Triage takes time. The more people, the more time it takes. While wading through colds and sniffles and minor injuries someone else’s more serious problem may go wanting. Not everything is as dramatic as spurting blood. People have died while waiting to be seen in an ER. They get crowded at times, with lines just to get to the triage people.
What?! I don’t get your insinuation here.
I am now fully employed and have been off “taxpayer support” for MONTHS. In other words, not only was your attack snarky, it is also INACCURATE. I’m paying taxes again this year just like every other employed person, thank you very much. Now take your high horse and ride out of town on it.
Or did you actually believe the myth that no one ever gets off aid? Do you always kick people when you think they’re down? Does it make you feel like a superior person when you do so?
Or maybe I just have an even better appreciation for just how thin money is for various government programs and actually give a damn about wasting a scarce resource for those need it? Money going to waste in the ER is often public money that can’t go to some other worthy cause. Whether you believe it or not there is a great deal of genuine need out there and not enough funds to really cover it all.
Heaven forbid that someone who has at some time been a beneficiary of something, wish that something isn’t utilized unnecessarily! (I don’t get it at all either. As a recipient of tax-funded UHC, I too despise people who waste that resource.)
Anyway, this post from the linked ER thread had me in stitches, pardon the pun:
Hey ToeJam! I’ve seen you around more lately, playing a little Mafia. You have to be close to done with school. Did you finish last year and I missed it graduating this spring? How’d the Match go for you?
Is this a good time to revive my Ask the ER Doctor thread?
Yeah, but aren’t sick people really easy targets too?!
May I add another item to list 1?
Anal itching. I had the not-so-great pleasure many years ago of dosing a family of five with Combantrin because the father had brought all his children into Casualty (as it was called way back when) with anal itching. Oh, and it was at 2:00am.
So, just to be clear…are you defending those who go to the ER for a cold, or are you attacking Broomstick? I really don’t see any other options for interpreting your post. She said nothing about taxpayers initially. She said it “drives up costs” which is absolutely true, insurance or no. *You’re *the one that brought “taxpayers” into it.
Emergency Room abuse has absolutely **nothing **to do with having a medical card or public aid - plenty of ER abusers have BlueCross/BlueShield or no insurance at all. I don’t care if you’re Dick Cheney with the best medical insurance in the country, going to the ER for a cold is *still *an abuse of the system and a waste of resources. Just because someone’s willing and able to pay for them doesn’t mean it’s not wasting time, supplies, the skills of a specialist physician and nurse and possibly delaying someone who actually does need emergent care. Get enough ER abusers in the door, and you’ve got to hire more staff to triage and do paperwork and housekeeping, you’ve got to buy more paper gowns, you’ve got to stock more gloves and tongue depressors and machines that go Ping!, you’ve got to build a bigger waiting room to hold them all - all that’s a waste of money and those costs will be passed on to future patients, with insurance and without insurance.
It’s not a waste of *taxpayer *money, specifically. But thanks for dragging politics into it and derailing the thread.
ETA: BTW, a suspected heart attack is absolutely reason to use the ER. I hope you don’t think anyone here is suggesting you shouldn’t have used the ER for that. You absolutely did it right.
One more time for clarification:
A drug-abusing convicted felon pimp who collects foodstamps due to having no legal income and fast talking at Public Aid who is horribly burned while smoking (insert substance of choice) being taken to the ER is, actually the proper use of an ER as it is a medical emergency regardless of how loathsome the individual and/or how stupid/illegal the act that landed him there.
A millionaire mommie with premium Blue Cross/Blue Shield insurance taking little Timmy to the ER because he has sniffles and slight fever and she doesn’t want to wait until morning to call the pediatrician is a despicable abuse of the ER regardless of whether she’s using her insurance or paying out of pocket. Why? Because it’s not an emergency.
Both cases cost money, but only one of the two actually needed to be in the ER. Only one of them should have been in the ER.
ER’s have to take all comers. They don’t triage based on income, criminal history, employment status, or any of those other social concerns. They triage based on medical need, nothing else. In that context, Mr. Crispy Pimp has legitimate reasons to be there, Millionaire Mommie does not and she is wasting time and money better spent on those actually requiring emergency services.
Quebec has a phone number - 811 - that you can call, 24 hours a day, to speak to a health professional. My family has made good use of the Ligne Info-Sante, especially as my grandmother developed more symptoms as she got older and got onto more and more medications. We would call and ask them whether this or that development (blood pressure swings, insomnia, puffy ankles) was a big enough deal to bring her to the ER immediately, or if it was better to get an urgent appointment with her cardiologist in the next week. Considering most of her ER visits ended with “you’re ok, just really old. We’ll consult with your main doctor to tweak your meds and maybe help the edema a little”, having a resource to consult was a huge help. Dragging a 90±year-old to the ER where she’s going to wait uncomfortably for several hours and leave the same way she arrived is a strain on everyone involved.
