It’s not a secret that emergency departments are becoming more crowded by the day.
Especially if universal health coverage is enacted without appropriate primary care doctors to see the newly-insured, expect the problem only to worsen.
So, it comes as no surprise that those who wait longer, especially for symptoms that could be cardiac in nature, potentially can have worse outcomes.
As reported in MedPage Today, a study shows that, “emergency room patients seeking treatment for chest pain were more likely to suffer adverse cardiovascular outcomes when the facilities were crowded.”
Makes sense, since when it comes to a blockage in a coronary artery, seconds count. The authors also account for other reasons, including the fact that a crowded ER leads to higher nurse-patient ratios, along with the risk of medical errors as patients are “handed off” from one doctor to another.
In any case, this isn’t a problem that’s likely to get better anytime soon.
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{ 9 comments }
When more people are covered by insurance, I wonder if this may actually ease the crowding in emergency rooms. ER’s would not have to be used for primary care for the uninsured. Also, people with cardiac symptoms may go earlier to their doctor if they have insurance, rather than waiting until it is really bad and then winding up in the ER.
There is a wonderful myth that the ERs are crowded with smelly, uninsured people who don’t understand the concept of “primary care”. well I am a billing supervisor for a large ER and I can assure you this is not the case. on most nights we are crowded with INSURED patients who don’t wish to wait SIX weeks to see their PCP or TWO weeks to see his NP/PA.
This meme needs to die. People want care and ERs provide it. Get more PCP/PAs./NPs and the ERs can go back to being a place for drunks and nursing home patients.
I think having to “wait six weeks to see their PCP or TWO weeks to see his NP/PA” is also a myth.
Patients run to the ER because it is convenient.
In my office, every patient who has an acute need is seen within 24 hrs, and sooner if it is more urgent. Frequently, however, this is not good enough for them because they think they have a right to be seen immediately, regardless of why. This is one of many reasons why healthcare is expensive; Americans demand it, and it winds up costing more because it is being done in an er instead of a primary care office.
Americans treat primary care medicine like fast food but then are disappointed with the service and quality.
You can train as many primary care providers as possible; the mindset of Americans has to change if any meaningful health care reform is going to occur.
“Patients run to the ER because it is convenient.”
Exactly. Is this wrong? Suck it up. Be “convenient” and you won’t have problems. As long as the patient is shelling out their hard earned dollars, they feel entitled to a certain type of care. They don’t care how long you’ve been practicing or what you think of that. They see most doctors as lazy assholes who make too much money (believe me, I hear it all the time when they get a bill for a 15 minute visit where the doctor barely acknowledges their presence) and don’t really give a hoot if they don’t like how they receive their care.
You have it twisted. It’s not up to the patient to do anything. If you want to stay competitive in this field then it’s really going to be up to providers to get on board with patients’ wishes.
From a humble billing specialist who has to listen to every complaint, swear word and tantrum (for the doctors, but directed at me) you “providers” have no idea how much your patients hate you.
Ouch, Janice.
Again, every patient who wants to be seen in my office is offered an appointment.
I cannot stop them from running to the ER for strep throat or posion ivy, even though I try my best.
If Americans continue to demand such care, the cost will only continue to rise.
The system is dysfunctional on every level, be it the government, insurance companies, hospitals, patients, and yes, even us doctors.
In my practice, patients have access to us 24/7 (phone calls are free of charge!), we offer to see patients on weekends and evenings and we still round on our hospital patients. For some patients, this is still not good enough and they abuse the ER. What more do you think we need to do?
People have busy lives and want to be seen earlier, sometimes, because they need to get back to their lives. Every person in every country would want quick, immediate, competent service if they could get it. The ER is an expensive option for this. If you don’t have a true emergency, you might have to wait multiple hours to get that service, but it might be worth the trade off for you.
On the whole, ERs have provided this service. Primary care offices have become extremely slow and laborious to deal with. Even if a physician has a policy of saying he/she will see patients who need to be seen urgently, those taking the initial phone calls don’t always understand this. Besides, it is often an entire gauntlet of screeners you need to get through to finally get that urgent appointment. What a hassle!
