First, ER visits are SKYROCKETING upwards.
Second, its not just simply the uninsured or indigent using the ER because they cant get care anywhere else.
Its a popular misconception amongst many people I know both medical and non-medical. The conversation usually goes something like this:
Them: "Oh man, you work in the ER? That must be pretty exciting"
Me: "Yeah, it can be pretty fun."
Then: "I bet you see some pretty crazy stuff huh? Like gunshots and car wrecks???"
Me "Yeah, some of that. But you know mostly its just regular people and sickness. Heart attacks, runny noses, rashes, strokes. You know, things like that."
Them: "WHAT???? You see RUNNY NOSES in the ER????????? THATS CRAZY!!!! Must be a lot of poor people without insurance or doctors. That even happens in the 'Burbs, huh?"
People in general are incredulous to learn that laypeople FREQUENTLY got to the ER for trivial things. They assume people use the Emergency Room for Emergencies. Whats funny is how often I get a call from these same people telling me about their own trip to the ER for their own trivial symptoms that they were CONVINCED was something bad.
In my sleepy little Suburban Emergency Department, our census has gone up almost 75% in the last 3 years. In our case it is multi-factorial, but visits are going up all over the country. Interestingly, no one really seems to be able to put a reason to why this is. Its easy to assume its the uninsured inappropriately using the ER because they dont have Primary Docs, but paper after paper seems to suggest this isn't the case. People just simply are using the ER more often.
So why is this? If visits are increasing and its not just the uninsured as many people assume, why did visits to ERs go up by almost 30 million over a matter of a few years? Well, as with many things of this nature, the reason is multi factorial. It most likely involves a combination of complex access to care issues. I though, have my own theory. Its the Internet. Yep, THE INTERNET, Greys Anatomy and Dr. House are the reason ER visits are increasing at alarming rates, contributing to overcrowding, hindering patient care and ultimately putting patients at risk. Its all the Internets fault. Seriously.
I believe that people in general, across all races and socioeconomic groups are using the ER's more frequently because they are constantly bombarded on TV and in the news by shows like Greys Anatomy, House and the Discovery channel by all the HORRIBLE things that can happen to them. They see the newly wed with the rash who is dead 12 hours later. They read on the Internet about Bernie Mac dying of a pneumonia that started as a cold. Seemingly reasonable people get scared that even the most minor of ailments could end up literally being the death of them. They hear about these things and immediately rush to the internet where they find confirmation that yes indeed, horrible diseases have many seemingly trivial symptoms.
I would say on any given shift, of the 20 or so patients I see, at least 5-8 of them are "worried well". People who just simply want reassurance that their side ache isn't a ruptured spleen like they saw on House last night. Most of them went on the Internet to "research" their symptoms and saw all the horrible diseases that could conceivably cause their symptom and want reassurance from me that they aren't going to die. "I just want to know I'm know gonna die". I hear that literally 3 times a shift.
So that's it. Take away the Internet. Cancel House and Greys Anatomy and you'd solve the ED overcrowding problem. I don't care about "throughput" and "output" and "multi-factorial". I don't wanna hear about papers suggesting "ED Overuse" isn't nearly as bad as physicians believe it is. Its the Internet. Its House. Its Greys Anatomy. And its the Worried Well. Thats my story and I'm stickin to it.
Its good to be back.
4 comments:
I had never thought of that! I always thought that it was because primary care docs had to "cover their butts". I had assumed that with all the law suits over, well EVERYTHING medical, it is safer for a doc that gets a phone call in the night to just say "go to the ER" than anything else.
Oh no, we're leaving House just the way it is. That's the only medical-ish show I watch.
Or put some sort of enforceable I-will-not-be-a-jackoff-who-cannot-differentiate-TV-drama-from-my-own-minor-symptoms policy in place.
Nice theory. I'd like to add on to it.
If you're pretty sure you've got a complicated problem, the LAST thing you want to do is go to your regular doctor.
Why? You call your regular doctor. Now you have an appointment tomorrow (if you're lucky). He decides you need a specialist. Now you have an appointment for a specialist next week (if you're lucky). The specialist decides you need some imaging/lab tests. Those tests get run within the next two weeks (if you're lucky). You don't get the results for a month, which is when you are scheduled to see the specialist again. Maybe you find an answer. Maybe it's more appointments, more specialists, and more tests.
All the waiting between appointments (presumably while feeling poorly) plus all the time off from work plus the travel time to/from plus the "doctor is inevitably running late" time plus all the fragmented care (just to MAYBE get to the bottom of your constant abdominal pain) equals frustration with the current system.
When I have a choice between waiting eight hours for an answer or waiting for nearly two months, I would rather wait eight hours, thanks. I'm tired of doing year-long dances with doctors ten minutes at a time until they finally stumble headfirst into an answer.
Of course, it doesn't help that any call to a PCP inevitably ends with "go to the ER if it gets worse."
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