The delay is serious and unconscionable.

And that’s not even getting in to whether it is good practice or ethical to leave patients in misery in a waiting room for extended periods after triage.

ivf-md. I don’t think people who are in pain can stop and reflect. Wouldn’t the fact that you can actually stop and reflect and think of something other than your pain mean that your pain isn’t that bad to begin with?

I do understand that people who are brought up by an ambulance because they are having a heart attack have priority. I also realize that there are a lot of people who come to the ER who have no business coming there. I wonder if sometimes just because someone walks in, there is an assumption that the case is not as emergent.

1. 10% illegal imigrants
2. 20 % self pay = no pay
3. 25% medicaid laughingstock rates.
4. 20% Medicare – just covers cost
5. The remaining are insured patients that have been able to coercively pay a reduced rate.

In any other business would there be good “customer service” if you had to give half of your goods away?????

Yes, “care” and “service” are two distinct things. It really stems from: What do you want, expect, and deserve from your doctor? This is the very question we recently asked at Brain Blogger.

We would like to read your commentary on our article. Thank you.

Sincerely,
Shaheen

I’m not an insider, I’m afraid. Unlike in the software company, where I could see how management decisions and understaffing were ruining the product and annoying our customers, I really have no idea how a typical ED is staffed.

I can only see the problem as a symptom: long wait times in less-than-ideal conditions for people who are feeling bad enough to be there and doctors who are so pressured for time that they are a) demoralized and b) in a hurry.

Blue Cross Blue Shield referred me to an ED when I called their help line with symptoms indicating a likely kidney stone. (It was, indeed, a kidney stone.) I sat in a chair in the waiting room for over an hour when all I really wanted to do was curl up into a ball on the floor. Then I was sent to an ED “bed”, one of the temporary ones lined up against the walls where I waited a couple more hours before somebody noticed me and said “has your nurse come by yet?”. No, nobody had.

In the meantime, since I was parked near the ED’s central station, I got to hear interesting things while I was writhing in pain on my little bed. An older doctor was complaining within earshot that things could not go on like this. He rattled off a list of people who didn’t belong in an ED, who had been brought there by ambulance at great expense for practically nothing. He bemoaned the fact that the ED is now the de-facto “Urgent Care” for everyone after all the daytime doctors go home. They were ten patients above and beyond capacity, and still had a full waiting room. This couldn’t go on. I agree with him.

So if we can’t magically increase the supply of doctors, perhaps we can re-route people away from the ED? I sure would have gone to an Urgent Care if I could have found one available in my area at 9pm. Maybe it’s time for hospitals to offer both Emergency Departments and Urgent Care clinics? If EDs weren’t paranoid about drug seekers or malpractice suits, maybe it would be fruitful for triage to assist non-emergency patients with their pain such that some of them could be sent home to see their regular doctors in the morning (and the rest, presumably, would be less frantic about having to wait).

But I’m not an insider, so I can only muse. Maybe you have suggestions?

My only real point was that pain is important. When people are in pain, they can only focus on themselves. If we could make genuinely ill people more comfortable, they might not complain so much about the wait.

I agree that you have stated the problem. But what are some solutions?

They’re most definitely two different things.

I used to work in a software company where I frequently had to explain to the public that we had “limited resources” and thus could not fix all the bugs in our software at once. Okay. That’s fair. Nobody can wave a wand and make all problems go away. But the huge secret was that our company was so grossly understaffed that the software was in a horrible state, the workers had no morale, and the entire project was circling the drain. So in addition to being rightfully angry that the software was junk, the customers were now additionally angry that they had to wait and be “patient” and “understand” that we couldn’t address everyone’s problems in a timely manner.

Of course we, the demoralized workers, only saw the immediate problem. The immediate problem was the customers riding our behinds all the time to hurry up and fix stuff. This made us feel even more demoralized about the staffing shortages and other things we could do nothing about. However, the real problem was the lack of resources, not the customers complaining (quite rightly) about the time it takes to get something done.

The answer to ED wait times is not more tolerance, patience, and understanding on the part of the customer who rightly expects humane treatment (and possibly a little help with their pain while they wait). I don’t think an hour is too long to wait. I’ve certainly waited that long to be seen when I had a migraine that didn’t respond to my normal medication. I brought a face mask and some earplugs and asked for a cold pack.

When I was coming down with a case of acute abdomen, I was sent to sit interminably in one of those uncomfortable waiting room chairs as waves of pain and nausea ran through me. At one point I began to sweat profusely and fell forward out of the chair. I had blacked out. Even if I had to wait to see a doctor, I think a lot more could have been done for my comfort during the period of waiting, namely a chair that didn’t force me to sit bolt upright like I was in church. Sick people in hospital waiting rooms often want to lay down or recline a bit.

I think we’re past the point where we can ask patients to keep being understanding and tolerant as service gets worse. We need to do what it takes to get the EDs staffed appropriately and make sure those who have a long wait are at least somewhat comfortable while they do.

The woman with the migraine who had a history of migraines I wonder why she didn’t have some meds she could have taken. I mean if you’re prone to them wouldn’t you have some around?

But the kidney stone does seem like something you’d legitimately go to the ER for. I was under the impression that pain from a kidney stone was pretty intense.