I in no way, though, blame the primary care physicians. They are attempting to continue to provide a service at very low rates of reimbursement. They truly are doing the best they can under the circumstances. Those who ’suck it up’ end up burnt out and hating their jobs. Others choose the MDVIP (concierge)route and provide excellent service to their patients with same day appointments – at a premium price. This might be the way for all of us to go!
David:
I appreciate your understanding.
Why are people some demanding when it comes to waiting in a primary care doctor’s office?
They are quite patient in a specialist’s office; they may complain amongst themselves, but patient’s will wait for hours and not say boo when finally seen by a specialist.
Hey, how about the cable guy? How long have you waited for him? Or a plumber? Or an electrician?
The fact is when it comes to primary medicine, people feel entitled to it, so a different standard applies; convenience is more important than a doctor-patient relationship. And if my doctor does not jump to my beck and call, then he or she is the problem, not me.
I recently had a patient upset because she was not seen quickly enough for preop clearance for her facelift.
It is really a modern form of old fashioned American narcissism.
“On the whole, ERs have provided this service. Primary care offices have become extremely slow and laborious to deal with. Even if a physician has a policy of saying he/she will see patients who need to be seen urgently, those taking the initial phone calls don’t always understand this. Besides, it is often an entire gauntlet of screeners you need to get through to finally get that urgent appointment. What a hassle!”
Having see this from both a billing and practice manager standpoint, I have to stand up for the admin staff. They are usually OVERWORKED and at the mercy of whatever clinical staff they have in the office that day. They certainly do get the message that providers will take people “urgently” but unfortunately since they lack ESP, they don’t always realize that some patients are “more urgent” than others in the most Animal Farm understanding of things. Many a “screener” will curse the day they were born if they stick the “wrong” urgent patient on a provider’s schedule. So, no, they aren’t going to stick their necks out. Doctors bitch when they have too many patients and they bitch when they do not have enough patients. Basically they do a lot of bitching.
People have kids, partners, work and other obligations and they don’t like feeling held hostage by medical professionals, in terms of how they spend their limited “free time”.
And honestly, it’s people who are insured who feel the most entitled. I am not disputing that there is a real systemic breakdown, but rather, as a BILLING person, I’m debunking the myth that ERs are filled with those who lack coverage. Most ERs demand payment after services, which often discourages those without coverage from waltzing in with something minor like a sore throat or some other easily treatable (by a PCP) condition. Usually, the uninsured show up when a condition is gone beyond the point of return, thus requiring more resources to treat and obviously that means bigger costs.
“Why are people some demanding when it comes to waiting in a primary care doctor’s office?”
Two thing:
1. Because doctors are seen as rich, privileges jerkoffs and the cable guy is seen as a hardworking smoe. It’s a PR problem more than anything. And also people DO get pissed at the lazy ass cable guy. And are rewarded with six months of HBO for free. Complain about your PCP running one hour behind schedule you don’t really get anything but ignored. (and rightfully so)
I am very pro-PCPs. I am just offering what things look like to patients. Unfortunately, it seems many of these issues are matters of perception and there aren’t always good ways to get people (on both sides) to reframe the conversation.
Dr. Family Practitioner and Janice
(note: my website is in progress…it will be available soon)
The ED dilemma is a very tough one to solve. The lack of primary care physicians, the closing of MANY inpatient psychiatric hospitals and no incentives for bright medical students to seek out this avenue, the “we want it now” attitude toward healthcare, the millions of uninsured…all contribute to overpacked EDs and the multitude of serious problems in the ED. In fact, the volume of people crowding in for care is creating the burgeoning and serious additional problem of violence in the ED. I have written about the many dilemmas facing EDs and how these issues add to the potential for violence. My book will be published soon (Violence in the ED: Tools and Strategies to Create a Violence-free ED pub by Springer Publishing Co http://www.springerpub.com/prod.aspx?prod_id=10596) EDs in the majority of instances are ill equipped to handle the volumes of people needing/demanding care let alone the critical patient. Patients with psychiatric illness compound the problem since they often have no other place to go for care. The ED was created some years ago as the place to treat life-threatening illness and injury. It has evolved as a place to go for any medical need. Should the function of the ED change? Are there other creative solutions to impact the current state? EDs have serious problems including the abuse of the physician and nurse caregiver in a mostly-chaotic environment that is the ED. I hope that my book will enlighten many people about the issues that EDs encounter and will present even nuggets of a beginning toward solutions.
pba
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