Problem: many patients go to hospital emergency rooms “when what they really need is to see or talk to their primary-care doctors”, with resulting high expense and interference with genuine emergency cases. As usual, the legal system’s role is a helpful and constructive one:
Assume a patient calls his doctor about a new symptom. Ideally, after listening on the phone and deciding that it’s probably nothing serious, the doctor arranges an office visit for the next day, offers reassurance, and averts an unnecessary late-night E.R. visit. But doctors don’t get reimbursed for that call. And what if they tell a patient to wait and something bad happens? Then malpractice lawyers have a field day.
(Zachary F. Meisel and Jesse M. Pines, “Medical Examiner: The Allure of the One-Stop Shop”, Slate, Sept. 12).
10 Comments
This article hits the nail on the head. When you are called in the middle of the night because someone has a headache, you can not assess them and thus have no way of determining what is going on. So, to cover yourself you recommend that they go to the ER. At the ER, the ER doc does not want to get burned so he orders a CT scan. Only when all that is done can you say, take an aspirin and call in the morning. For those that do not believe in defensive medicine, it is $400-800 to be seen in the ER and the scan is $900-1200. An aspirin is about 2 cents.
Let’s put some reasonable numbers to this – how many of these calls are there? Number of calls times about $1500 would provide a very defensible “hard” lower limit for the rael costs of defensive medicine.
On the other hand, is there any estimate of how many people are saved by this? That is, I’m sure there is SOME benefit, at least once a year or so. To call it a COMPLETE waste is a lie… but to call it “poor resource management” would probably be a pretty big understatement, too.
Anybody willing to put real numbers to this?
How about when your doctor only has office hours from 9:30 AM to 3:30 PM and your kid is coughing so hard that they are having a problem breathing at 8:00 PM? Our local hospital has opened an Acute Care Center staffed with Nurse Practitioners. It isn’t a full fledged Emergency Room, but it is right next to the Emergency Room, in case there is something beyond the capability of the Nurse Practitioner.
throckmorton your completely right. My wife would also like to add the fact that many of these people going to the ER with a headache will also use emergency services to get there.
As Jim Collins suggests, part of the solution to this problem is to have facilities other than the ER open outside regular doctors’ hours. Where I live we have Out-of-Hours clinics. You don’t see your regular doctor and have to wait a while since they don’t take appointments, but otherwise it is like going to your regular doctor. People do need medical care outside regular hours. If the Emergency Room is the only place they can get it, they are left with no choice.
Just wanted to point out that a great number of people don’t have PCP’s because they’re uninsured. They instead go to the emergency room and use that as their PCP.
I had a PCP even when I did not have insurance. I simply paid the bills myself.
So that isn’t the reason that “a great many people don’t have PCPs”
Ah, Mr. Lane’s veiled push at socialism.
Yes, and the law in its majesty forbids the rich as well as the poor from sleeping under bridges. Deep insight there. 🙂
Sorry Bill but I am not sure if you are mocking me or not.
I have sometimes made uninformed comments but, if this is one, I’d like to leave better informed than I started. I fail to understand your point. Probably a failure on my part.
Are you saying that the reason is that they cannot afford the cost of office visits? That might be in many cases. But could argue for reducing costs rather than providing insurance. I was simply pointing out that lack of insurance doesn’t make health care unavailable.