ER Visits

DoomDuck's picture

This isn't the first time I've wondered, but why do people come to the ED so often?

Healthy 18 yo comes in with a cold she's had for 3 days. Healthy 10 yo has a cold since this morning, mother brings him in. Healthy 17 yr old comes in because she gets a brief chest pain while sprinting for the bus that goes away when she stops running.

I think a large part of the problem is the "I want it now" mode of thinking that we Americans have fallen into. Yes, I could make an appointment to see my primary care doc in a week or two, but I want information now. Not treatment, just to talk to a doctor immediately and on my schedule.

I'm not sure everyone's aware, but in 2003 the avg ED visit was $560. That's a lot of money, and I can assure you that number's only gone up. The average stay in the ER's 3.7 hours. Another factor that I don't think people take into consideration. (Especially those of you without a serious problem who want to be seen quickly. Sorry bud, your sore shoulder? Not gonna see it 'til that guy with the stroke's got his plan set and he's going somewhere. That's... another story though.)

So, 4 hrs and half a thou. The thing is, most people don't know those numbers. The copay (if they pay one at all) is significantly lower. Many obviously believe this should be a quick stop. Meanwhile, the ones who really do need to be seen get stuck behind everyone else because the hospitals are getting overloaded. This is problematic.

My suggestion? Bill for the total amount so they at least KNOW how much they're actually paying. If nothing else, it would be informative. I mean, I'm in healthcare and I still have no idea how much some of this shit costs. Just found out a pathology report was 300 some dollars if not more.

As for changing people's "now" mentality, I recommend viewings of both Chocolate Factory movies until they can sing along with the Oompa-Loompas (from Loompaland). If they can do the dance, they get a bonus.

I think it's some of that.

I think it's some of that. I think there is a subset of parents that like to talk about how great they are because at the first sign of something, THEY took their kid to the ER and THEY got something done about it. It's a focus on the image of caring and being effective rather than the act of it.

But you know, I think also that a lot of people don't consider what their medical options really are. Not just in respect to what their insurance can provide for in a variety of situations, but what's really out there. I know that here, I can get a same day/late hours/weekend appt with my doctor's office, and it's one of the reasons I use them, and chose them in the first place. I know if there is a serious enough problem that I can't wait for my doctor to open to see, I can go to an urgent care facility and not waste my time and the ER's time for something I know really isn't life threatening, but ought to be handled. And I know when I SHOULD go to the ER and I know what to expect. But I also recognize that I have a greater familiarity with health and medical systems than a lot of people simply can. I recognize that a lot of the way I handle it has to do with a) how I was raised, b) what I learned I could do as an adult in college and c) the options I found to be available to me locally at this time.

We can do a better job of educating people about how to use the medical resources available to them efficiently and effectively. You'll still have that segment that can't or won't figure it out, but I believe there's a lot of people who WOULD do things differently. I wonder if there's been a study?

Do you ever consider having

Do you ever consider having conversations with patients in the ER about what other options might exist and what they can do the next time, especially if you think they are going to be repeat offenders at that level of pain/illness or for that condition?

Most definitely. Actually,

DoomDuck's picture

Most definitely.

Actually, every time a patient leaves I've been basically trained to give a summary of what's been done, what they should look for that means they ought to come back to the ER, and if it's a chronic problem what they should know about it and the kinds of care they should aim for. I've given this talk about 5-15 times a day for the last 2 weeks thanks to the H1N1 thing.

On the other hand, I have yet to tell a patient their trip to the ER was not a good choice, was unnecessary, was dumb - true though it may be. They don't want to hear it, and having talked to several patients who HAVE been told that at one point or another, they resent being told.


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