The “go to the ER” Mentality of American Medicine

Patients waiting in a hospital waiting room

Original article HERE by Edwin Leap, MD 

Currently, in American health care, experts are wringing their hands in confusion.  I mean, people have insurance, right?  And yet, health care is still expensive and dang it, people just keep going to the ER.  Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.

I’m not a medical economist.  I do have some thoughts on the well-intentioned but deeply flawed Affordable Care Act. However, I won’t go there right now.  What I do want to address is the “go directly to the ER” mentality of modern American medicine.

Call your physician.  If it’s after hours, the recording for any physician or practice of any sort in America will have a message:  “If this is an emergency, hang up and dial 911.”  It’s a nice idea.  But of course, it presumes that everyone really understands the idea of emergency.  In fact, they don’t.  We understand that, or we try to, but we see lots of things that come in ambulances, or just come to the ER, that really aren’t.

“I feel fine, but my blood pressure is up.”

“I was bitten by a spider, and I watch nature shows, and I know how dangerous they are.”

“I have a bad cold, and I have taken two rounds of antibiotics.  I have an appointment with my doctor tomorrow, but I thought I’d just come on in to get checked out.”

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6 Responses to The “go to the ER” Mentality of American Medicine

  1. Mike RN

    1) EMTALA needs to be revised, clearly and definitively. While I’m uncomfortable with the “wallet biopsy” I witnessed working in one ED, it at least fulfilled the emergency screening portion of EMTALA. If you don’t have a valid emergent condition, you pay cash on the barrel head for using ED as a primary care center. The public doesn’t understand that the obligation is to examine and stabilize you *if you have a medically unstable condition,* not to examine every less-than-first-aid-required-insignificant-ailment-that-someone-read-on-the-Internot-might-be-the-beginning-of-something-devastating-and-I-brought-my-whole-posse-because-I-might-drop-dead-any-second-now. Oh, you’re sending me home to follow up with a PCP? Now I’m suicidal! (Yes, i’ve seen this so many times.)

    2) Moving to a large Southwestern US metroplex, I was astonished to find my PCP doesn’t admit patients directly to a hospital, something I was used to in a smaller Southern city as a matter of course. He said he can’t afford to maintain privileges at various facilities, doesn’t have time to see all the patients he would admit, and most stunningly, “who am I to tell the physicians at the hospital that you need to go in?” The answer was that you go to the ED, where you hopefully do have a serious, emergent condition they can evaluate and address, including inpatient admission if need be. And you get managed by hospitalists who don’t now you at all, ditto for the specialists. That happened to me twice last year, even after extensive workup and treatment by my PCP for a certain (and yes, serious) ailment.

    This is seriously f—ed up. And people wonder why continuity of care is becoming such a rarity in the current “system.” This certainly drives increases in ED traffic.

  2. Straydog

    I’m a nurse who recently had food poisoning or something the like. After being sick and unable to eat for a whole week I tried to work a short day but felt like passing out. The next day I tried to go see my primary but she told me I was too sick and referred me to the Ed where I received liters of fluid and some stomach meds. I was trying my best not to go to Ed. Get this-then I got a bill from the Ed for $200! I found out this is our copay as I have the highest level PPO from the hospital I work at-and I went to my own Ed. This really sucks-really?

  3. Brandison

    Don’t forget about pregnant patients who treat we as their ob and the ob Drs whose staff tells every patient to go to the er for every little pain sometimes multiple times Ina row instead of taking care of their patients as they are paid to do . ? They don’t have ultrasound machines in their office

  4. SNB

    We incentivize behavior and wonder why people behave that way.
    I work the EMS side of this and it all part of the same problem: for most it is easier, faster, cheaper, safer, and less hassle to tell people “Call 9-1-1 and go the Emergency Room.”

  5. PainedRN

    As to the comment about gas, and going to the ED, I have had many abd surgeries and get excruciating pain from blockages from massive amounts of adhesions. I do my best not to go to the ED, there are times I have to go. I hear the comments of some staff, “drug seeker” “oh it’s just another stomach ache” I find this sad, and don’t wish my pain on anyone, just a little understanding.

  6. cinmich

    As a home health nurse, we tell the patients on the day of admission to home care ” call us first”. We will help you over the phone or we will make a visit 24 hours a day. I’d say ( without doing a study) about half will call us first. And we usually keep them out of the ER.