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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  9. Eric says:

    “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.”

    It makes perfect sense. Emergency care is easy to get without insurance or ability to pay; routine care is hard to get without those things. The reason for this is that–rightly or wrongly–we care more about (dramatic) rescue than about prevention, even though this priority uses resources inefficiently.

    In other words, a foreseeable, if unintended, consequence of giving free emergency care while not requiring payment for routine care is that people will crowd the ERs.

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  10. Beth says:

    In my experience, ERs are actually pretty good at gauging how long a patient can/should wait, which isn’t the same as our comfort level. When my son went to the ER for a dog bite, we waited over 3 hours. When we came in to confirm that he had developed Type 1 diabetes, we never even sat down in the waiting room (because the admitting team spotted signs of a life-threatening complication called DKA we were unaware of) and walked straight to an exam room with a waiting physician.

    Generally, the severity of your need (from the ER team’s perspective, not the patient’s) is in inverse proportion to your wait time: the longer you are there, the better shape you must be in.

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  11. Zach says:

    I’m not usually one to prance about and proclaim my country’s greatness, however, In Canada we have a semi-socialized health care system and I have never had such a problem with a trip to the ER. Ive waited for upwards of 4 hours to see a doctor, but within 10 minutes of showing up with a non life-threatening in jury ( a broken ankle) a nurse came to check on me and make sure it wasn’t anything worse. Another time when I came in with CO poisoning I was sent into the Intimidate care line by the front desk and was on oxygen within a couple minutes of showing up. When the system cares about making people better and not making(or saving) money.

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  12. Jesse says:

    Reminds me of a Bush quote Paul Krugman uses often (quotes someone else saying the same thing here: http://krugman.blogs.nytimes.com/2008/08/28/let-them-eat-cake-and-go-to-the-emergency-room/). No one is uninsured because they can always go to the emergency room. I’m assuming your point is that clearing emergency rooms is another reason we should have universal (ish) healthcare.

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  13. michael says:

    I’ve been in the ER twice in the last year – for myself and my daughter. Without knowing the true inner-workings, I did feel that most people there were the poor and uninsured who for the most part were waiting a long time for routine treatment.

    That isn’t to say there were people with genuine and immediate problems – and they, like me and my daughter, were waiting.

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  14. prfx says:

    Health care has gotten pretty messed up in this country. There is a bizarre, perverse and incestuous relationship between pharma corps, lawyers, insurance, docs, academia, hr and bureaucracy that leaves most Americans with unreasonably high cost of healthcare in terms of time and money (which progressively more and more Americans can afford). Check out the cost of healthcare as a percentage of household income (double digit growth every year for the last decade, wtf?) Very dysfunctional.

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  15. VEH says:

    Setting aside the fact that he did pull strings (and what parent wouldn’t if they were alarmed by their kid’s condition?), he’s right. This is no way to run an airline.

    To everyone who shrinks in horror at state supported health care, shouting about the evils of socialized medicine, I say–how can it be worse than the pathetic “system” we have now?

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  16. Fred Anon says:

    Of course, if there was universal health care in the USA, most of those that were in the ER would be seen by a regular walk-in clinic, leaving the ER for real emergencies

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  17. Nic says:

    Wow, I knew that one could do pretty cool things with instrumental variables but i didn’t know that they were used in emergency rooms as well!

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  18. JM says:

    As much as we would like to avoid emergency rooms, it has been a necessary evil two times in the past year (and we have excellent health coverage). The key is the triage nurses and process. Some hospitals are better than others obviously. We have walked into a ER with at least 50 people waiting and been seen within 30 minutes of our arrival….rightly so, as our situation turned out to be urgent but the key was triage. How quickly they evaluate and with a can-do attitude. Hats off to St Rose Hospitals in Southern Nevada!

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  19. Lewis says:



    “You can usually reverse mild to moderate dehydration by increasing your intake of fluids, but severe dehydration needs immediate medical treatment.”

    And given that the treatment is so simple, what exactly is wrong with dealing with it pronto?

