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.