Tuesday, January 12, 2010

Re-posting "Why Health Care Reform Won't Work"

Dr. Danielle's advice:

Monday, December 21, 2009

Why Health Care Reform Won't Work

Today I worked a day shift in the Emergency Room (i.e. business hours). In my short time, I saw 21 patients. All of the patients I saw today had some sort of medical coverage, mostly Medicaid, but some private insurance as well. Out of all of these, 19 complained about their wait time and 2 thanked me. However, much more importantly, 20 didn't need to be there and 1 person seriously had an appendix that needed to come out that second, but he had to wait 4 hours behind "ear pain," "STD check," "sore throat" and "rash." Before I started my shift, I made it a point to be sure and document if each patient had access to a primary care provider, either a pediatrician or family medicine doctor. Out of 21 patients, all 21 answered "Yes" to having a primary care doctor, and knowing how to contact them. Two patients had contacted their PMD before coming to the Emergency Room. The first one was the appy, whose pediatrician had taken one look at him and sent him straight to the ER for a surgical consult. The only other person who had actually called their PMD was a child who fell off a kitchen chair. The reasons that 19 other parents didn't call their primary care doctor and instead came to sit in the Emergency Room were as follows:

"Didn't think about it" = 6
"Couldn't get in to be seen today" (all could be seen before Christmas, however) = 9
"Don't get along with my PMD" 1
"The ER is closer than my doctor's office" = 2
"Thought this was an emergency" = 1

Just because people have medical coverage and ample access to primary care providers, does not mean our Emergency Rooms will be any less crowded. Just because people have access to a primary care provider does not mean they will not be impatient. It does not mean they will not want care "RIGHT NOW" and it surely does not mean they will understand the difference between a minor annoyance and a full blown emergency. I try to educate families on appropriate uses for the Emergency Room, and some parents actually feel comforted by that. They are glad to know a plan of attack, and what things should worry them. Most parents, however, just roll their eyes at me and ask, "How much longer?"

A long time, my friends. A very, very long time.


Timestep said...

To some extent I agree, to some extent I disagree.

When we were in CA, we could call the doc on call after hours. In every case, the answer was to go to the ER. I was a first time mom, I was looking for guidance. One night we spent all night in the ER when Sarah spiked a fever. It went down with tylenol and didn't go back up. We left after 6 hours in the waiting room when we weren't even close to seeing the ER doc (it was 4 or 6 am by then). Not sure why the doc didn't advise giving meds and then if that didn't help go in, but he did. Nothing was wait, everything was take her in.

So, after a while, you stop calling and just go. After all, they never tell you anything else, why bother checking.

Where we are now, we don't have an after hours number, there is no way to get a reading. So, we use best judgement. Later this month, we will finally get an urgent care from our hospital. Our other hospital opened on in a store last year. So, during store hours we've had access to a urgent care. Sometimes I go there, sometimes to our ER (which is also the current urgent care).

When Sarah gets an ear infection, I take her the minute it hurts. Her tolerance for pain is NOTHING and ear infections go from 'mom I have a bubble in my ear' to major pain quickly.

For Joe, once an ear infection comes in, it can take him over a month and several courses of antibiotics to get rid of them. So, he has to be seen NOW, not on Monday.

For me, it depends on the city and system I'm in. What Danielle never tells us is if there is an urgent care available. In the patient management she's in, she doesn't know if the parents have some knowledge of their kid that is driving the decision. She doesn't know if this is the 5th occurrence and after the third time of the doc saying 'just go in' that they stopped calling to ask before arriving.

There are many times I wish we had an after hours phone line - even if it was the hospital nurse - so I could ask questions, but there is no such thing in this town. If I want advice I can only do it in person.

Also, this isn't Health Care Reform. This is patient pathway and utilization reform. That is different than if someone has access to health insurance, how expensive health insurance is to purchase, and the decisions health insurance companies make care decisions.

If the answer is 'wait 48 hours until the doc office opens' as the only way I can get care for Joe or Sarah, they can't wait that long. If the answer is "did you know you can use the urgent care, after hours line, etc. I'd happily use them first. I don't like waiting for hours or taking up space at an ER either. But, if nothing else is available, I'll do what I have to.

Anonymous said...

What is the difference in the co-pay of going to the ER versus your PCP. Mine is $150.00 versus $20.00.
I manage to wait and see the doctor in her office.

Anonymous said...

Dr. Danielle's one-day-caseload in the ER is representative of a large group of ER-population. Her hospital would appear to be in need of some 'triage' training.

The current constantly changing so-called health care reform will not help other patients receive their appendectomies sooner or reduce the waiting in the ERs.

I have a whole series on healthcare insurance - each post just a bit about the behemoth it is. Boxed in the middle column on my blog. Barbara