    Basically, the problem with admitting teams is they don’t think you know what you’re talking about. If the professor thing is what did it, it’s because it convinced them that the person insisting so much may in fact be on to something regarding the severity of the condition.

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  20. Jenn says:

    Check for Urgent Care facilities or No Appointment Needed doctors if you have a non-life-threatening emergency.

    These typically move faster and I’ve always had great care from them.

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  21. Edwin Steussy says:

    After two episodes of arriving at an Emergency Room to find exactly the same situation (both cases were potentially life-threatening), we’ve hit on always calling 911 for an ambulance. With the ambulance service, you get qualified people looking at you immediately and they will handle the triage to get you to a doctor.

    Regarding the comment from Mike, I don’t think he has had the pleasure of having a loved one horribly ill and withering in front of you, while nurses routinely ignore your presence. You need to get their attention any way you can. I worked at a hospital for five years in the 80’s and have three doctors in my family – I know it does not have to be this way.

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  22. MS says:

    Of course, everyone in the ER thinks that their problem is an emergency — including you and your daughter. For many (40 percent according to the link you posted) it turns out not to be an emergency — also including you and your daughter.

    I don’t get it. You probably have enough money. Don’t you have a family doctor? Or a doctor you know who you could call? Or were you trying to save a few bucks?

    And I’m with #2, using your influences to help yourself and only yourself make you sound like a prima donna.

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  23. aaron says:


    He mentioned that she wouldn’t eat or drink, was vomiting, and that she was getting worse. I think he took the proper action going there as he had no way of knowing the actual root cause of the problem, if making her drink when she didn’t want too was dangerous or the routine illness was something more serious.

    Now he did override the judgment of the triage nurse by giving her false info which isn’t proper, but honestly given a parent with a sick child you’re going to have to expect that. It’s obvious from this article that the emergency room is being used by a lot of people who should go elsewhere. What isn’t obvious is if the triage performed its proper function. For instance if the triage nurse was initially correct in thinking his daughter could wait longer and if the other people were able to stand waiting longer for treatment.

    It seems that there’s two kinds of people who go to the emergency room, those with a medical emergency, and those who want quick and convenient treatment. If you can redirect the second group to alternate institutions than you’ve removed a lot of the problem.

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  24. JoseAngelCMS says:

    It’s stupid to call an Emergency Room one, when doctors are not ready to attend in case of an emergency. Doctors never appear and nurses are never ready to look at the people with any type of emergencies. The first thing they ask is for them to fill in a set of paperwork, when there are some patients who’s emergency doesn’t allow them to write.
    My sister is studying at Babson College and a friend of hers had to go to the hospital; she was not being able to breathe properly due to an asthma attack. My sister took her to the Emergency Room, and when they arrived they were told to fill out some paperwork, which my sister did for her, and even though the nurses saw how bad my sister’s friend was, they did nothing until my sister filled out all the paperwork. Fortunately, the help arrived before it was too late.
    The Emergency Rooms are called Emergency Rooms because they are supposed to treat any type of emergencies. There are some people, who in the case of an emergency just don’t have the time to fill out the paperwork or anything, and they shouldn’t be forced to fill them, losing so much time, therefore reducing their chances of survival.

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  25. Chad Albert says:

    The key to clearing out the emergency departments is actually pretty simple, but nobody wants to take the steps needed to do so. The modern emergency department is the catch basin for the health care system. If you don’t need emergency services, you should be referred to another provider. Period. And this should be done without regard to insurance. If you have insurance that will pay for an ER visit when you could be seen by your primary care care MD, you should be bounced just like the uninsured or medicaid patients. Also, more time and money needs to be spent training paramedics to do field triage to determine whether or not you will be transported to an ED, or an alternate treatment facility. Currently, most (I’d hazard a guess to around 95%) of ambulance agencies are required, either by law or protocol, to transport to an emergency department.

