Why the stupid reasons to come to the ER?

GingerSue · Aug 18, 2007

Could it be that the general public is less self reliant? Could it be that no one has a special family doctor anymore; 'the family doc' many people are allowed to have is some group that changes and migrates more often than wild animals. Does our family physician really know us? Probably not. Are we self reliant but still in touch with the family doctor? Probably not, that costs too much. Do we know the difference between a pimple, a spider bite and mrsa? and do we really know why we should know that?..I really doubt that one. My thoughts are that the changes inflicted on our aging society have really done harm more than good. We dont have close contact with any health care professional anymore, and when we do have some contact it is so brief that the teaching is meaningless. Most of the teaching that I do happens during the discharge instructions as I don't have any time to do teaching during my rounds, my patient group changes daily or hourly, med pass, discharges, admissions, trouble shooting for other departments, talking to doctors, talking to multiple family members who are clueless or angy, trying to attend poorly timed meetings of the committees I am required to be on, helping the overwhelming number of new nurses figure out things I don't even worry about anymore.
Back to the point I tried to make, we need better education for patients and that has to be at the basic stage....the family physician office. There is not a shortage of family physicians is there?

yes, there is a shortage of family physicians (in my community there is)

Doctors leave this community and go to nicer climates, etc

This recently happened to both of my elderly parents - their family physicans left. So now they find themselves wondering where to find another doctor. Many aren't taking new patients.

But I have to comment on your idea that better education for patients is to be in the physican office - in the clinic where I have been recently, they are so busy - I can see that they don't have time (they call out about 6 people at a time for one doctor and he herds all of us down to each separate room, then gets to us one by one, then he calls his next 6 patients and herds them to the rooms. And the kind of physician education that I received myself yesterday by a "physician" was his repeatedly dictating to me to "pray to god" - he basically had nothing useful to say (I'm not a religious person, and I had never met this man before, and I won't be going back - instead I might report him to the College of Physicians).

I think what is needed is more health care staff who are educated, and who have the capability to share information and, of course, the ability to develop therapeutic relationships with patients. (The old doctor of yesterday wasted my time making me listen to his health problems with cancer and then insisting that I pray. Inappropriate).

Who is going to monitor what these doctors are teaching in their offices?

At least nurses document in the patient's file and have a care plan (based on the teaching in our own programs - I think we nurses are all learning about nursing diagnoses and expected outcomes and to evaluate our teaching).

What are doctors taught to do about a care plan, or interventions that are appropriate for the patient, or about evaluation?

Just my thoughts right now.

I do agree that people benefit with appropriate eduation.

RNperdiem, RN · Aug 18, 2007

The pediatric practice my children use has 7 doctors, and 10,000 patients. I make sure to use the same doctor every time, but building a personal long term profession relationship is not likely. A doctor in a small community might have more of a chance. They are a dying breed.

I remember one doctor, now retired, who was deeply embedded in his community. Patients told me about the condolence letters he wrote the families, how he gave the eulogy at the funeral of a long time patient- even remembering when she moved to the area in the 1950's. People are more mobile, and less tied to a place.

The ER is like the fast food joint for medical care for many.

Trauma Columnist · Aug 18, 2007

I agree with both of you! Having worked in the ER for 10 years, it was a madhouse. There was no time for education, let alone providing continuity of care. Am not sure of the solution, but do feel that something needs to be done.

allnurses Guide · Aug 21, 2007

Its also a sense of entitlement, people don't want to wait for an appointment next week, they "deserve" immediate care (and that 4 hour wait is too long too!) for a case of the sniffles.

Also, it costs too much at the office (like you don't have to pay here?) No, I have medicaid, I don't have to pay, so why should I wait?

Some truly don't know how to care for their kid's fever, others just treat us as their primary care because they won't bother getting into a doc's service (there are plenty available here). :angryfire

rachelgp · Aug 21, 2007

I agree with what you guys have been saying so far. I think in my community it boils down to ignorance/lack of education and a dwindling number of minor emergeny clinics. Used to be, you'd find a minor emergency clinic on every corner (almost). Now, I think we have 3-4 in the whole city. I live in South Texas, and we have one of the highest high school dropout rates in the entire country (kind of embarrassing). So, that can't help, either.

Joe B1 · Aug 21, 2007

Let's not forget that we encourage people to come to the ED and return to the ED for the slightest problem. We have to do so we don't get sued, even in a patient that is highly unlikely to need to return. If you hear, "Come back if you have any problems" enough times, you're threshhold for a trip to the ER is a lot lower.

We have a lot of things working against us and it's only going to get worse.

Joe

bigsyis · Aug 21, 2007

At least in our area, Medicaid pts see the ER as a walk-in clinic. As we have commented in several threads here before, they seem to look upon a sore throat or lady partsl infection as a family & friends event, and bring multiple members of both with them, all of whom seem to have money to spend freely in the vending machines, and for cigarettes. If their baby or child is cutting a tooth and has a fever, they bring it to the ER, but do not bring an extra diaper or bottle for the baby. These are not societal lapses; they indicate a lack of responsibility by the individual, to me. With that line of thinking, a small personal problem begins a snowball effect that winds up not only the responsibility of the individual, but the Nursing Staff, the ERPs, Hospital Administration for staffing, Management, and billing issues, the State that is administering Medicaid (or the insurance company(ies) being billed for the ER visit), and ultimately, we who work and subsidize the government programs.

