Straight, No Chaser: When (Not) to Visit the ER

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I’ve spent a lot of time discussing the life threats that should prompt you to rush to the Emergency Room.  Today, I’m going to give you some factual information that could save you some time and a lot of money and keep you out of the ER.  There are so many misconceptions about the appropriate use of an ER.  Let’s address five points you should consider before you come to see me or my colleagues.  The message is not meant to be disrespectful to you and your families, but it’s just straight talk, and remember, the most important consideration is if you ever feel yourself (or your family) to be in harm’s way, don’t even think about it, get to the ER, and we’ll sort it out for you.

1)   Your expectations are sometimes completely unrealistic about the appropriate use of the ER.  One of the most expensive and inefficient healthcare laws on the books is the Prudent Layperson, which places in the hands of the public the right to go to an ER if one ‘believes’ an emergency exists.  Of course, the result of this is 80% of ER presentations represent things that could have been seen elsewhere for a fraction of the cost (mostly strains and sprains, bumps and bruises, sniffles and coughs – none of which usually requires an ER visit).  Admit it.  Your family sometimes uses the ER as a convenience because we’ll see you quicker than your doctor and can do certain tests quicker.  That doesn’t make it right and certainly doesn’t make it cheap.  But it sure makes for good business.

2)   The ER is not a clinic or a take out restaurant, regardless of what you think or need.  The ER’s notoriety as the ‘facility of last resort’ doesn’t mean we’re a substitute for seeing your doctor.  We rule out life-threats.  We’re not necessarily trying to diagnose the issues you’ve had for 3 years.  We don’t have the equipment or inclination to diagnose chronic disease.  It’s called an emergency department and is a specialty just as much as Surgery, Obstetrics or anything else.  We understand if you leave with some degree of dissatisfaction when we don’t address the reasons you came that were not life-threatening and/or emergent, and your complaining doesn’t impose a different standard of care onto us.   All to which you are entitled on an ER visit (as spelled out in the EMTALA law) is a medical screening exam, which is still going to be expensive.  All this accomplishes is the ER doc determining that you really aren’t trying to die at this moment.  Just because you think you need an x-ray doesn’t mean we’re going to order one.  We’re practicing medicine, not taking orders.  I’m not doing a spinal tap on your child because you saw a news report on encephalitis when you don’t have the symptoms (and as a rule, that analogy fits whenever you say the words “Can you do…xxx…just to be sure?” to an ER physician).  We do care.  We will go the extra mile for you and accommodate you – within reason.

3)   The ER is the most expensive portal of entry into the healthcare system by design.  Controlled for the same typical presentations, the average cost for an ER visit is $1020, and the average cost for the same in an office setting is $140.  The government sets prices, not hospitals or physicians.  Hospitals are able to charge more for any presentation because the infrastructure and operating costs of hospitals are massive compared with your doctor’s office.  In fact, hospitals charge a facility fee of several hundred dollars just for you walking through the door, in addition to everything else.  Insurance companies also attempt to discourage this by charging you higher co-pays for your ‘bad behavior’ ($50-150 upfront) to be seen in the ER instead of your doctor’s office, and in some instances, they require pre-authorization.

4)   The ER, hospital and the medical care system in general in this country is not about charity (or health care for that matter).  The US system is capitalistic by design, and has been very successful at that, capturing 1/6th of the US Gross Domestic Product.  We spend $2 trillion a year on medical care, fully one out of every six dollars spent in this country.  It’s probably the very best place to conduct business in this country.  Your occasionally irrational fears are costing you money.  And this is how hospital bills have been the #1 cause of personal bankruptcy in the US.  Just because you’re not paying upfront doesn’t mean the hospital won’t be tenaciously coming after you for payment.

5)   About 80% of disease takes care of itself if you’re patient.  The body is able to fight off most disease.  Nearly all of your creature comfort symptoms can be addressed by over the counter preparations.  Stop letting your fears be played upon.  Use the internet and other resources available to you, and smartly (i.e. selectively) decide when you need to come to the ER.   And please call your primary physician first.

Doctors, nurses and pharmacists are still the best advocates you have left in the system, and we love taking care of you.  Virtually every survey this century shows that the aforementioned medical professionals are the most trusted in the United States, with teachers occasionally in the mix.  The ethics of healthcare providers offer a nice cover for the sometimes questionable (but legally permissible) behavior of insurance companies, pharmaceutical companies and for-profit hospitals, who all too often are all about the profit margin.  The business of American medicine in the 21st century is business first and medical care second.  I’ve told you time and again that diet, exercise, moderation and ounces of prevention preclude all manners of disease.  Take care of yourself, lest you’ll become one of the many for whom medical care expenses destroy personal finances.

If you have any questions, comments or financial horror stories to share, I’m all ears.

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