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  26. Al Dugan says:

    Couple things here…..A hospital near us has a split emergency room. If a child comes in, they are sent to the pediatric ER right down the hall. It has a pleasant enough atmosphere and the attention given the children appears to be more timely.

    Illnesses are not diagnosed as they are on TV. Time will go by.

    I have been a patient in emergency rooms several times int helast two years. And I once spent an entire day (yes an entire 24-hour day) in one. But there care was great! I got better, and time moves on.

    I think a lot of it is trust. We don’t trust the doctors and nurses to know what they are doing. We think they are ignoring us, but yet they could not function without ignoring us. Trust the folks in the ER to know what they are doing. I have been there 5 times in 2 years, and I’m alive typing this and have absolutely recovered.

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  27. Speed says:

    An elderly lady I help was sick. I got an immediate appointment with her primary care physician who decided she (the patient) needed to be hospitalized. “Take her to the emergency room. They’ll admit her.” And they did.

    The ER has become the way into the hospital for all but routine elective admissions. And for many it is the way into the health care system.

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  28. RT says:


    If their PCP is anything like mine or any other PCP I’ve had, then they would have just told them to take her to an ER or an Urgent Care facility. My doctor does not have the ability to give IV fuilds, which is what his daughter needed. It doesn’t matter how much money you have, the ER is still used for Emergencies, which he had. Usually ER visits with insurance is most costly than just visiting a doctor. And if your situation is not deemed an emergency by the health insurance company, they can decline payment.

    However, ERs cannot turn away care, even to someone who has an unpaid medical bill. Uninsured go, get care, and may or may not pay.

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  29. Lisa says:

    People get seriously ill on the weekends or at night or other times. This is the primary reason I’ve had to go to the E.R. Primary care physicians are only available during normal office hours and they are usually booked weeks in advance.

    Sometimes something is wrong and it is bad enough that you are scared. You need a doctor to help you find out what it is. It isn’t a planned thing and NOBODY wants to spend hours and hours and hours in an E.R. trying to get help. But what is the alternative?

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  30. Frank says:

    at # 22, i don’t know too many people who can afford health care that willing go to the emergency room to “save money”. For me, the ER fee is at least 4 times the fee i have to pay for a general practitioner. This means i only go to the ER for emergencies, and if it can wait, i make an appointment. When your kids are involved, you usually err on the side of caution.

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  31. Kevin H says:

    Emergency rooms will only go back to being emergency rooms when we do one of two things

    1) Pass a law, (and get physicians to agree) that anyone who doesn’t have insurance cannot recieve treatment in an emergency room.


    2) Provide a mechanism where >95% of the population can afford routine care.

    My vote would be for 2, and that probably means some form of state subsidized plan.

    Oddly enough, simply moving people out of the emergency room and into more acceptable settings will also save lives and money. Inefficiencies = potential savings.

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  32. Tom says:

    It is grossly false to say that everyone in the ER thinks that their problem is an emergency. Many uninsured people use ERs as clinics and expect long waits. That’s not Levitt’s fault; it’s a problem with the system.

    Levitt could not triage everyone in the room. His daughter was very, very sick. Unless it was obvious that someone else was even sicker, he had to act on with what he knew, and do what ever he could to take care of his daughter.

    Social justice is a Good Thing. But when your kid’s life is in danger, you can’t be getting all squishy about first-come-first-served. Or whether some people think you’re a prima donna.

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  33. C R says:

    Lots of interesting feedback on hospitals and ERs. I’ve had too much experience recently and agree on the severity matching the time waited. (BTW–we have excellent health coverage but did have emergencies.)

    One Sun morning my husband was in excrutiating pain from a kidney stone that had cropped up overnight. I recommended we go to the hospital nearer us without a trauma unit. We got in right away–clearly a good choice for a non-trauma. (We have a pretty good test case there as his sister was in the hospital with a trauma unit also with a kidney stone–very weird coincidence–but a good test case. And their brother is an ER surgeon in the hospital with trauma so that’s a “pretty good string” if such things worked but still we did better in the non-trauma area.)

