The ER is not just for the uninsured
In the last year my mother has been to the ER several times. She is elderly, unsteady and has osteoporosis. She fell a number of times and broke her shoulder and and her wrist. Each time this happened in the middle of the night. Since her regular doctor nor her orthopedist are not available at night, she was packed off to the ER.
I'm a volunteer ski patroller who works evenings and weekends at Spring Mountain Ski area. We deal with a great deal of trauma injuries. Because these happen in the evening and on the weekends, we send many to the ER via ambulance. We might send some to their regular doctor instead of the ER if that doctor were available evenings or weekends.
The moral of these two stories is that doctors and doctor's offices are not open nights, weekends and holidays. So if you come home from work on Friday feeling poorly, and your fever spikes to 102F on Saturday, you go to the ER or wait to see your doctor on Monday, Tuesday if it is a holiday weekend. There are 168 hours in a week and doctors are available to see patients in their offices less than 40 hours. That's less than 1/4 of the week!
Politicians talk about getting the uninsured covered so that they don't use the expensive ER for non-emergency care. But those who are insured use the ER for non-emergency care also. When they get sick or injured at night or on the weekends they go to the ER. Since everyone knows that an ambulance patient has priority over a walk-in at the ER, many go by ambulance when they could have been driven driving up the cost even further.
The ER should only be used for real emergencies: life or limb threatening illnesses and injuries. Many illnesses and injuries don't need emergency care but can't wait days to be treated. If you call your doctor after hours, you often get a service or an alternate on-call doctor who sends you to the ER anyway. If the system had doctors available 24/7 outside the ER, costs could be reduced. But doctors don't want to work second and third shift. Only hospital interns and residents work these shifts and they look forward to the day they don't have to.
Perhaps doctors need to be part of after hours co-operatives where they each take a turn seeing each other's patients nights, weekends and holidays. They would accept whatever fee the primary doctor accepts and bill whatever insurance would be billed by the primary doctor. Follow-up care would be with the primary doctor. Only patients really needing to see the doctor after hours would be seen. New flu cases and non-emergency broken bones would be some of the cases they would treat. They wouldn't see patients with rashes or nail fungus which could wait until regular hours.
If we want to reduce costs in our healthcare system, we need to make non-ER doctors more available. I'm surprised insurance companies aren't lobbying for this.
Dave's comments hit the mark effectively. There are abusers of the ER facilities, guaranteed by the 1986 law signed by Ronald Reagan, but there are a lot of people in need when their normal doctors are not available, nor may have the proper medical skills to help them during evenings and weekends. I have had to use the ER in such an event, which is considered an emergency. As Dave has, my mother-in-law suffered from osteoporosis and was subject to problems at inopportune times when the ER was the necessary vehicle to correct her problems.
Dave, thanks for the article.
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