I read the New York Times. I read the health section as much as I can to keep track of what the paper is saying about health-related issues. I read Jane Brody. I like Jane Brody. I’m not sure what Ms. Brody is, but I don’t think she’s a clinician.
In her article “Avoiding Emergency Rooms,” she makes some suggestions on how people should get care if they need it after hours. This is a relatively recent problem born of the understandable lifestyle choices doctors are making these days. You can’t get your doc on the phone, so you go to the ER.
The first thing Ms. Brody suggests are more of the walk-in clinics that are popping up in malls and drug stores. These would be great if the electronic medical record technology was better. Until we get EMR systems that can talk to each other, these clinics are a bad idea. Fragmentation is the enemy of all good health care.
Second, she suggests that doctors on call should give patients their cell phone numbers. Not gonna happen. When I was a resident a page operator gave my phone number to a patient who was, well, drug-seeking is a generous description. I was hounded for months. When Ms. Brody gives out her cell phone number to all her readers we’ll talk.
Then she says, “Your doctor should devise a care plan that will reduce the chances of a crisis that requires emergency care.”
Yes, for some chronic conditions you can put in place contingency plans. For everything else, I’ll have to get my crystal ball fixed. Then she says that if your doctor doesn’t do this for you, research your condition on the web. That would work great if the web had nothing but accurate and unbiased information.
The last point Ms. Brody makes, at the very end of the piece, is a brief mention of how much emergency room care costs. Yes, it’s outrageous, but that is a much larger discussion about why those costs are so high, not about who is incurring the costs. I suppose a walk-in clinic would be cheaper, but only for the most basic of problems. Everything complicated or unstable goes to the ER anyway.
There is no easy solution to the problem of getting sick after 5pm or on weekends. Even the most dedicated doctors can’t do the 24/7 thing anymore. Unless he is prepared to come to your house and examine you or open the office in the middle of the night, for no pay, it’s impossible. Maybe it used to be, when your doctor lived down the street from you and didn’t have 10,000 patients, required because he has to pay the bills.
One idea is to have group practices chip in to run an off-hours office staffed by an MD, NP or PA, in which the medical records are accessible and patients can go at any time. For instance, all the pediatricians in a certain town could all send their patients to one office off-hours, and the location could be rotating so the practices don’t have to pay for additional office space. At least then a patient could be seen by someone who theoretically knows them or has access to someone who does. Doctors could flag certain patients that they expect might call in during those off-hours, or those who maybe a little tenuous. I’m sure it’s possible to find doctors and nurses who would be glad to staff the off-hours in exchange for having the days free, or for part time work.
This would, of course, not be free. Practices would probably have to spend their own money, unless a way can be found for the government or local hospitals to subsidize such a system. It also wouldn’t work as well for some specialty practices. Maybe such systems already exist. Doctors want to take care of their patients all the time, but they can’t. If we work together, we may be able to save a patient a trip to the ER.
Shirie Leng is an anesthesiologist who blogs at medicine for real.