    A year ago our 2 year old son was admitted with a severe allergic reaction. We were taken without even being seated–they knew right away.
    Five months later we came in after a car accident and were again taken right away. Our son didn’t seem injured and he was fine. It took longer for me to be seen, even though I had a minor to medium injury.
    A few months later our son developed swelling in the lips. I didn’t think it was allergy but called the doctor. As it was the evening, they said take him to the ER just to be sure. We waited a long time and it was “hoof and mouth” disease.

    Three for three I’d say.

    So on top of the good suggestions above, I say go to a non-trauma hospital if you’re not a trauma. (Or a place with a good Pediatric ER if that’s relevant.)

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  34. Don says:

    Where I live, the major healthcare organization has hospitals with emergency rooms as well as smaller clinics for non-emergency care. The instant care clinics can provide any kind of care that you need at night and on weekends when your primary care physician may be unavailable either because they’re too busy or it’s after hours. I don’t know how it is for everyone else, but for me it seems like my kids always have problems Friday night, so we’ve got the whole weekend to wait until the family doctor is available, so we end up most often going to the instant care clinic. The way our insurance works, a visit to the instant care clinic is the same as a regular office visit, so you’re not paying higher emergency room copays. Then if you need to see a specialist, the instant care clinic will give you a referral that will get you into the specialist right away, instead of having to wait a month if you called the specialist first.

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  35. Tarak says:

    Having been a physician and worked in Emergency rooms. I think what people (general public) see as emergencies differs from what truly is a medical emergency emergency.

    I do think ER’s can do a better job of triage. For example a nurse can take the vital signs as soon as you register to immediately identify people who are hemodynamically unstable or in respiratory distress.

    Majority of the cases that come to ER’s and especially in cities is non-emergency. I would say from my experience about 75-80% are non-emergencies. So you have all these non-emergencies filling up beds in the ER.For exapmle if the ER has 20 beds. Most ER’s will always leave a bed or two open in case of an emergent trauma or for a cardiopulmonary arrest (CODE BED). The other beds are filled up by non-emergent cases. Most cases, even extremely simple cases take afew hours in ER because ER’s have to practice defensive medicine. They have to order a lot of labs and diagnostics because of the possible legal liability. Very rarely will you go to an ER and not get a blood test or an X-ray. Another factor is that if there are not enough nurses even, if you have the beds you can’t bring patients back and use the rooms.

    Your daughter probably had moderate dehdration and would have been fine if she was seen 4 or 5 hours later. I know it would have caused you a lot of discomfort. I’m not saying that the other people already being treated are more sick than your daughter but they have used up the available resouces and the ER would have to use the resouces that they have in reserve to treat your daughter. People have to realize that true emergencies are acute trauma to the chest, head, abdomen…, Myocardial Infarctions, Strokes, Gastrointestinal Bleeds, respiratory failure… The biggest complaint that I see is from people who think a sprained ankle, broken foot, hand, laceration is an emergency. Yes some conditions may cause pain but in reality if there are limited resouces they can wait a few hours before they get stabilized.

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  36. aaron says:


    Well I think if someone came in in obvious and immediate peril they’d be able to skip the paperwork and get immediate treatment. There’s obviously some conditions triage nurses will miss but on average I’m guessing someone told to fill out paperwork isn’t someone who’s about to fall over dead.

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  37. Hmmmmm says:

    Wow. Some of these comments are unbelievable. Last I checked Stephen was an economist not a doctor. He has also had a bad experience with a child’s illness in the past. You better believe if that was me I would be doing everything humanly possible to get my child seen pronto.

    It is easy to say, she was just dehydrated, but exactly how was he supposed to know that?

    With two kids and general family mishaps, we have been to the emergency room many times.

    Our priority for determining this route is:
    Any severe bleeding? Yes. 18 month old taken and ends up with stitches

    Any wild pain or discomfort? Yes. Once a kidney stone was being passed and my husband was in so much pain that the other people waiting in the ER asked for him to be allowed to go first. Needed IV fluids

    Is everything else closed? Yes. Christmas Day snowstorm, ear infection leading to busted eardrum. ER trip.

