The conundrum of busy emergency rooms

"God, how long are we gonna have to wait. We should have just stayed home."

I hear that often as I walk by the crowded waiting room on busy nights at shoreline, and I think, "If you're even thinking of leaving, maybe you shouldn't be here in the first place.

Trust me on this: RT Cave Rule #7: if you are having a true emergency, you will not have to wait to be seen by the ER physician. If you are suffering from anything critical, you will find yourself in an ER bed faster than you can say ER.

"It's ridiculous I have to wait this long," I hear.

And I think to tell them, "So, do you want us to treat you before the man in room F who's having a heart attack, or should we treat you right away so you can get back to your beer and cigarette."

Being the good boy I am I usually keep on walking.

I had a discussion with an elder doctor who told me that 20 years ago he didn't even stay in the ER at night, he simply went home. If he was needed he was paged. And, he said, that when he came in he knew it was for an emergency, which is what the EMERGENCY room used to be for.

Not anymore.

So why are todays ERs so busy?

Anonymous over at Respiratory Therapy 101 wrote an excellent post on this today. I encourage you to read it, because he is right on. I can honestly say I agree with him 100%.

He writes that ERs are busy because the government does not reimburse independent doctors enough money, so these doctors have no incentive to accept Medicaid patients. This leaves Medicaid patients with no option but to flock to the ER for their non-emergent medical problems.

That, coupled with the threat of a lawsuit, has resulted in doctors ordering a bunch of tests that aren't' even indicated just to "cover my ass." This makes for a long ER visit.

There's another factor involved here, and that's the idea of FREE. It is a natural human tendency that when people hear that something is free, they flock to it.

And, since it's illegal for ERs to turn people down, they have no choice to accept Medicaid patients, and even uninsured patients they know will never pay up.

Like Anonymous RT, I'm not proposing that we throw these patients out of the ER. I do, however, believe we have a serious conundrum here that needs to be addressed.

Here is my 2 cents worth of ideas that should get the ball rolling:

1. Do not go to a Federalized Health Care system. Giving away more free stuff will only make the matter worse.


2. Force doctors to do the procedures they order. Frivolous orders would soon be a thing of the past. The ER will clear out faster.


3. End frivolous lawsuits by forcing people who file them to pay all court fees if they lose. Doctors will no longer have to order procedures, "just to protect myself."


4. Encourage RNs and RTs to chart when they think a therapy is not indicated and hope that insurance and government agents read that charting. When agencies stop paying for these not indicated therapies, hospital administrators will be forced to crack down.


5. Encourage politicians to spend a day shadowing in the ER. I bet it wouldn't take long for them to catch on.


6. Have mandatory health education classes for anyone using government health care programs. Here they will learn what constitutes an emergency.