The Cheerful Oncologist

The following is a hypothetical advertisement seen on a community sign, let’s say by a bus stop.

ARE YOU EXPERIENCING ANY OF THESE SYMPTOMS?

*chest pain, pressure, discomfort, tightness or squeezing, with or without nausea / sweating
*inability to breathe
*loss of consciousness
*worst headache of your life including at least the past six incarnations
*uncontrollable vomiting, or vomiting up blood
*hemorrhage from the rectum, with or without light-headedness
*traumatic injury
*abdominal pain that is severe enough to interfere with your ability to remain upright, not to mention remain calm, cool and collected
*sudden loss of sensation or muscle strength
*altered mental status

IF YOU ANSWERED YES, PLEASE GO TO THE NEAREST EMERGENCY ROOM.
IF YOUR SYMPTOMS ARE NOT SEVERE NOR MENTIONED ABOVE, PLEASE CALL YOUR PERSONAL PHYSICIAN AND LEAVE US THE HELL ALONE – WE’RE SWAMPED!

Patients seeking urgent care in U.S. emergency rooms are waiting longer than in the 1990s, especially people with heart attacks, U.S. researchers reported on Tuesday.

According to the experts, more and more hospitals are closing their E.R.s because, as study author Dr. Andrew Wilper states, “…in our current payment system, emergency patients are money-losers for hospitals.”

In other words, the fact that hospitals do not get adequately reimbursed to run an emergency room, combined with the hypothesis that increasing number of patients are using the E.R. as their family doctor, combined with the fact that emergency rooms need to be redesigned to allow for better access, treatment, transportation and coordination of care (plus given a larger space) means longer waits to see the E.R. doctor.

I can attest from personal experience that the emergency room is a lousy place to spend an evening. Are there any solutions? Dr. Wilper et. al. in the paper from Health Affairs have some ideas:

Reversing the trend of longer ED waits would likely require multiple reforms. Possible interventions include expanding insurance coverage and access to primary care resources to increase alternatives to ED visits; directing hospital resources to medical need (for example, the expansion of ED resources) instead of profitable but unnecessary services; increasing available ED space, staff, and specialty consultation services; and modified management of elective surgery scheduling.

Nice thoughts, but “directing hospital resources to medical need instead of profitable but unnecessary services”? Come on – cut the crap! The only way to ensure that emergency care will improve in this country is to increase reimbursement to the point that hospitals can afford to expand their E.R. care, or force hospitals to provide care (if I may paraphrase Ayn Rand) at the point of a gun, known to some as the term socialism.

Memo to all idealists: just because some Oxford don pronounces a certain medical treatment as “unnecessary” doesn’t mean that the American people will gladly stop having said treatment “for the common good.” Good luck convincing us that a single-payer government run universal health care system will bring peace, love and understanding to all those who cry out in the wilderness for relief from their suffering. Remember, suffering doesn’t go away magically with the wave of a pen from Congress, or the opening of the vaults of Fort Knox. Someone has to treat the sufferer, and that someone is people like me. Unless Uncle Sam decides its time for mandatory medical service, the little people like me can and will vote with our feet, thus the continuing crisis.

Comments

  1. #1 natural cynic
    January 16, 2008

    Good luck convincing us that a single-payer government run universal health care system will bring peace, love and understanding to all those who cry out in the wilderness for relief from their suffering. Remember, suffering doesn’t go away magically with the wave of a pen from Congress, or the opening of the vaults of Fort Knox

    Actually, NO. We just think that single payer will do a somewhat BETTER job.

  2. #2 Scott S.
    January 17, 2008

    The answer is to steer non-emergency cases to the clinic next door, akin to the ‘doc in the box’ free-standing clinics I use when I don’t want to pay the $3,000 fee that is always costs for a visit. Since I have cancer with lots of scary symptoms, I visit the ER several times a year.

    As far as Hillarycare goes, she and her left-wing ilk will destroy the best healthcare system in the world.

    What people fail to realize is if they take the profit motive away, people have no incentive to work hard.

  3. #3 Dave Briggs
    January 17, 2008

    What people fail to realize is if they take the profit motive away, people have no incentive to work hard.

    This is a tough issue with people falling through the cracks on both sides! I really admire those hanging in there and doing their best working within the broken, or at least bent system!
    Dave Briggs :~)

  4. #4 Dr. Val
    January 17, 2008

    I think Scott has a point – don’t you think that people who aren’t having real emergencies would go to a convenient care clinic (Redi Clinic or Minute Clinic) if they were aware it existed and had one nearby? Let’s try to divert the thronging masses of unsick away from the EDs without breaking the bank. :)

  5. #5 Dr. H
    January 18, 2008

    The idea for patients going to urgent care centers is great EXCEPT the urgent care centers actually make you pay for your visit. ER’s don’t always collect. So patients that don’t plan to pay for their visit will always go to ERs.

  6. #6 @Home sick 103
    January 24, 2008

    I was just sent away from my local urgent care clinic because they were ‘booked’. “And afterhours?”, I asked. “Booked.” Try another day.

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