Emergency medicine, we can do better

When someone gets sick, what are their options?

They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you’re not sure if clinics can take care of everything, so you head to the emergency room, thinking that you will get urgent care because of the word emergency in it.

And you will, after various amounts of wait time, but what do you give up in return?

To answer that question, let’s see how the emergency room works.

When patients come in, they are triaged based on severity and afterwards shuffled to different parts of the ER accordingly. ER doctors then ask you just enough questions and draw just enough labs to make sure you do not have immediately life-threatening conditions. The ER does not necessarily address your chief complains or the main reason you come to the ER – it only makes sure you don’t die in the immediate future. Everything else is left to be dealt with by the admitting doctors or your primary care doctors – if you have one.

That means you will have to explain your medical problems at least a few times over, if not more, and the more times you tell it, the more interpretations of the story you will have, resulting in contradicting information and decreased quality of care. Moreover, that fact that there are more people involved in your care – admitting doctors, ER doctors – means that there are more hand-offs, resulting in more errors, disagreement on management, miscommunication, redundancy, waste of efforts and resources.

Why do we set ourselves up to do the same work twice? Have patients repeat their stories over and over? And most importantly, why do we subject patients to risks and low quality of care?

There must be a better system, where we work together instead of separately at separate times, redoing each other’s work. There must be a better triage mechanism that screens for better information that will allow doctors to collaborate as soon as patients enter the system and long after they leave the hospital. There must be a better system that allows health care personnel to get rid of their short-sightedness and view patients as a person, with identities other than medical conditions that immediately kill and worries that must be addressed other than their health. Instead of looking to finish just our responsibilities and deferring the rest to others, we should think about how to deliver complete care to patients as a group. Thinking about how to make lives easier for our colleagues will help patients and reduce work for ourselves, because we will reduce inefficiency and redundancy all around. The whole system will be more lean and happier for it.

There is no formula to a better system – we must find out through trial and error, but first we must recognize that separated we will fail. We cannot just save ourselves anymore – the world is too connected and too strained for resources for one person to make a fortune without making others poorer, and human beings by nature will not tolerate continued marginalization. It is the source of conflicts and violence in our world – war, terrorism, burglary, revolution – so let’s save ourselves some agony and start giving instead of taking.

In the end, it’s the individual who’s not interested in fellow men who has the greatest difficulties in life and provides the greatest injury to others.

“angienadia” is an internal medicine physician who blogs at Primary Dx.

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