Posted by kylenn on August 8, 2006, at 21:27:29
In reply to Re: Yikes! I agree with Estella, posted by AuntieMel on August 8, 2006, at 14:48:24
You are right about the ERs being used as clinics. but as a person who has worked in ERs MANY times as a student, resident, and now as an attending, I have to point out that the ones who truly abuse the ERs generally (sorry, I have to generalize because I am aware that there are exceptions but public welfare systems run on statistics and statistics are, by definition, a way to find out, GENERALLY, what things are or how things are used, etc)
but generally, the biggest abusers of the ER for things like an earache for 3 days brought to the ER at 10p.m on Thursday night ARE folks that are taken care of by the system, and they DO have clinics they can go to during the day and they GENERALLY get better care, wait less, and have better follow up, if they go to their clinics.
But, they don't they go to the ER. At 10pm or 1a.m or 4a.m with their 6 year old who has had a sore throat for 5 days. I kid you not. Now, what was that kid doing on Monday, Tuesday? Wednesday, all day Thursday? I have EVEN seen them come in like that and actually say THAT THE KID IS FEELING BETTER TO DAY BUT THEY THOUGHT THEY SHOULD JUST GET IT CHECKED OUT!!! Guess what, I agree, but why the ER? why in the middle of the night? why not when they were feeling really bad? why not this morning? why not in a couple of hours? Why is your 6 year old up at 4 am on a school night?
Dont get started on Oh my God how can you say that?
Maybe the kid couldn't sleep! Maybe they thought it would get better!
and maybe monkees will fly out of my $%@!
Ok, for all of you who just can't take it,
THERE ARE exceptions. OF course I realize that.
BUT the majority just do not care.
They are awake, they have a ride, whatever, I just fail to believe that that many people really think that waiting until some ungodly hour (or during the day) and GO TO THE ER for something that IS NOT AN EMERGENCY are abusing the system, they know it, and they simply couldn't care less. They aren't paying for it.
(and I am not saying that they should)
but they might think twice if they were.
SELF PAY patients ( usually hard working lower middle class to middle class people) RARELY abuse the ER. BECAUSE THEY KNOW THEY ARE GOING TO GET A BILL AND THEY REALIZE THAT PAYING $2000 FOR A SORE THROAT AT 4 AM IS JUST PLAIN STUPID.
But, the folks on medicaid never have to pay. they never see a bill. AND I AM NOT SAYING THAT THEY SHOULD
But, they should be educated what constitutes an emergency (and my patients are, by me) and what an emergency room is meant to do (and I think most people are aware) and I think there should be a review of a situation when a person is repeatedly abusing the free healthcare in such a fashion and after education and understanding is performed and documented, repeated infractions should be fined. I am not saying make them pay the bill, I realize they could never afford it.
But, I am telling you, if they knew they were going to get docked $25 for every documented unneccessary er visit out of their SSI check, they would think twice. It would STOP. I virtually guarantee it. And, almost every health care worker I have ever heard discuss this very issue agrees. A few bucks at 4 a.m. for a sore throat vs free at 8 a.m. and they WILL wait.
When I work the ER, I am very lenient on what I consider an "emergency" because I try to look at it through the eyes of the patient. But when I can see that it is just blatant abuse of the system. I realize new parents are frightened and nervous of every little sniffle! I know that a child that you thought would get better, but didn't and now it is three a.m. and you are REALLY getting worried that something is terribly wrong is an emergency. (Maybe not to a doctor or a nurse, because we might be more objective and realize the kid is ok, but you may not know that and it is our job to reassure--even at 4 a.m.--and be gentle about it.
But the abuse is usually so obvious, let me tell you.
Like a kid with "ringworm" in the ER.
When was the last time ringworm killed anyone?
or the rash for 3 days (like poison ivy)
or , the 4 a.m. sore throat that is a little better today and the kid is running down the hall chasing his big brother at 4 a.m.
That is wrong, and they know it, and if it is repeated after it is brought to their attention there should be some repercussions, and THAT is what will increase the efficiency of the ER and THAT is what will bring health care costs down in this one small slice of the pie, and THAT is putting personal responsibility back where it belongs. On the person; not the public.
ALL medicaid and medicare pts have clinics. They are assigned to doctors, and if they do not like the doctor for some reason, they can switch to another clinic, and it is all free.
And, that is fine, I am ok with medicaid for the poor kids and the truly disabled.
But the ones that don't have clinics are the ones that fall through the cracks. And, like I said, they rarely, if ever, abuse the ER.
It happens, I can think of a couple cases, and they get sent a big bill, and they can't pay, and they get mad, and they ignore the bill, and it goes to collections, and whatever, but I promise you, this is the exception to the rule of the patients that abuse the ER.