I was always irritated at how many people came into the ER for a sore throat - I should not be running 35 rapid Strep tests in a night on teenagers! But I’m new to this country and its health care system, and I’ve been told that these folks usually have no other options because of a lack of insurance. I don’t know how accurate that is, but it seems to me that if more people could use doc-in-a-box places for an after-school sore throat, it would be a good thing.
And because it can’t be said enough - if you feel like something scary or uncomfortable is happening to your heart, GO TO THE ER NOW. That is always, always the right decision, even if you’ve just got heartburn and leave feeling like an idiot.
Those are marginal cases - a number of big chain stores like Walmart, Walgreens, CVS, etc. have low-cost walk-in clinics now at some of their locations. Also, doctors’ offices will generally work with you on payment plans/immediate cost cuts if you don’t have insurance, especially if they’re part of non-profit hospitals. But some clinics might turn you away. ERs stabilize without insurance - even though their costs are worse than for normal clinics, so the truly poor may be digging themselves a worse hole than if they had looked for/been able to find another option.
And to back up what the others said above - it’s not just a “taxpayer” issue, it’s a “healthcare user” issue. Unpaid hospital bills and huge ER bills affect hospital costs, which translates into hospitals closing down/cutting services, insurance rates going up and/or benefits/coverage/networks being cut, and finally, yes, additional tax burden if the patients had Medicare/Medicaid.
Broomstick, when I told Frank to drop it, it didn’t occur to me that I needed to tell you to drop it also. Once something has been defined by a mod as off-topic, it’s off-topic for all.
Everyone – and by that I mean *everyone *participating in this thread –
If you want to talk about government funding of emergency services, take it to GD. If you want to bicker with each other, take it to the Pit.
No warnings issued, yet, but they will be if I have to come into this thread again.
Thanks,
twickster, MPSIMS moderator
I don’t think you phrased that quite right; I think it goes, “You kids are going to regret it if I have to stop this thread.” 
Quite true; an ALS (paramedic) truck bills at a 4-figure rate
Since I got into EMS, I’m amazed at how many people call 911 for complete & utter horseshit. There are reasons to need an ER that do not require a really expensive trip to get there (like a cut with controlled/stopped bleeding that *may *need stitch(es), like to get an x-ray to determine if it’s a sprain or a fracture while you are otherwise ambulatory, etc.)
Hint: if it’s not even remotely life threatening, we don’t put the whop-de-whops on, we drive in traffic, stopping at red lights just like you do, or more explicitly, just like you family member who follows (& sometimes beats) us there, & could have taken you without us. In our corner of suburbia, even if we do go “hot”, we’re saving maybe 30-seconds to a minute because the hospital is so close.
If it’s relatively minor, we’ll assist you to the triage station, we won’t even take you in the back.
And while we’re playing chauffeur to you, the guy with the *true *life threatening emergency is is waiting even longer for a cover ambulance from the next town over.
Hey USCDiver, it’s great to see you around!
Match went really well for me, I’m actually staying on the East Coast, matched at my #1 program, and I’m slowly returning to the Dope (Though Intern year may cut that down, but no more long hiatuses hopefully).
I’m currently working in an HIV Ambulatory care clinic for my last rotation of the year, and then I’ll graduate this May!
Well, usually as soon as the ED tends to know they’ve got a Suicidal/Homicidal patient, they’re placed in a separate room (usually one room is kept “open/away” for Psych cases, and evaluated/seen by the staff, with usually at least 1:1 care- so someone is always watching them, and then Psychiatric services are called to talk to said patient.
The Homicidal people aren’t just left to wander about the Hospital. And they’re usually searched for weapons or any devices they may have brought with them as well. That’s if everything goes to plan.
I think the OP is wrong about these two items needing an ER visit:
These suggest a condition developing over weeks or more likely months, and if you’ve waited until they are so bad you have to call 911, you’ve failed the test.
They are things you should call your primary care provider about to schedule assessments and/or tests.
I disagree, both patients are skating on very, very thin ice at present. Likelihood that bad outcomes are imminent is pretty high. One may have a progressive pleural or even pericardial effusion (to name just a couple possibilites,) which will go critical. The other could have a rapidly expanding abscess with respiratory compromise about to become its main feature.
Sorry I wasn’t clear. I should have said they should have made those appointments weeks before.
Those situations can arise in days, or even hours.
When should one call an ambulance/911 vs. getting to the ER through other means (drive, family/friend, taxi)? When in doubt, should one call 911 or try to get to ER themselves?
Would you provide some form of treatment/medication/pain killers prior to sending them to wait in the triage line? Is calling an ambulance a way to fast track treatment/medication/pain killers, instead of waiting (possibly hours) in ER to be treated?