Tuesday, June 20, 2006

Time to Get Over It

The June 15, 2006 newspapers carried reports of an investigation by the Institute of Medicine on the state of Emergency Rooms in U.S. Hospitals. To no one’s surprise, the investigation found that Emergency Rooms are overcrowded and overwhelmed.

How can it be that a wealthy nation that devotes over one seventh of its wealth to health care, and boasts the largest, most elaborate, most abundantly financed hospitals in the world finds this prominent service “at the breaking point?”

At the risk of being immodest, I think I know the reason. Within the culture of the U.S. system of health care, emergency rooms have never been popular. There are two reasons. Hospitals don’t like them because they attract patients without the means to pay. Doctors don’t like them because they compete with private practice.

The article I read in The Boston Globe quoted Dr. Arthur Kellerman of Emory University as pointing out that Emergency Room care is “the only medical care to which Americans have a legal right.” So once a patient shows up, the hospital has to provide care whether the patient can pay or not.

Doctors get upset not only because they lose fees when their patients go to the ER instead of to their offices, but also because they often lose patients that way. Once caught up in the ER process, patients get referred to whoever happens to be on call and may well just stick with that physician and never go back to the one they were seeing before.

In addition to all that, care received in the ER is identified more with the hospital than with the medical profession – something not at all appreciated in the culture of health care.

All of that may be understandable, but that doesn’t make it excusable. ERs have become a central feature of our health care system. They may not like them, but it’s time for hospitals to get over it and operate their ERs properly.

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