Re: inappropriate ED use ... RE: ER misuse

[Guest guest]

Annie,It is clear that you bend over backwards for your patients. It is hard for me to understand what would cause your patients to choose to go to the ER over coming to see you in your office. I have not dismissed any patients for this, but can certainly imagine the scenario that would prompt me to. I would take the approach that Terri did. I would contact them, first by phone, then by certified letter if I could not reach them by phone. I would tell them that I was concerned about their frequent ER visits. I would insist that they need to come to see me to follow up on whatever brought them to the ER as well as their ongoing medical conditions. At their visit, I would make it clear to them in writing as well as verbally how access to me works. I would explain the benefits (to them) of them seeing me rather going to the ER. I would suggest that they schedule regular follow up visits to hopefully avert the need for ER

visits. If they still couldn't avoid unnecessary ER visits, I think I would dismiss them.Lonna" Malia, MD" wrote: Kathy --You mentioned about patients using the ED inappropriately (see below).Interestingly, I was a co-author two years ago on an article that looked at that issue for pediatric ED patients (Nonurgent Use of a Pediatric Emergency Department: A Preliminary Qualitative Study. Pediatric Emergency Care. 22(1):22-27, January 2006). The tinyurl below will get you to the

article. We used anthropology techniques to explore why folks used the ED inappropriately. The interest in the research stemmed from our evaluating pediatric emergency care in La Paz, Bolivia and noticing that all the docs and staff were saying the same kind of things that we American docs and nurses say -- too many patients come to the ED for the wrong reasons. But the La Paz, Bolivia research pointed to patients doing the best they can to make choices in a mixed up health care system and doing the best they can in mixed-up, very difficult lives.Then, we did some evaluation here, and basically found the same thing. Few patients really came to the ED by their own accord but were there after trying to get care from primary docs, or their lives (work, etc) forced them there. It didn't relate to mis-trust of docs or to them just coming for no good reason.Now, of course, some patients do use the system inappropriately -- health care is

not alone in that, some people will try to manipulate all systems, and some of those people have personality disorders, etc. And they cause significant stress. But, really it's a small percentage, more anecdotal.So, check out this tinyurl to see the abstract for the article I was part of --http://tinyurl.com/232vevDoing the research in La Paz, and then finding some of the same issues pop up here was interesting, and really changed my thinking about patients using the ED.Now... about those patients you just loath ... I support you if you feel you must dismiss them ... and that's a complex issue for both patients and docs alike.TimOn Sat, January 19, 2008 9:19 pm EST, Kathy Saradarian wrote: The reason ERs are overburdened in my neck of the woods is notthe lack of primary care doctors but the abuse by patients wanting care whenthey want it and not understanding what “emergency” really meansand then complaining about having to wait when they feel so awful. Thenstay home!!! Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner

5/03 Low staffing From: [mailto: ] On Behalf Of Annie SkaggsSent: Saturday, January 19, 2008 8:29 PMTo: Subject: ER misuse

Has anybody ever fired a patient for ERmisuse? I just got a faxed ER note. Married couple, 30-something. Both morbidly obese with elevated BPs and glucoseintolerance who fail follow my recommendations, but then decide (withoutcalling me at all) to be seen in theERfor very trivial complaints (URI --basically a common cold from the notes, although the ER got the benefit ofdoing labs and CXRs on both). And this is the second time in 4 monthsthat they have done this. I am inclined to dismiss them onprinciple…even with the specter of P4P, their behavior is sociallyreprehensible and just pisses me off (‘scuse my French). I have never dismissed anyone for anything other thandrug-seeking, abusive behavior, or owing me more than $200 for more than ayear, but these two just have my blood boiling. And it’s not like I don’toffer access…I’m on my way to the office now (8:20 on Saturdaynight) because a healthy 55 yr old lady just called and told me she has beensick for 2 days but decided RIGHT NOW that she

has to be seen and if Idon’t want to come in, she will go to the ER. ARRRRGGGGHHHHH! And it’s 8 degreesout there… Annie ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra

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