Medical Tuesday Blog
Going to the Emergency Room for a Common Recurring Condition
If patients would avoid going to the emergency rooms for non-emergency conditions, we would reduce emergency room costs easily in half.
When I worked in the Emergency Room during my internship at a busy 500 bed county hospital, there was a holding ward for men and boys and one for women and girls. Each of these two rooms contained four beds and 20 chairs. These were filled with patients who the triage nurse decided did not have an emergency and could be seen after the emergency patients were treated or at least stabilized. The beds were primarily used as sofas when the waiting patients got too tired and needed to lie down and rest.
The nurses would place the critically ill in one of the two surgically equipped rooms that could resuscitate, manage cardiac emergencies, bleeding patients or other life-threatening emergencies. The interns would always treat any patient that the nurses placed in one of these two rooms. These patients were evaluated, treated, and the surgical emergencies (acute appendicitis, fractures, etc. who required admissions) were referred to the hospital surgical resident assigned to the emergency room; the medical emergencies (heart attacks, congestive heart failure, respiratory failure, GI hemorrhages, etc. who required hospital admissions) would be referred to the medical resident assigned to the emergency room. Then the interns gave their attention to the eight treatment rooms which were furnished with basic diagnostic equipment necessary for a general examination.
As one of two interns assigned to the ER for a month, I came to appreciate that this type of experience was not available in most private hospitals. However, my colleagues at Detroit General and Kansas City General Hospital all experienced similar training. What was not fully appreciated by a young intern in training was that the large number of patients that came to the emergency department for routine care could more easily have been treated in a private doctor’s office during regular office hours.
Every couple of hours I would make the rounds into the female and male wards. Pain was an over-riding issue with the majority. I always carried a bottle of enteric coated aspirin in my white coat. I remember one diabetic that appeared miserably in pain. I gave her two ECASA tablets and continued my rounds in that ward. I proceeded to the male receiving ward. When I was about half way around, a man tugged on my arm and asked me what those two pills were that you gave my wife. She had not been this free of pain in months. When she was finally placed into one of the eight treatment rooms and I entered to interview and examine her, she was totally free of the pain which was the reason for her emergency visit.
This is a frequent occurrence in medical practice. Patients do not take basic medications from their own medicine cabinet as the initial step in treatment. The minimal ER cost in my hospital was $800 and the average about $1500. This cost could have been avoided in many cases by less that one dollar out of the family medicine cabinet. It is this kind of glutinous behavior that is pushing the efforts for the government to take over all of health care funding. Don’t you think it would be better if we all took our health care costs seriously to avoid the access problems of a national health care service as in many socialistic countries?
The insurance companies could assist in this national health care consumption by never issuing a 100% coverage policy. In our studies, reported in our companion HealthPlanUSA review, if ER and Urgent care visits had a 20% copay, it would not jeopardize needed care but would eliminate the majority of the unnecessary ER traffic. We found that if the 20% was collected at the registration desk, which would have been $120 at my hospital, more than three-fourths of the people would voluntarily turn around stating that they would see their own doctors in the morning. This would also solve the problem of over utilization in American Healthcare without any government health care intrusion.
Medical Gluttony thrives in Government and Health Insurance Programs.
It Disappears with Appropriate Deductibles and Co-payments on Every Service.
* * * * *