Medpundit has commented on the ER (mis)use piece written earlier this week, emphasizing the convenience (“In fact, you don’t even have to walk to your tests. You get rolled to them in a wheelchair or gurney.” – how true). Perhaps people are willing to wait the 5-6 hours in exchange for a second opinion, or in some cases a specialist evaluation. Beats waiting months.

A recent radiologist commenter had this to say:

. . . clearly a large part of the increase in ER visists is clearly the increased convenience, however, in recent years it has clearly become apparent that the ER is in a large part covering the off hours of the many primary care and specialist practices affiliated with that hospital.

It is interesting to note that when I now call doctors’ offices off hours for an emergency interpretation, there is almost never a service on call that will take the message and contact the doctor on call. Instead, most practices now say, “If this is an emergency, please call 911 and go to the ER”. There is no option for patients to reach their physican practices on call on off hours anymore. Thus they use the ER for all complaints.

I cannot comment on how other practices work around the country – just in my area. My particular 5-person group has 24-7 physician coverage by pager. Whenever the ER wants to consult on our patients, a simple call should be able to reach a physician within the group. More difficult is the telephone consultation. When a patient calls on the phone off-hours, I would have a pretty low threshold to send them to the ER. Too much risk in giving advice and treatment over the phone without actually seeing the patient.