Emergency Room Visits for Non-Urgent Medical Needs

Good Morning to Everyone !

Let's tackle another hot topic of health care - non-urgent use - abuse of ERs. I would like every one's opinion on why people use ERs for their primary care or non-urgent needs. I did a little research and have found that the media, the government, the patient population and medical personnel really have differing thoughts on this - which I find very interesting. As a health care professional, I do like to try to be convinced of the other sides' viewpoints.

So let's take a spin around the googling world. I read several forums and news articles on this subject and there are varying views on the reason people come into ERs and how these costs affect our already broken health care system.

The governmental agencies seem to realize that a big factor in ER use is the broken health care system. They think with broad reform and insuring the entire population, these numbers will decrease significantly. They feel that many more ERs would be able to stay open and the lines would diminish if everyone was insured. The President, the Democrats and Republicans alike all think that if we insured everyone, increased our funding in the public programs and rebuilt our infrastructure to include strong community-based and home-based medical services, we would all be much better off.

The media has an entirely different view of the subject. They claim that most people come to the ER with non-urgent needs for two reasons - that they either are uninsured or have Medicaid and don't have access to providers they can see - as doctors are refusing care in the clinic settings for nonpayment. So they trickle into the ER where they know legally they have to be seen due to EMTALA laws. Interesting concept and one I hadn't really considered. And secondly they feel that most patients do not know what is emergent or urgent or routine. They feel that in the moment any amount of pain or suffering that people are feeling is real and they can't differentiate between something that is life-threatening or not. Again, interesting.

Next on to people in general - what I found online is almost next to nil. People don't really weigh in too much online about health care issues. There are a lot of right wing and left wing spouting off about the health care system in general - but I didn't find a whole lot of people just asking general health care questions. I did find a few real life stories of the pay offs of going to the ER - and then some nightmare stories of private sector clinic care. Again, interesting enough, it seems we do too good of a job in the ER of giving patients just what they want and what they need. There were many stories of patients not being able to get into their doctor's office for routine or non-urgent needs - having to wait weeks to months to see their doctors. Plus there were many sightings of patients wanting a fast track to getting the xrays, CTs, MRIs and specialist referrals they have been having trouble getting from their own doctors. Plus, where else can you go to get IVs, medications, tests, etc.. - one stop shopping for your needs - in a relatively short period of time.

On the other hand, there were also several stories about how the general population feels they get the best care from the best trained personnel in the system. They talked of nightmare stories of their loved-ones dying from delayed treatment and missed diagnosis in the primary care setting. And they also expressed that they weren't sure when they should or should not use the ER. There seems to be a little confusion about what is emergent and what is not. Most people seem to know if you're having chest pain or shortness of breath, they should go - or if they have an ear ache or a sore throat, they shouldn't go. But with the Internet and the symptom checking on web sites, they are confused about is emergency in the abdominal pain, nausea and vomiting, back pain, headache, broken bone and laceration categories. And truthfully, there leaves a lot to desire with telephone triaging - if you can't see the patient, you don't know where to send them - so you send them all to the ER. Great ! I know, you're all worried about being sued for liability for missing something - but come on.

Now, let me just say, there are a lot of online forums from health care professionals. Some are constructive - some are just plain mean. Some people have definitely identified a lot of factors in the use/abuse of the ERs. And some people just get soooo frustrated about the piddly little things that come in.

Let me just give you some real-life examples from my friends and co-workers - you tell me what you think. Are they emergencies - could they be - or come on, should you just stay home for a day or two - go to urgent care - or wait for an appointment with your doctor? Let me know what you all think !

Examples:

2am STD check
Sore Throat for 3 Days
Knee Pain for 10 Years
Bug Bites
I need a Note to go back to work because I called in sick last Friday.
I had a Fever ....yesterday.
My Child was at a Party yesterday and was exposed to Chicken Pox. Is there a Shot for that?
Cold Sore
Dandruff
Pregnancy Test
Prescription Refill
Rash for 14 Years
The Cops or the Airport Security took my Prescription for Pain Medicines, Can I have Another?
I drink too much but I don't want to be here - but called the Paramedics anyway?
A Zit?
Someone concerned about getting AIDS from a Bite.

