When Will Emergency Rooms Go Back to Being Emergency Rooms?

The University of Chicago hospital made headlines this week when it was criticized by the American College of Emergency Physicians for a plan that tries to get non-emergency patients out of its emergency room.

I’ve been fortunate to have only made one visit to the University of Chicago emergency room in the five years I’ve lived in Hyde Park. My youngest daughter Sophie was the reason for the visit. What had seemed like a run-of-the-mill kid’s illness had taken a turn for the worse. She had become extremely lethargic. She wouldn’t eat or drink and she had been vomiting, so we figured she was likely dehydrated. I took her to the University of Chicago emergency room at about 9 a.m. on a Sunday morning.

My visit started like most other visits to emergency rooms. When we arrived, there must have been 30 people in the waiting room. All of them were African-American. I filled out some paperwork and waited for the triage nurse to call my name to hear Sophie’s symptoms. At least half an hour passed and nothing had happened. I’m not usually very aggressive, but Sophie was looking worse and worse. So I went to the triage nurse and tried to do anything I could to see a doctor. I started by describing a set of symptoms that sounded like meningitis, even though she didn’t have all those symptoms. The nurse seemed unmoved. I then told her I had a son who died of meningitis. That definitely got her attention; but when she asked when he had died, and I said five years ago, she was much less impressed.

I guess she originally thought I meant he had died yesterday of meningitis. I told her that Sophie had become nonresponsive (and Sophie complied, staring off into space absently). I told her I was a professor at the university. I told her I would get my pediatrician on the phone. I’m not sure which of these strategies actually worked (I think it was being a professor), but within 10 minutes I was in to see a doctor. It turned out Sophie was badly dehydrated. They put an IV in her and she sprung to life. Our visit still took four to five hours. As we left, I was shocked to see that most of the people sitting in the waiting room when I arrived were still in the exact same spot, not yet having seen a doctor.

I don’t know the full history of emergency rooms, but I can’t imagine that the folks who designed them ever imagined they would turn out the way they have: a place where patients with no health care go to first wait six hours and then get routine care.

It is a system that makes no sense. If you read the description of what the University of Chicago hospital is trying to accomplish with its Urban Health Initiative that is being criticized, it does make sense.

Or you can do what my grandfather did and just avoid emergency rooms altogether. My grandfather was a doctor who practiced into his 80′s. I heard the following story from my father, so who knows what part of it is true, but this is how the story goes.

One day, while at home, my 80-something grandfather realized that he was likely having a stroke. He called in a prescription to the drugstore around the corner for some clot-busting drugs and sent my grandmother to the pharmacy to pick up the drugs. He crawled upstairs and got into bed. When my grandma got home, he took the drugs and just waited to see whether or not he would die. It turned out that he lived, with no noticeable side effects, which makes me wonder how true the story really is. One facet that I know is true, however, is that a man who spent 60 years of his life practicing medicine would do anything in his power to stay out of the hospital.

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  1. Jim says:

    I understand your frustration. I have had similar experiences to yours in an ER. But after thinking about it, what is their incentive to provide good service?

    If they had taken care of you and gotten you (and everyone else) in and out in 30 minutes or less, that would only exacerbate the problem. More people would use ERs to get good, fast medical care.

    So it is in their best interest to provide limited customer service and try to match it to the seriousness of the illness.

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  2. Mike says:

    I assure you, whatever point you were trying to make here has gotten lost. I leave this post thinking of a guy trying to pull every string he can (including flat-out lying) in order to get his daughter a drink of water. I hope no one you cut in line was seriously hurt by having to wait behind you as well.

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  3. Jon Luke says:

    Tragedy of the ER–commons.

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  4. Scott Wentland says:

    I’ve long wondered why they don’t put free clinics NEXT to the emergency rooms. When someone comes in for routine care, they can just point them next door (or even connected to the emergency room if you’d like).

    Problem solved. All emergencies go to the ER, free healthcare patients (who do not have urgent symptoms) go to the clinic next door. Does anyone know why this doesn’t happen more often?

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  5. K says:

    #2 If you read the post, it’s clear this was not just a matter of “needing a drink of water”. Severe dehydration can cause quite a number of serious side-effects. It’s also pretty easily treatable most of the time with IV fluids and monitoring. The amount of time the doctor probably spent on this case was negligible, but clearly essential for Sophie.

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  6. Neil (SM) says:

    #2 Except he was there with what seemed like an actual emergency. The long holdups are undoubtedly caused by the non-emergencies, ie, the masses who are using the ER as primary care.

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  7. John says:

    How is the fact that everyone in the ER waiting room was African-American germane to your point?

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  8. edel says:

    In Spain it has published that around 75% of patients’ in ER are in no need of Emergency care. Two are the main reasons for that:
    1) Hospitals do barely ever offer non-standard hours for medical procedures so patients on tight schedules don?t have a choice.
    2) Even with the line queues, you still can save time* than doing the calls and appointments for a regular visit.
    *In the US would be interesting to know if the monetary cost is different too.

    One thing I have never come across is a prioritization scheme at the door of an ER department. This will solved three problems:
    1) The “real” emergencies will be treated sooner
    2) The injustice of selfless people (sorry Steven) be allowed to cut in line in front of others that follow the norm at their own expense
    3) Discourage those with no real issue, since now their time may not be comparable to doing the regular appointment.

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