I completely agree with everything said. I can’t count the number of patients that tell me that their doctor told them to come to the Emergency Department. This creates the false impression that they have an emergency, when in reality they have a simple medical condition that could have safely been handled in the office the next day. Are primary care physicians no longer keeping a few appointment spots open for “urgent” visits? Must be much easier just to dump on the ER, but this is a very poor solution, since the massive influx of patients who really don’t need to be seen in an Emergency setting just makes wait times longer and allows ED MD’s to provide less than perfect care. Not to mention providing care in the ED is the most expensive by far – no wonder health care costs are spiraling out of control. And guess what it all comes back to? CYA, because of the lottery-based incentives of the tort system.

And the rant about the unscrupulous PR department reminded me of an incident I had working as an ED Tech where a father nearly became physically violent towards me.

I’m a general psychiatrist who recently left the hospital jungle. I knew it was bad when I found myself treating an ER Physician. It’s becoming a pressure cooker for those expected to provide care.

The ER unfortunately has become the pathway of least resistance for primary care overflow. Psychiatric emergency criteria has become limited to a loaded gun with clear intent or x amount of pills already ingested. Anything less usually doesn’t qualify as medical necessity for managed care orgs. Yet the doctor must accept the liability for what choices a mentally unstable patient makes. Patients pick up on how the system is evolving and will do or say whatever necessary to get their perceived or real needs met.

We have created a monster that can become self defeating if all the providers are at great risk of high frustration and eventual burnout.

I couldn’t agree with the Graveyard Shift idea more.

Maybe the ER should spin off the Primary Care After Hours, and true ER.

Seriously, I think we should make it a national policy, aka standard of care, to send every single person who calls in the middle of the night to the ER.

In fact, NO ONE should be on call at night.

Every citizen in this country, afterhours, go the the after hour clinic or the ER.

There are cases of missed diagnosis of infant menigitis, tubal pregnancy, rupture AAA, progressive PE, etc.

Healthcare is such a mess. I am so deprssed thinking about it.

Anne

I shouldn’t have a telephone at all. There should be open office hours whenever I’m there (and not off someplace else trying to earn money at my second job, to subsidize my practice costs) and when I’m not there, the patient should go to the Emergency Department, or other open facility.

Telephone calls are 1) not paid for 2) dangerous. (After all, I haven’t seen the problem at hand, have I? Why should I take responsibility for it?)

In an earlier era, the phone call was paid for by the subsequent, or earlier, office service. But now, the office service payment has been stripped of any additional amenities (and often downcoded, that is, payment reduced) by the insurance payor.
The phone call can’t survive as a medical service.
After the last doctor has been driven out of practice, the ER will be what’s left. Enjoy.

I can’t believe that each of you are commending what the woman says and just blaming the system for the problem. People have to be able to trust their doctors; if your physician tells you to go to the emergency room, you have to assume that s/he’s giving you the right advice. And having done what the doctor told you to do, why should we put up with the crap from the nurse? Because she’s just as much at fault; let’s not blame the patient when the medical profession is clearly futzing around on all sides.