The ultimate and funniest and saddest one of the bunch - a Dialysis Patient was sent to the ER because of a necrotic belly button - OK, did any one look? It was a blueberry that missed his mouth in the morning. Come on !

OK - now, I know people aren't just feeble-minded - at least not everyone - but in all these cases, we all know - us and patients alike - these are not emergencies and do not belong in the ER. I'm not sure that even one of them, in the worst-case scenario would be urgent or emergent. OK - maybe one - the sore throat could be something cooking - I'll give them one - maybe - unless of course, it was just a sore throat with no other symptoms.

I want to tell you what I think about all this. I'll give the government, the media, the people and the health care professionals all kudos. Everyone has touched on at least one aspect of the system that is just all or partly wrong in the US.

But I think we're missing one important aspect - and I'm not sure how to fix it - well I have a few ideas that I'll touch on a little later. This is the generation of instant gratification - and not wanting to be inconvenienced by anything. It's all about me, me, me. And I can attest to this as I know, I have a little bit of that in me as well.

So let's be a little constructive and talk about how we can fix some of these issues.

#1 - Health Care Reform, Health Care Reform, Health Care Reform - can I say it any more??
We so need to refocus our infrastructure. We need to insure everyone in this Country - well everyone here legally. There is a certain sub-population that is always going to end up in the ER and not have coverage. With EMTALA laws, we have to see anyone who shows up in the ER. Sorry, that includes illegal aliens. There's no way to get around that - they are always going to cost all of us some money. But if we insure everyone else, then we cut down on all the uncompensated care we give to the poor and the homeless, uninsured and under-insured population. It just has to be done.

#2 - Let's rebuild - increase funding for our community health systems. We need more community health centers, more urgent cares, more primary doctors who see all people. We just really need more Primary Care Doctors - they need to be compensated more. People need more access to their doctors. There are not enough doctors to go around. We need to refocus our funding on the home-health field as well. People would love to stay in their homes if only they could afford to be taken care of there - or in residential homes.

#3 - Education, Education, Education. Patients need to be educated on where to get their care, how to get their care, the costs of their care, alternatives to care, what's emergent and what's not. Transparency is all too important. Maybe a big sign in front of the hospital with all this information would be good. Maybe simpler plan books or brochures with easily understandable language would be nice. Written instructions at discharge from the doctor's office, the ER, the inpatient setting could be mandatory. Maybe some big organization could take on this task - the American Heart Assoc., Blue Cross/Blue Shield, Kaiser Permanente, maybe the government could launch a big advertising campaign about this???

#4 - There needs to be some sort of sliding scale co-payment system in the ER- in my opinion.
If someone comes to the ER with a true urgent or emergent condition, the co-pay should be less. People should be charged more for non-urgent, routine ER visits to discourage them from coming in on just a whim. I don't know exactly how to restructure this, but I believe if people have to pay $200.00 + for an ER visit (if that's what the estimated cost would be to see an ER doctor), I believe that it would only take once to figure out that you shouldn't do it. I think that the pocket book hit would squash some of the instant gratification drive.

#5 -And lastly from me, I think that every hospital should have some sort of in-person triaging system. The ERs should have a triaging doctor in front - and the hospitals should have a system of deflecting patients to the clinics, PMDs, urgent cares and clinics. If everyone is insured, this should not be a problem. If your clinics don't have any openings, then the patients get sent down the street to a place where there is an opening. I like the idea of a concierge service. I feel it would help everyone involved. The ERs would be used for emergencies - the uncompensated care would go down and the people would get the care they want, deserve and need in a fairly short period of time.

And to Stan - I love your philosophy on our ER specialty - I'll call it your mantra -

"Common Sense is Not that Common"
"Job Security - There will always be plenty of "Emergencies""

So come on everyone - brain storm - what do you think? Do you have any other solutions to the health care crisis that is happening in our ERs???

Comments, Fixes, Bitches !

See Ya back here Later !