A Night At the ER

Joe Cantlupe, for HealthLeaders Media , June 10, 2010

When Schneider suffered the stomach ailment, she was convinced she had gallstones. Her doctor never determined what she had, and eventually she felt better. Ironically, she later treated a woman in the ER who had a similar ailment, and her condition really was gallstones. After the quick diagnosis, the woman eventually was treated, and recovered.

Looking back on her own condition, Schneider said, "Why should I have suffered for 14 hours? When I saw what happened to the woman, I said to myself, 'you fool, you sat at home, feeling nauseated and in horrible pain for 14 hours and you could have had some relief.' That's why in these situations primary care physicians are sending their patients to the emergency department. We can work through it, very quickly. We have the ultra sound, the blood tests, and the medications right there."

Various studies have focused patient usage of emergency departments. An Urban Institute study found that even after Massachusetts adopted universal coverage, visits to the emergency department remained high, with some people just finding it was more convenient. In looking at the uninsured use of emergency departments, the NCHS report said "uninsured persons are not more likely than others to assess the ED (emergency department) for non-urgent visits."

Schneider says she understands the focus of the criticism of emergency care. "We are doctors for the uninsured." But questions about "appropriate treatment" can be spread across the medical spectrum, Schneider says.

"We don't hear about cardiologists, or allergists, or plastic surgeons, or psychiatrists or anyone else, whether they have appropriate treatments. I strongly suspect that not everyone who goes to those places has an appropriate visit," Schneider says. "Emergency departments are the low hanging fruit, the cause célèbre."

As to my son's condition, he spent about 45 minutes in the emergency department where he was watched closely and given fluids. Apparently, earlier in the day he drank much too much soda, and the food he ate didn't agree with him, either. We never really got an explanation for the breathing problems.

When I talked to Schneider about my son's ER visit, she said, "That would have been considered an unnecessary visit. But should you have waited until Monday until you see a doctor? I don't know how you have would slept at night."

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Joe Cantlupe is a senior editor with HealthLeaders Media Online.

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