inappropriate ED use ... RE: ER misuse

[Guest guest]

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 Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

I also recall that similar studies were done in Canada (same complaints there) and found the same results. Generally people are very good about appropriate use of ERs and urgent cares. Those who misuse EDs are in the minority.Theresa

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.