this. Patients will always continue to abuse the emergency system. There's the patient who comes in with abdominal pain x 3 months, and oh yeah, I have this hangnail/earache/sore toe/etc. And we will always continue to treat. I don' t know the answer to the problem.