Tuesday, June 11, 2013

ER Mythology 

It was just about fifty years ago that I first became aware of the mythology surrounding hospital emergency rooms.  The buzz word then was “abuse.”  A patient going to the ER for anything other than an emergency was “abusing” it.   

As time went by, other objections arose.  The service was too costly.  It was inconsistent with the ideal of continuity of care.  

None of these were valid.  ER use by non-emergency patients was only “abuse” if you said it was.  ER’s always gave priority to “real” emergencies.  As to cost, an ER must be staffed 24/7 whether anyone shows up for care or not and non-emergencies are a way to level out the workload.  In an age when patients were increasingly getting care from multiple specialists who never communicated with each other, concern about continuity was a little contrived. 

Services for non-emergencies were usually pretty bad, with hours-long waiting times.  Improvement was discouraged on the questionable grounds that it would only attract more indigent patients. 

What I came to realize early on was that these mythologies were invented by private practice physicians, who wanted these non-emergency cases to be cared for in their offices. 

Now, at long last, the situation is changing.  The cover story of the May 27 issue of Modern Healthcare was titled “One-stop shop for care.”  It described how three medical centers had decided to cater to patients seeking episodic care in their ERs rather than discouraging them.  It observed that primary care physicians are increasingly oriented to the promotion of wellness and the management of chronic disease and don’t want to be bothered by unscheduled patients with urgent complaints. 

One chief of emergency medicine was quoted as saying “Emergency departments have become a portal for patients to get care very quickly.  To be honest, I think that’s one of the real advantages of emergency medicine.” 

So it seems that at long last, the mythology is disappearing and hospitals are deciding to give ER patients the service they have been seeking all the time.


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