Doctors alone can't treat this emergency
Doctors alone can't treat this emergency
By Bonnie Salomon, an emergency physician in the Chicago area
Copyright © 2006, Chicago Tribune
Published November 3, 2006
You wouldn't go to an emergency room for a pregnancy test, would you? Recently, I had a teenage patient who came to my ER because she wanted to know if she was pregnant. While that might qualify as a personal emergency for a young woman, I highly doubt it qualifies as a medical emergency. After she tested positive, she wanted an ultrasound. She had no idea how far along she was in her newly discovered pregnancy. As it turned out, she was four months pregnant.
As an emergency physician, I find myself feeling more and more like the crazed anchorman in the movie "Network"--I'm mad as hell, and I'm not going to take it anymore. The difference, though, is I have to take it. I work in an absolutely irrational health-care system. I'm supposed to care for the wounded and ill, but I cannot believe the ridiculous so-called system that we tolerate.
The examples are too numerous to count, but let's start with some blatant cases of misguided public-health policy. As long as there are parents and babies, there will be a need to check out the little tykes when they get fevers or stomach flu. I cannot blame any parent who tries to take her child to a doctor. I blame our moral blindness as a society to the needs of the poor and uninsured. Here's a typical case: a mother brings in her well-appearing toddler because he's had two days of diarrhea. She is on public aid. Did she call the local health clinic for an appointment? Yes. Give her credit for that one. Did she get an appointment? Yes, in two weeks.
I ask you, would you be willing to wait two weeks if your child were sick? Of course not. But that is what this mother was told. If she had private insurance, perhaps she wouldn't go to the ER at all. She'd be at her pediatrician's office, getting continuity of care for her child, with a physician who knows the child from birth.
The scenarios go on and on. Take the patients with chronic diseases such as congestive heart failure or diabetes. They use the ER for almost all of their care, and as a result come to the ER sicker. Their lack of primary care causes a downward spiral in their health. Without careful management of their chronic illnesses, they need emergency treatment more often. They might get admitted to the hospital for a brief while, and then out they go, until the next medical crisis.
This is all very expensive. So expensive that it boggles my mind that we don't do something about it. I am not a financial wizard, but even I can see that our lack of public health access is costing billions. Think of the costs for all those ER visits. Think of the costs of intensive-care units, X-rays and lab tests. The health-care system is hemorrhaging, and all we do is put a bandage on it. A meager bandage, at that.
Politicians can give their speeches, but I see very little hope on the horizon. As a doctor, I know the diagnosis, but the treatment is controversial. As a society, we need to ask ourselves some difficult questions: Would we rather spend billions of dollars for "crisis care" resulting from lack of access or not? Apparently, we prefer to limit access, and we prefer to let the uninsured and indigent suffer from such a lack. If a child from a low-income family has a toothache and can't see a dentist, apparently we think it's better that he develop an abscess, have to go to the ER, then have a costly (and unreimbursed) procedure. We have made these decisions.
Or have we? I believe most of us know what's fair and what's right. Ignorance of the situation is partly to blame. Apathy is also rampant. As an emergency physician, I am witness to the constant parade of suffering caused by limited access to health care. The word, "doctor" comes from the Latin "docere": to teach. I can point out examples and try to educate the public about what I see coming through the doors of my ER. It is up to all of us to figure out if we want this to continue, and like that crazed anchorman, declare: I'm not going to take it anymore.
By Bonnie Salomon, an emergency physician in the Chicago area
Copyright © 2006, Chicago Tribune
Published November 3, 2006
You wouldn't go to an emergency room for a pregnancy test, would you? Recently, I had a teenage patient who came to my ER because she wanted to know if she was pregnant. While that might qualify as a personal emergency for a young woman, I highly doubt it qualifies as a medical emergency. After she tested positive, she wanted an ultrasound. She had no idea how far along she was in her newly discovered pregnancy. As it turned out, she was four months pregnant.
As an emergency physician, I find myself feeling more and more like the crazed anchorman in the movie "Network"--I'm mad as hell, and I'm not going to take it anymore. The difference, though, is I have to take it. I work in an absolutely irrational health-care system. I'm supposed to care for the wounded and ill, but I cannot believe the ridiculous so-called system that we tolerate.
The examples are too numerous to count, but let's start with some blatant cases of misguided public-health policy. As long as there are parents and babies, there will be a need to check out the little tykes when they get fevers or stomach flu. I cannot blame any parent who tries to take her child to a doctor. I blame our moral blindness as a society to the needs of the poor and uninsured. Here's a typical case: a mother brings in her well-appearing toddler because he's had two days of diarrhea. She is on public aid. Did she call the local health clinic for an appointment? Yes. Give her credit for that one. Did she get an appointment? Yes, in two weeks.
I ask you, would you be willing to wait two weeks if your child were sick? Of course not. But that is what this mother was told. If she had private insurance, perhaps she wouldn't go to the ER at all. She'd be at her pediatrician's office, getting continuity of care for her child, with a physician who knows the child from birth.
The scenarios go on and on. Take the patients with chronic diseases such as congestive heart failure or diabetes. They use the ER for almost all of their care, and as a result come to the ER sicker. Their lack of primary care causes a downward spiral in their health. Without careful management of their chronic illnesses, they need emergency treatment more often. They might get admitted to the hospital for a brief while, and then out they go, until the next medical crisis.
This is all very expensive. So expensive that it boggles my mind that we don't do something about it. I am not a financial wizard, but even I can see that our lack of public health access is costing billions. Think of the costs for all those ER visits. Think of the costs of intensive-care units, X-rays and lab tests. The health-care system is hemorrhaging, and all we do is put a bandage on it. A meager bandage, at that.
Politicians can give their speeches, but I see very little hope on the horizon. As a doctor, I know the diagnosis, but the treatment is controversial. As a society, we need to ask ourselves some difficult questions: Would we rather spend billions of dollars for "crisis care" resulting from lack of access or not? Apparently, we prefer to limit access, and we prefer to let the uninsured and indigent suffer from such a lack. If a child from a low-income family has a toothache and can't see a dentist, apparently we think it's better that he develop an abscess, have to go to the ER, then have a costly (and unreimbursed) procedure. We have made these decisions.
Or have we? I believe most of us know what's fair and what's right. Ignorance of the situation is partly to blame. Apathy is also rampant. As an emergency physician, I am witness to the constant parade of suffering caused by limited access to health care. The word, "doctor" comes from the Latin "docere": to teach. I can point out examples and try to educate the public about what I see coming through the doors of my ER. It is up to all of us to figure out if we want this to continue, and like that crazed anchorman, declare: I'm not going to take it anymore.
posted by Carlos T Mock @ 9:10 AM
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