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In today's NY Times we get insights from an ER doctor about what it's really like in his world.
Excerpts from the article:
"My choices as a doctor in the emergency room are up or out. Up, for the very sick. .... Out, for everyone else. ... Up or out is what the E.R. was designed for. Up or out is what it’s good at. ... traffic through the emergency room has been growing at twice the rate projected by population growth and has been for almost 20 straight years, ... demand is such that new E.R.s are already too small by the time they are built ... The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Up, out."
IIRC the NYTimes allows non-paying viewers a few articles per month at no charge. I spend $25/month for unlimited access and consider it money well spent.
This thread might be equally at home in Current Events as well as here in Health and Wellness.
Bottom line for me is to never used an ER unless it really is a true emergency.
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In today's NY Times we get insights from an ER doctor about what it's really like in his world.
Excerpts from the article:
"My choices as a doctor in the emergency room are up or out. Up, for the very sick. .... Out, for everyone else. ... Up or out is what the E.R. was designed for. Up or out is what it’s good at. ... traffic through the emergency room has been growing at twice the rate projected by population growth and has been for almost 20 straight years, ... demand is such that new E.R.s are already too small by the time they are built ... The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Up, out."
IIRC the NYTimes allows non-paying viewers a few articles per month at no charge. I spend $25/month for unlimited access and consider it money well spent.
This thread might be equally at home in Current Events as well as here in Health and Wellness.
Bottom line for me is to never used an ER unless it really is a true emergency.
Yes, ER should be for true emergency. For instance, I had leg swelling and pain back in August which I thought was sports injury. When it got much worse I went first to urgent care; who promptly referred me to ER for blood clot, and they took me in right away.
There are a lot more urgent care places opening up, and while in my case I should have gone straight to ER, many people can be seen and treated by the urgent care clinic.
This article was posted in a medical forum I read regularly and had a lot of responses. General themes expressed by people that work in ED's included:
1. We need more PCP's.
2. Frustration about patient abuse of the ER (and abuse of ER staff by patients, TBH).
3. We need more PCP's.
4. Lack of support from hospital administration and hyper focus on customer satisfaction, Press Ganey scores etc etc.
5. Need more mental health resources.
6. Did I mention needing more PCP's?
I'd love to hear stan4's thoughts if she'd care to weigh in.
We need more PCP's and we need more hours of operation. I don't know of any PCP who is available on the weekends, which means it's either urgent care or ER.
PCP's are dwindling because they need to know more -- more broad base of patients rather than 1 specialty, same thing every day -- and they get paid less.
PCPs should be paid the most. They are the gatekeepers.
I agree with the premise of this thread. I used to work in a pediatrician's office. Many of our patients would take their kids to the ER when the office was closed, then sometimes call us the next morning to ask if the care was appropriate. They did not seem to want to utilize the on-call system that was set up. Patient only needed to call the office # 24/7. When the office was closed, calls got routed to the answering service. Doctor would call patient back. Granted, sometimes the advice was then to go to the ER, but other times such a visit was not necessary and home care advice was given. My point is that patients should utilize their office's on-call system first, instead of going to the ER or even Urgent Care unnecessarily.
Our doctor's office runs an urgent care after the practice closes each day. They also run it on weekends (8-4ish on Saturday's and 1-5 on Sunday's). A couple of doctor's take turn staffing it along with PA's and NP's. We took our son there recently, when we thought he had a sprained ankle, and it turned out he had broken his leg in two places (we learned pain level isn't a good gauge on our 11 year old).
Our doctor's office runs an urgent care after the practice closes each day. They also run it on weekends (8-4ish on Saturday's and 1-5 on Sunday's). A couple of doctor's take turn staffing it along with PA's and NP's. We took our son there recently, when we thought he had a sprained ankle, and it turned out he had broken his leg in two places (we learned pain level isn't a good gauge on our 11 year old).
Same here and for a very similar experience with 9yo son who didn’t break his ankle but tore ligaments. I choose doctors for my pcp and my son’s based on whether they offer after hours visits and care. If they don’t then I won’t use them because 90% of the time I don’t know he’s sick or hurt until I pick him up from school after work. Ours also has walk in hours every morning at 7 am so you can find out what’s going on, can kid go to school or I go to work, etc all before 8 am.
In today's NY Times we get insights from an ER doctor about what it's really like in his world.
