We all complain about ER abuse, frequent flyers, drug seekers, etc.
We have this idea that the ER is for emergencies. Get over it. The problem is with the name. ER evokes images of life saving, ameliorating pain, and all that good stuff. It really should be called "free and convenient medical clinic that is more likely to give you what you want then your own doctor, and is also set up to deal with the occasional emergency". It's not a cool name, and kind of a mouthful, but it's a hell of a lot mor accurate than ER.
While we may be right to complain, we are complaining about the wrong people- it is silly to expect the users of the system to change when we constantly re-enforce their behavior. This is a population not especially renowned for responsible use of their own money. Any reason to think they would be any more responsible with your money?
We are open 24/7.
Even a long wait n the ER is a hell of a lot shorter than the time it takes to get an appointment.
We are more likely to give what you believe is necessary than follow any evidence based guidelines.
We are more likely to:
Give narcs for a headache than any neurologist.
Give antibiotics for mildy symptomatic OM than any pediatrician.
Give antibiotics for a viral uri than any family practice doc.
The list goes on, but the bottom line is we frequently give people what they want, rather than what medical research indicates.
We do all our tests on the spot, and do a lot more of them than a PCP would. Does your doc have a CT machine? By the time you get an outpatient appointment, your problem might have resolved on its own. We can get a pt in to a specialist a hell of a lot faster than their own doc can.
In addition to the superior service we provide, we advertise, soliciting the business we complain about. The focus of ER advertising is convenience. Billboards on the side of the road boasting short waiting times. Ever see an ER advertisement that explained acuity based priorities?
And don't forget- It's free. Obviously it's actually expensive, but the ER users we complain about don't pay anything. While many have government insurance that prohibits non emergent use of the ER, this is not enforced.
So- we solicit the business, and reward the behavior. Kind of numb for us to complain about it. The ER you dreamed about doesn't exist. Get over it. With very few exceptions, if you want to do any emergency nursing, you are going to have to wade through a bunch of crap to do it.
The people we complain about aren't the problem, they are the symptom. The problem is the system. I bet half the complainers on this forum don't even vote. While venting is healthy, it doesn't change anything- except how you feel after work. Change the system.
I don't think the post in question is too far off the mark. Everybody prioritizes health care differently. Some people choose to spend money on their pack a day tobacco habit, yet never go to the dentist, and come to the ED with dental pain. When asked why they didn't see a dentist, they say they can't afford it. Yet, they can afford $5 a day on tobacco.
We see mothers with small children who say they can't afford Tylenol, yet, they reek of cigarette smoke, are wearing designer clothes, and have a brood of kids in tow each carrying a Happy Meal that Mom picked up on the way in, and she's chatting on her brand new smart phone with her BFF when you're trying to ask her questions.
Then there's the chronic lumbar pain who has been having this pain for years, says he can't afford to see a PCP, yet is covered from head to toe in high quality tattoo work that is more recent than his complaint of back pain. That stuff ain't cheap!!!
You may be right that there is a "Welfare Queen Fallacy" that exists and that people buy into, but it is true that we see people every single day who prioritize their wants over their needs, then come to the ED for non-emergent problems with no intention of paying the bill (if they can't afford a dentist, Tylenol, or a PCP, then what in the world makes you think they're going to pay their ED bill?). We don't make this stuff up.
By the same token, I do see an awful lot of people who just have no resources and don't know where else to go for help. I agree with you that those people exist as well, and it is a shame that those people tend to get lumped in with the former group.
I did notice that Turd said "a lot" of ED abusers, not "all". And with that, I do agree. A lot of them do fit the stereotype, unfortunately.
And you know, I really don't care if people come to the ED with non-emergent complaints, and I don't care how they spend their money. What irks me is when they are impatient, complain about everything from how long it's taking to how cold it is to whether the TV works or not, while I'm running my tail off doing the best I can. If you're going to use the ED as a walk in clinic, at least have the decency to sit down, shut up, and wait.
Personally, I don't see any end in sight. EDs want business, they want high customer satisfaction scores, they want doctors to provide billable services, all with as little overhead as possible which means short staffing nurses, because we are the biggest expense.
I'm curious as to how you came to this conclusion. You know all of these people personally? You know their financial circumstances, their spending habits, what car accessories they have? I doubt it. I think it's more likely that you are simply parroting the welfare queen fallacy. It's typically a very racist, classist point of view, and is unsupported by anything other than biased anecdata. I'm always surprised and disheartened to hear such things from people who have purportedly dedicated their professional lives to caring for others. I hope you can see past your own biases when you're taking care of your patients, and that they aren't shortchanged because of your personal views.
it is all about priorities. i know people who "cannot afford health insurance", but their car payment is 450$, their ins is 120$, and they smoke 1-2 packs a day. they can afford ins, they choose not to prioritize health care as a need.
no one needs a 30k car, go get a kia brand new for 8k. 5$ a day would buy insurance for young healthy people, but they smoke instead, all while claiming "i cannot afford health care."
this is not everyone, but it has been the majority *i* have experience with. it is not the welfare queen either, it is every day individuals who refuse to make health care a priority.
I'm curious as to how you came to this conclusion. You know all of these people personally? You know their financial circumstances, their spending habits, what car accessories they have? I doubt it. I think it's more likely that you are simply parroting the welfare queen fallacy. It's typically a very racist, classist point of view, and is unsupported by anything other than biased anecdata. I'm always surprised and disheartened to hear such things from people who have purportedly dedicated their professional lives to caring for others. I hope you can see past your own biases when you're taking care of your patients, and that they aren't shortchanged because of your personal views.
