Kevin, M.D. - Medical Weblog

Isn't there a contradiction in your point, though? How are members of the public--untrained medically as they are--supposed to discern the difference between emergent and non-emergent problems, except by going to the emergency room? There are surely some that are obvious (look--I have an ingrown toenail!), but many are not.
 

I agree that many people (about 54%) according to those estimates overuse the ERs. But, where is the solution? Is there a study or an arm of one that breaks that down further to include the persentage that are there based on advise from their general practice physician? That might be a major part of the problem. I know in my area if you are ill and call your Dr. office you are told there are no openings for any where from 2-5 weeks and you are further advised to go to the ER to be evaluated. That might be an area where a solution needs to be found.
 

I work in triage for a level-one trauma center. When the potential patient walks through the door, I am the first person he or she will be talking to. We DO get referrals from doctors all the time-- people have called their primary care physician and been told to go to the ER, but we RARELY have a referral where the patient should NOT have come to the ER. When they call their doctor at 4:45pm and have the symptoms of a viral upper respiratoty infection, for example, they DON'T get sent to the ER. The one problem that does exist, however, is that patients who have been referred by their doctor seem to think that they will get special treatment. They don't. They go through the same system as everyone else. Some people think that just because they call the ambulance that they will get special treatment. They don't. We've actually had people call an ambulance from the parking lot of another hospital where they waited for four hours for foot pain, but were never seen. Little did they know that they would be taken from the ambulance, wheeled to the triage waiting room, and would sit for another few hours.

Yes, I know that their time is valuable, but so it that of the medical staff. We treat more than 74,000 cases per year-- more than 200 per day-- and that takes time. What irks me, though, is the person who asks, "Would your family member be treated the same at an ER as what the general public is?" The answer is "Yes." Employees have a special place to go before 5 o'clock, but after that, they go to the ER, and they wait just like everyone else-- treatment times depend on the severity of the injury. Their families also go to the ER, but they wait just as well. They way things are run today, it would be virtually impossible to give special treatment to any one individual. Why? Because another employee would notice and there would be hell to pay later. There are actually quite a few employees who don't bring their families to our ER, simply because they know that therte will be a long-- sometimes very long-- wait time.

Friday night was unusual because it was slow, and no one asked to sign out AMA. On most Friday's there are patients who come in with stomach pain, but leave after a few hours telling us that the pain is better now. Still, they get the spill about needing to wait, because something serious could be wrong with them, but they still DON'T get any special treatment. They continue to wait until a room opens in the Pod. It's not like "Days of our Lives" where everything stops just because someone "special" walks through the door.
 

kv4c, I dont know why the question about medical professionals family members being treated in the same manner irked you. I think it was a legitimate question that by answering, you have provided a valuable piece of information for laypeople. We now know that "no they don't get any special treatment." However, it seems amazing to me that if this particular patient had been sitting there with a family member, who just happened to be a physician, that the outcome would have been the same. I'm certain his knowledge of the severity of her symptoms would have prompted him to seek care quicker than what she received it. Sorry, I just cant buy a physician sitting patiently by in a waiting room with a family member and allowing them to sit there to the point of needing a vent without raising holy "you know what."
 

Responding to the first comment: I'm not asking the public to determine what emergent care is and isn't. I'm referring to those who use the ER for routine and primary care, thus clogging the system for those who need it the most. Take this quote from a recent report on emergency room misuse:

"Men, poor families and African Americans are more likely to head to the state's emergency rooms for routine care rather than seek out a family doctor or clinic, according to a new report from the California Institute for County Government at California State University, Sacramento. Latinos, Asian Americans and older adults, meanwhile, are among the groups less likely to do so.

California adults and more than 60,000 children use high-cost emergency rooms for routine care, increasing overall health costs and putting a strain on hospitals and counties."
http://www.emsnetwork.org/artman/publish/printer_10803.shtml

Solutions such as providing universal health coverage and improving primary care access are keys to solving misuse of the ER, and avoiding the problems for the individual cited in this story. I am frustrated with the media's refusal to address these problems, and continually taking the easy way out - which is blaming the hospital.
 

kevin, i think that your last comment is exactly what this author was getting at in his story. doctors, overwhelmed by patients abusing the system, often respond when tragedy strikes by saying, 'if the patients did' x y or z, this wouldn't have happened. when the lay person hears that, they hear that they are responsible for receiving a lower quality of care, even though the person in this story used the emergency room in a case of what was clearly an emergency.

unfortunately, the media does not have any sympathy for overworked physicians burdened with an ineffective healthcare system. i'm not sure blaming the media is the best response however. are doctors, or the AMA, doing a good enough job educating the public as to when to use the emergency room? let me tell you, i've never been able to figure out when to use the emergency room and when to wait. the media reports the news, typically sensational news. when these stories break, physicians have a golden opportunity to get a message to the public. are you using it?

lay people don't get it. they don't know what doctors deal with. and they never will unless doctors become better advocates for their own profession.
 

I'm afraid of what the answer to this question will be..We hear everyone complain about patients who use the ER for non-emergency treatment but on the other hand I havent read any solution to that problem. If there are all these people who have no insurance or have Govt. ins that almost no Drs. will accept, where do you propose this large group of people should receive treatment for non-emergencies if not at an emergency center?

Should they not get any reasonable medical care at all unless their life is in danger? I understand the ER is not the correct place for them to be and I would imagine they prefer not to be there as well. But, if you arent going to see this group in private practice and you force them from the ERs, where do they go for treatment then? Free clinics? Many areas don't even have them, so for some that is not an option...