using the ER as your primary doctor

[donedeal]

for those of you working in the ER, or even those of you who frequently bring us patients, what percentage of your patients do you believe truly belong in the EMERGENCY room? I would say that during my shift, maybe 3 out of 10 patients are actually experiencing an emergency. As for the other 7, the frequent flyer drunks, the earaches, the sore baby toe, the unproductive cough....these people need a primary doctor. well, except for the drunks, they need rehab. but all these other cases clog up the ER and unfortunately, they do not have health insurance, so in the longrun john taxpayer picks up the tab anyway. now...massachusetts recently passed a bill for mandatory health insurance for every state resident. it would be very interesting to see any correlation from the passage of this bill and a reduction in nonemergent ER visits. anyone from mass experience this? i honestly dont know if the bill has been put into effect yet, so perhaps in time, keep a lookout in the ER for me.

[CoyoteMedic]

You hit it right on the money. Most people don't have health insurace. And healthcare is so expensive, they cannot afford to buy into the plans, and thus get a PCP. Even those who do go to the ER, how many of them do you actully think can afford to fill whatever scrips they get in the first place? I'm sure there are more then a few ER docs and RN's that read these boards that can probably give a good guess. As for the universal healthcare, I know it works wonders in Europe, and I think its going in Canada to, someone please correct me if I'm wrong. There are some states out there that have a universal healthcare system, basicly all it is is government run. I know that here in california, there is something like that on the ballet for this november, but I havn't heard much past that.

[NREMT-Basic]

Unfortunately, 911 and the ER are the only forms of medicne available to abot 30% of our population here in the States. And most hospitals will get subsidized if a pt fills out a form stating that they are in need of financial assistance. Since the subsidies are from the government, they will eventually find their way into a tax hike.

If anyone out there is interested in starting a non-profit, free ambulance service, please let me know. This is my ultimate goal in EMS.

[Ridryder 911]

I just am finishing up a thesis on abuse of E.R. Call it what you like "state insurance" etc.. is just medicaid contracted out to another insurance company, no difference in reimbursement pay.

There are multi problems with abuse in the ER. Some from being uneducated, partly from physicians using it as a "dumping ground" in lieu of seeing their patients, to those that want a quick tx. for their ailment.. covered or not.

ER patients have drastically changed in the past 15 years, they are not the same we used to see. More demanding, non life threatening, and have higher expectations of treatment. So many patients expect and demand treatment like a drive through at McDonald's, and if inappropriate treated, will be the first to seek litigation.

That is why so many ER's are placing non-urgent centers in the ER. Basically, a clinic inside the ER, because people are either lazy, don't have a Doc, or the Doc over books himself as an HMO provider and can not see them for 6 months. Which is a whole different rant...

Remember, only and if only that patient has a true life threatening emergency, will that ER get reimburse from Medicaid, if they do not most state has a cap level of payment.. usually $30-50, which basically, doesn't pay for squat. Now, you see why hospitals would love to dump the ER business? Yes, if there was not a law making the hospital to see everyone, there wold be a lot less ER's and as well a lot less patient's to. Many patients are quite aware of the EMTAL rule, and use it to their advantage.

We have just reached the tip of the iceberg, on this problem.. wait another 5 years, when experts predict the ER visits to triple in number....

R/r911

[Just Plain Ruff]

i had a sage doctor friend one time told me this "it's not your emergency so get over it and treat the F*&*ing patient" and I have lived by that rule because I do not see things changing due to most of the above reasons posted. He was having a really bad day and the very next day he had a Huge MI while working. He survived but he hasn't practiced medicine in about 5 years.

I would love to see patients that have a true emergency but when I was working in the ER. Unfortunately there are many many factors that go into ER visits and abuse that not one solution will fit this scenario.

[csr]

I don't have health insurance. My primary care doctor is one at the VA clinic. If I can't wait for an appointment at the VA due to sudden illness or minor injury I go to one of the many hospital run After Hour Clinics in the area and pay to see the doctor there. Until being transported after a Motor Vehicle Wreck about 3 weeks ago I had not been to a ER (as a patient) in many years.

[rayemtjax77]

What makes me angry with this situation is the females that are 19 wks pregnant and have not seen a OBGYN yet. In our ER, we do not see pts that are over 20wks with preggo related symptoms. They go to the birthing center.

[pyroknight]

Socialized medicine is NOT the solution. Here in my town, the native people have free health care. They have a clinic that is open every day. Do you think for one minute that stops people from presenting at two in the morning with dental pain they have had for two weeks? Nope.

A lot of the problem is doctor shopping / med-seeking behavior. These people (they are not really patients, patients have medical conditions) will come back for several days until they hit the doctor who will send them home with a "pre-pack" of narcs and a prescription.

All that is required is that we ensure that no life threats exist. Unfortunately, in today's litigious society, the doctors have to rule out EVERYTHING in order to cover their a$$es. If we could limit liability, maybe they would be more inclined to decide that pain is not life-threatening.

[whit72]

Now how much fun would that be if we only transported emergencies in Emergency medical Services.

[rayemtjax77]

The Local Fire/Rescue department can refuse to take a patient because it is not a emergency if they wanted.