There’s something wrong with emergency care. Here’s what it is.


I am an emergency physician, forever grateful of the responsibilities entrusted by my patients. This is a relationship I hold dear. As such, I’m an active participant in the war of life and death for our patients. I’m in the trenches with the best nurses, techs and EMS personnel holding the line as the battle continues. We have our victories and share our defeats, all in the name of what is best for society and our fellow man.

Health care is a very hot topic in our society — as it should be. Every time I turn on the television or computer, there is a barrage of media commentary or special interest reports dealing with health care legislation, the AHA, or skyrocketing insurance premiums.

Parts of the proposed health care laws give glimpses of hope, while others leave me scratching my head in confusion. As with anything as complex as our current health care system, there are no easy fixes, but I do believe that with genuine bipartisan negotiations and open dialogue, we can find the best solution.

Unfortunately, recent media coverage of emergency care has me somewhat alarmed. I believe vital information is often left out of media stories, distorting the facts as they are compressed into a two-minute segment or three paragraph editorials. This is a multifactorial issue with many layers that need to be addressed.

One popular misconception is that emergency care can be compared to urgent care and primary care physicians. Recent media coverage of freestanding emergency rooms — ERs not attached to a hospital — has compared their costs to urgent care clinics. This is like comparing apples to oranges. These are two completely different entities that undoubtedly provide different levels of services. Urgent care is for treating minor complaints when access to a primary provider is not available, either due to scheduling or after hour illnesses. Freestanding ERs are fully functional emergency departments, capable of treating complex injuries and illness with charges comparable to hospital-based emergency departments.

As an emergency physician that works in both traditional hospital-based emergency departments and the new freestanding model, I have a unique perspective. In both settings, I’ve seen major strokes, heart attacks, infections and broken bones. I see the similarities in acuity between both facilities, and I understand the importance of providing quality emergency care to patients when they present at these emergency care facilities.

However, I was disheartened by a recent Today Show piece by Stephanie Gosk concerning freestanding ERs. In the piece, Gosk spoke of a child with abdominal pain that was ultimately diagnosed with constipation. An emergency is defined as “any medical condition such that a prudent layperson possessing an average knowledge of medicine and health, believes that immediate unscheduled medical care is required.” An emergency is not dictated by the final diagnosis.

Emergency physicians are trained to rule out life-or-limb threatening conditions. For example, abdominal pain in an ER is assumed to be an appendicitis, obstruction or infection until officially ruled out by the diligent physician through evaluation and diagnostics. This is consistent for emergency physicians practicing in any ER setting.

Abdominal pain is a presentation I see quite often in both of my practice settings, often referred from a local urgent care to rule out an acute intra-abdominal pathology. As an emergency physician, I’m ecstatic when a life-threatening condition can be ruled out. Unfortunately, this level of evaluation can’t always be ensured at an urgent care facility.

However, there are more glaring issues facing emergency care than just those related to freestanding ERs.

The first is gaps in insurance coverage. Insurance premiums have skyrocketed, and deductibles have increased resulting in massive increases in the out of pocket expenses for patients. This has coincided with record earnings for many of the largest insurance providers. Cost of emergency care hasn’t increased, but insurance companies have shifted more of the financial responsibility to the patient.

The second issue is decreased access to primary providers, which has increased consumer use of emergency departments for non-emergent conditions. I see this in both the traditional hospital-based ER and the freestanding emergency department. It is imperative that insurers and providers educate the public on when to seek urgent and emergency care. Our group has taken an active approach, providing information and lectures in order to educate the communities in which we operate. We have actively pursued relationships with local urgent cares and primary providers for non-emergent referrals to assist patients in finding the appropriate facility for care.

Emergency medicine is a noble profession, and I love what I do. I’m forever grateful to be an active participant in the lives of others. But for emergency medicine to evolve, we must seriously consider recent shifts in health insurance, and work to educate consumers and empower then to make the best decision for their care. I am hopeful that through effective communication and increased access, we can improve the health care system and decrease costs for consumers.

Jeffrey McWilliams is an emergency physician who blogs at Advocates Of Excellence.

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