Excerpts from the article:
"My choices as a doctor in the emergency room are up or out. Up, for the very sick. .... Out, for everyone else. ... Up or out is what the E.R. was designed for. Up or out is what it’s good at. ... traffic through the emergency room has been growing at twice the rate projected by population growth and has been for almost 20 straight years, ... demand is such that new E.R.s are already too small by the time they are built ... The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Up, out."
IIRC the NYTimes allows non-paying viewers a few articles per month at no charge. I spend $25/month for unlimited access and consider it money well spent.
This thread might be equally at home in Current Events as well as here in Health and Wellness.
Bottom line for me is to never used an ER unless it really is a true emergency.
All this assumes the best.
Now, assume that the ER is really being run by a hospital for the purposes of making money. I didn't used to believe that. However, my profession as an attorney allows me to see firsthand how the emergency rooms in local hospitals have been turned into "centers of profit maximization". Let me give a couple of examples:
1. Patient comes to the ER after having been involved in an automobile accident complaining of neck pain. In the past, this patient would have received an examination, an x-ray of their cervical spine, and perhaps a prescription for both flexeril and a prescription strength pain killer like norco. Today, this problem is treated differently. Most patients will be referred for a CT scan instead of a simple x-ray. The CT scan will have one fee for the actual scan and a separate fee for the radiologist to interpret the scan. The cost of this test alone will ordinarily be about $600-$700. If the patient reports headaches in addition to neck pain following the accident, a second CT scan of the brain will be ordered as well. If questioned why they are doing this, the hospital will complain about unfair "the malpractice system" is. This occurs even in places where not a single lawsuit was ever filed by anyone for such an occurrence.
2. A patient who is 45 years old comes to the hospital complaining of chest pain. A careful history reveals that the patient is susceptible to heartburn and reflux. Further, the patient has been taking an antibiotic that does cause stomach upset. No shortness of breath is observed. Yet, an EKG is ordered and performed. The patient is observed for several hours before being allowed to go home. The patient's family doctor just shakes his head when he hears all this. He tells the patient that chest pain is actually fairly common and tells him never to go to the ER again unless his symptoms are worse.
Honestly, the old cliche about "taking two aspirin" and calling your doctor in the morning makes a lot of sense.
Seriously though, as some have suggested the real solution to this problem is an expansion of primary care. The group that is most likely to rely upon the ER (and overuse it) are the poor and immigrants. Some cities have community health centers which are clinics largely funded by federal money that are designed to serve poor areas. The problem is that not enough of these clinics exist. I suspect we could create more of them and potentially save money doing so if we could get certain groups to go there instead of the emergency room of the local hospital.
Last edited by markg91359; 12-23-2019 at 07:45 AM..
#1. I have not a lot of knowledge about orthopedics. However, medicine is always moving on, and a treatment that was the "gold standard" in 1970 isn't the gold standard today. That may be the reason for the CT rather than a plain X-ray. I worked in a physician's office with 5 doctors and frankly, I do not recall any comments about malpractice or attorneys.
#2. That's more what I was getting at. I honestly don't think doing an EKG is inappropriate in the situation you describe. Just because someone has a history of reflux, it doesn't mean he can't be having a heart attack today. These doctors don't know this patient, or that he's having his typical chest pain, which does beg the question of why he went to the ER in the first place. I doubt the family doc would shake his head over what the doctors did. Family Doc may question why the pt. didn't call his "after hours" number (which is usually the same as the daytime number) and ask for advice before going to the ER.
Now, assume that the ER is really being run by a hospital for the purposes of making money. I didn't used to believe that. However, my profession as an attorney allows me to see firsthand how the emergency rooms in local hospitals have been turned into "centers of profit maximization". Let me give a couple of examples:
I'm not sure I'm convinced about the ER being a profit center considering such a large proportion of patients who present through the ER are either uninsured or underinsured, Katarina's link above notwithstanding (btw, thanks for that, KW, it was interesting) In my time spent working in hospital admin, a large percentage of patients the hospital had to eat the costs on was someone who came in through the ER.
I don't disagree with your assertion that too much and/or unnecessary testing is done in the ER, but I still believe a lot of it is due to the practice of defensive medicine. Your example of someone completely unknown to the ER walking in complaining of chest pain and not getting at least a partial cardiology workup seems like something that would completely be picked apart by a plaintiff's attorney in a malpractice case.
Last edited by Texas Ag 93; 12-23-2019 at 01:34 PM..
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