And the staff gathers ’round to watch the last episode of ER…..
I hear George Clooney will be back.
Doesn’t matter, I can’t stand that show.
It’s like being at work, only I’m not getting paid. Clooney may be handsome, but he’s not that handsome. Now, if Will Smith or Jeff Goldblum had been in the show, that would have been compensation enough for me!
My husband could never understand why watching “Trauma: Life in the ER” was not high on my list.
(Photo credit: Al Fenn for Life Magazine. June, 1955. Omaha, Nebraska)
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It’s time for an intervention.
I have to admit it.
I am Facebook illiterate.
People poke me, send me goodies, invite me to groups, send me really cool memes on rock songs, buy me drinks, send me plants.
And I have no clue what to do with those.
Okay, I do know how the Pirate game works and I will steal your gold coins if I find them, but that’s it.
Oh, and I learned how to upload videos – found an old Boyce and Hart video. Totally cool.
I’m in a mood.
Luckily, I’m not at work because moods don’t really make one popular with one’s colleagues.
This patient came into the clinic the other day…
Oh, you thought I worked in an ER? Well, that is what it says on the sign on the street and over the sliding doors, but trust me, I work in a clinic.
And, if you walk into your place of business and it says “Emergency” over the door, you probably work in a clinic, too.
I’m saying EEEEEEEEEE-NOUGH!
I give the general public, health care consumer, client, guest (or whatever the current politically correct term-of-the-day might be), credit.
Yes, I give the vast majority of those people who walk into the ER credit.
Credit for knowing exactly what they are doing and why they are doing it.
- Credit for knowing what a true emergency is: chest pain, stroke symptoms, broken limbs, eye injuries/pain, difficulty breathing, uncontrolled bleeding
- Credit for being concerned that something dangerous might be happening. You can have gastroenteritis from hell and think you are dying. Pain so severe it cannot wait until the next day. An ankle the size of a grapefruit and you aren’t sure if it’s broken. Cut a wide berth of slack here – pain is frightening.
- And most of all, I give most folks credit for knowing when an emergency department visit is not appropriate, but they use it anyway….because…
1. They can’t be turned away.
2. They don’t have to pay a penny up front.
3. They don’t have to wait for an appointment with their doctor.
Are you surprised by #3 up there?
I know we are supposed to believe that the emergency department crisis in this country is tied to the 45 gazillion un-insured amongst us.
Not in my experience.
I would hazard an educated guess that at least 80% of the patients I see for non-urgent problems have primary doctors, and that is a low estimate. I know, because I ask them at triage. Which means they have insurance coverage of some type, even if it is through the state.
If they have Medi-Cal, they are supposed to use the county hospital and clinic system, but they don’t because our ER is (a) nicer, (b) faster, (c) convenient. So, these insurance companies and the State of California are paying through the teeth for emergency department visits that did not need to happen.
Or, they don’t pay at all, which drops the over $1000.00 bill right into the patient’s lap.
And often, the emergency department doctor is not paid for their services and the hospital takes a loss because, well, not everyone can handle a debt like that, and not everyone makes payment arrangements.
If you get my drift.
One. Thousand. Dollars.
For a cold, a stubbed toe, back strain, minor fever, cough x 5 weeks, headache x 8 months (I’m not kidding), STD testing, family of five children with runny noses (I’m serious), family of five with no symptoms who were rear-ended and “just want to be seen”….
As long as it is convenient and there is no incentive to do otherwise, the ER will continue to be populated by people with clinic-type chief complaints that have no place in an emergency department – see #1, #2 and #3 above.
Meet the Emergency Medical Treatment and Active Labor Act (EMTALA), the King of Unfunded Mandates.
So, how do we provide the incentive to use a primary physician or clinic when the patient actually has one?
It’s called a medical-screening exam. A provider evaluates the patient at triage and if it is determined that the patient is not having a life or limb-threatening emergency (see above), and the patient has a primary doctor or clinic, they are told to follow up with their provider and will not be seen in the emergency department.
What is the advantage of the Medical Screening Exam?
I know it can seem harsh to send a patient away from the ER.
But in the end, it is a patient-centered procedure.
- Staff can focus on the patients who need care the most.
- The ER is not tied up with non-urgent/emergent cases, decreasing wait times for the patients who need care the most.
Meaning, the patients who truly require the resources and procedures of an ER receive those services more efficiently.
And while they may be miffed at not getting an emergency department berth, by being triaged to their doctor or clinic for follow up, the patient with the clinic complaint is (a) not saddled with an ungodly bill for unnecessary ER visit, a bill they may not be able to pay and (b) sitting in a waiting room, possibly for hours.
I know I’m a nurse and I should have unmitigated mercy and compassion for all those with whom I come into contact with in the course of my duties.
I ain’t feelin’ it.
Especially when I know that most people are not dumb and they know exactly what they are doing when they come to an ER for a non-urgent problem.
I give them credit.
Now give me time to work with the patients who really need me.