When you have 4 children, a smart phone, mascara and expensive long nails and a pack of $9.79 cigarettes... but "no thermometer at home" to check your children's fevers... and demand a 'prescription' for Motrin because state aid covers prescriptions versus OTC....
And you see this not once, not twice but DOZENS of times each shift....
You stop "wondering" and start to "draw your own conclusions".
When you place buying cigarettes and getting nail-jobs ahead of purchasing a thermometer and some blessed tylenol for your children; don't blame me for my views based on "anecdata".
By the same token, I do see an awful lot of people who just have no resources and don't know where else to go for help. I agree with you that those people exist as well, and it is a shame that those people tend to get lumped in with the former group.
Poverty is more than just paucity of funds.
Moral bankruptcy is worse than the financial kind.
I guarantee you won't find a single nurse who would object to serving the needs of an individual or family caught in financial dire straits - but you'll find many who vehemently oppose giving free-loaders a pass.
My whole point in this post is not to blame the abusers of the system. Sure, it's fun to vent, but pointless. We, in this country, have created an incredibly expensive and inefective system of which the ER is a part.
If there was something in my life that was free, convenient, high quality, and valuable to me, I would use the hell out of it. It is silly to blame others for doing the same.
I don't resent the individuals, I resent paying for the system.
If we can't vent here in a safe and understanding environment, where can we vent? It may be "pointless" to you, but maybe I need it. It helps get me through the day.
The urgent care I've been to required me to pay my co-pay upfront at the time of registration. Not a bad idea if you ask me, if I owned a private urgent care practice I'd want to be paid for the services I provide.
Unfortunately, a growing number of Urgent Care centers are billing like ERs. If I have to pay a co-pay when I arrive, will it be my $20 in-network copay, or my $250 ER co-pay?
I have to toss in my here . A lot of the time its the insurances telling people to go to the ER ,, It's so backwards it is not even funny.
Take my insurance , long story short but I needed to have a catheter put in and befor I got fed up and just bought and put it in myself ,they where telling me to go to the ER every time i needed a new one or to have it changed or flushed "what"
they will happily pay and cover $5000.00 ER bills and will pay $400.00-$600.00 doc .bills BUT will not cover a $35.00 catheter outside of the er or docs office and will not cover a home health visit that could do it for $65.00?????:banghead::smackingf
Unfortunately, a growing number of Urgent Care centers are billing like ERs. If I have to pay a co-pay when I arrive, will it be my $20 in-network copay, or my $250 ER co-pay?
A growing number of insurance plans specifically indicate a copay for an urgent care visit - sometimes it's the same as an ER copay, sometimes less.
If we can't vent here in a safe and understanding environment, where can we vent? It may be "pointless" to you, but maybe I need it. It helps get me through the day.
Good point. I do like venting here. My favorite part is when a non- ER person chimes in to let you know you are wrong. They have back pain because a large building fell on them, despite a healthy diet and complete compliance with medical and PT advice their pain occasionally breaks through when their pain specialist isn't working, and that they really are allergic to NSAIDS, tylenol, tramadol, Robaxin, and cox 2 inhibitors.
I really do like that. It happens consistently, and the reaction is consistently amusing.
Anyhow, my point is to aim some of that venting at the Moron who advertises conveninece and high saisfaction scores, rather than the person who takes advantage of them.
here . A lot of the time its the insurances telling people to go to the ER ,, It's so backwards it is not even funny. 
:banghead::smackingf
Anna Flaxis, BSN, RN
1 Article; 2,816 Posts
@ the above,
I don't think the post in question is too far off the mark. Everybody prioritizes health care differently. Some people choose to spend money on their pack a day tobacco habit, yet never go to the dentist, and come to the ED with dental pain. When asked why they didn't see a dentist, they say they can't afford it. Yet, they can afford $5 a day on tobacco.
We see mothers with small children who say they can't afford Tylenol, yet, they reek of cigarette smoke, are wearing designer clothes, and have a brood of kids in tow each carrying a Happy Meal that Mom picked up on the way in, and she's chatting on her brand new smart phone with her BFF when you're trying to ask her questions.
Then there's the chronic lumbar pain who has been having this pain for years, says he can't afford to see a PCP, yet is covered from head to toe in high quality tattoo work that is more recent than his complaint of back pain. That stuff ain't cheap!!!
You may be right that there is a "Welfare Queen Fallacy" that exists and that people buy into, but it is true that we see people every single day who prioritize their wants over their needs, then come to the ED for non-emergent problems with no intention of paying the bill (if they can't afford a dentist, Tylenol, or a PCP, then what in the world makes you think they're going to pay their ED bill?). We don't make this stuff up.
By the same token, I do see an awful lot of people who just have no resources and don't know where else to go for help. I agree with you that those people exist as well, and it is a shame that those people tend to get lumped in with the former group.
I did notice that Turd said "a lot" of ED abusers, not "all". And with that, I do agree. A lot of them do fit the stereotype, unfortunately.
And you know, I really don't care if people come to the ED with non-emergent complaints, and I don't care how they spend their money. What irks me is when they are impatient, complain about everything from how long it's taking to how cold it is to whether the TV works or not, while I'm running my tail off doing the best I can. If you're going to use the ED as a walk in clinic, at least have the decency to sit down, shut up, and wait.
Personally, I don't see any end in sight. EDs want business, they want high customer satisfaction scores, they want doctors to provide billable services, all with as little overhead as possible which means short staffing nurses, because we are the biggest expense.