Add to the above all of the illegals who seem to have been told that all you have to do is show up at an ER and you get free care, including dental! I had a pt one night, who through an interpreter, said exactly that! There he was in his fancy western boots, expensive stetson hat and stylish western clothes, wanting the free dental care at an ER that he had been told (in Mexico) that he could get here in the good old USA. You should've seen his face when he finally understood that was ONE thing he wouldn't be getting at our ERs! :uhoh3:

PedsER-RN, BSN, RN · Aug 21, 2007

i think one of the big reasons is that we live in a society where people don't want to wait, they want what they want when they want it, and they feel as if they're entitled to it. why call your pcp for an appointment in a few days for a cold when you can run to the er and have it taken care of (usually for free, at least for them)?

another poster said we encourage these people to come back. not me. if the child is legitimately sick, i'll go over the home tx plan, stress the importance of a pcp follow up, and mention returning if the prescribed tx isn't working and the condition worsens. if it's for something dumb like a cold or otitis, they're educated on the fact that yes, the child will run a fever, yes, it's ok, and no, it doesn't mean you need to come back.

the healthcare system is partially to blame. with all the regulations that are slapped on us we aren't allowed to say, hey, this ingrown toenail/runny nose/earache/sore throat/etc. does not constitute an emergency room visit-go home and see your pcp or go to a clinic. we're required to see them, bend over backwards at their every whim, and we get reprimanded if we don't give them what they want. it's absurd. the majority of the people that are using ers for stupid reasons are frequent flyers and know the system as well as we do, and know how to (at least try) to work it to their advantage.

sorry for the rant, this is a huge sore spot for me.

Joe B1 · Aug 21, 2007

My point about encouraging people to come to the ED for the slightest problem was actually about that last cya statement we always make during our discharge instructions or telephone advice call. I'm like you and stress heavily on the discharge and follow up instructions. What is really peevish is the ones that you sit and talk with and go over and over things with and they still are saying, "Well if he/she gets worse (or doesn't get better or better fast enough or better enough to suit us) we're bring him/her back!" Or the ones that fish and fish until they finally hear you say to come back if there's a problem.

Many folks do a great job of following the instructions and following up with their referral or PCP (if they have one), but there are a lot who will never, ever follow up as directed or follow any of the instructions that you give them. I suspect that there are some that wouldn't follow illustrated instructions or video instructions if you gave them.

We've bred a huge population of people who:

1) have no interest in taking care of themselves in any way, and never will, and

2) expect everything they want to be done the way they want it, when they want it and

3) believe that the universe exists only to please them.

This population gets larger and larger all the time. Eventually, the pendulum will have to start swinging back in the other direction and that's when things will get ugly.

I'll step down off the soapbox now.

Joe

bigsyis · Aug 22, 2007

We've bred a huge population of people who:
1) have no interest in taking care of themselves in any way, and never will, and
2) expect everything they want to be done the way they want it, when they want it and
3) believe that the universe exists only to please them.
Joe

I agree, except for the part about "We've bred..." I'll bet that you and yours are not ER FFs, as are none of my family members. So, WE aren't responsible, and neither is society, at large. However, all of the government assistance programs and the political "correctness" that I think began with Lyndon Johnson's "Great Society" are huge enablers of people who want to be subsidized by those of us who work. I'll probably take a bashing for this, but I was 12 when all of that began, and I have watched it (and society) evolve through the years.

You are absolutely right-until the pendulum swings back and people put up a serious fuss about not continuing this inane enabilization, nothing will change.

teeituptom, BSN, RN · Aug 22, 2007

Could it be that the general public is less self reliant? Could it be that no one has a special family doctor anymore; 'the family doc' many people are allowed to have is some group that changes and migrates more often than wild animals. Does our family physician really know us? Probably not. Are we self reliant but still in touch with the family doctor? Probably not, that costs too much. Do we know the difference between a pimple, a spider bite and mrsa? and do we really know why we should know that?..I really doubt that one. My thoughts are that the changes inflicted on our aging society have really done harm more than good. We dont have close contact with any health care professional anymore, and when we do have some contact it is so brief that the teaching is meaningless. Most of the teaching that I do happens during the discharge instructions as I don't have any time to do teaching during my rounds, my patient group changes daily or hourly, med pass, discharges, admissions, trouble shooting for other departments, talking to doctors, talking to multiple family members who are clueless or angy, trying to attend poorly timed meetings of the committees I am required to be on, helping the overwhelming number of new nurses figure out things I don't even worry about anymore.
Back to the point I tried to make, we need better education for patients and that has to be at the basic stage....the family physician office. There is not a shortage of family physicians is there?

1. There are fewer FPs available, and even far fewer that accept Medicaid,medicaire

But why should they, they dont get paid enough. Here is where we need Universal Health Care

2. Whatever knowledge the public has, is overweighed by the fact that they dont want to take responsibility for decisions.