    Fever and sick on the weekends? No. Check with Urgent Care. Get scrip and start kids on Anti-biotics ASAP.

    Everything else is at the mercy of regular Dr. visits.

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  38. Fool on the Hill says:

    If you have a point in noting that everyone in the waiting room was African-American, it was lost on me, particularly because according to the census, 100% of people living in the University of Chicago Medical Center’s ZIP (60637) are African American.

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  39. lobosolo says:

    it only took you four hours ? wait til we get more socialized medicine and those four hours will seem like the good old days…
    have you ever noticed that people who have health benefits from the the tax payers will run to the emergency room for everything, while people who work and have no insurance will crawl to work and push through the pain….

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  40. Alex says:

    There’s a rather large population of people who have their healthcare paid for in their own facilities and that belong to a purely American institution–the Armed forces and their families.

    It would probably be an interesting study to compare folks on military health care (not the troops, but their families) to the norm (if such hasn’t been done already). I was a military brat–and while we did have waits in the ER, it was never for too long. (Undoubtedly because routine healthcare was taken care of, since it was free.)

    I was shocked when I graduated out of the system and had to deal with civilian health care–it seems almost barbaric at times. My parents still can’t believe how much I pay yearly, even as a healthy person with good insurance.

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  41. Caliphilosopher says:

    “All of them were African-American.”

    What exactly does this have to do with your story about getting ER care? It’s quite meaningless, and can easily be construed in a way that you might not want.

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  42. d says:

    Seems like the point some comments are missing is that folks without insurance often don’t have access to ANY other medical care. Walk-in clinics are good for non-emergencies, but they also cost money. Something that many without insurance also don’t have. I don’t think I’ve ever visited a walk-in clinic for something like the flu and gotten away without paying 100+.

    I’ve had excellent health care through insurance for many years, but recently have also seen the flip side. I’d suggest that anyone who has never been without health insurance (you , too Steven, for eye-opening research!) visit Stroger Hospital in Chicago.

    There are people there trying to NOT tie up emergency rooms, yet still get some medical care. The wait is approx. 8 hours, and you need to get there very early – once it gets to be mid-morning, you won’t even be given a number. Go in the dead of winter, using public transport. Bring a book, and a bag lunch – you’ll be there for quite some time, likely the better part of 2 days by the time you fill any prescriptions at the pharmacy.

    That’s the reality of healthcare for many, many people. That, or the emergency room. Where, unfortunately, the ‘squeaky wheel does get the grease,’ and you have to be your own best advocate for care.

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  43. Alfred says:

    Point 1, If patients aren’t seen how does anyone know if they have a true emergency or just need routine care?

    Point two, U of Chicago’s recent problem stems from dending home a severely mauled child. The parents had better sense than to take U of Chicago at their word went to Cook County Hospital where it was immediately recognised that the child needed surgery at once.

    point three, Th University gets a tax break as a nonprofit for services it seems not to want to deliver. Research is great, but don’t take a tax break for treating the poor unless you treat the poor.

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  44. RobLL says:

    dehydration is an emergency at any age. IVs are generally the solution (pun – funny), and take very little time to set up, and nurses time to supervise. So don’t really delay those other people who are still in line.

    Our local hospital is developing a monopoly on clinical medicine in our rural area, and the doctors love to pass you on to the emergency room where there are serveral hundred dollar fees due to both the hospital and the ER doctor (even if you are seen only by a nurse.. Rip Off, and poor management.

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  45. ARM says:

    John @ 7:

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

    If I had to guess, I’d say shorthand. “All of them were African-American,” being a less-wordy way to say: “All of them were poor, uninsured, urban people, and many of them were there for otherwise routine medical care.”

    Presumably, this assumption is what allowed Mr. Levitt to feel justified in manipulating the triage nurse into allowing Sophie to “line-jump,” as it were. But to substantiate that assumption for this posting, Mr. Levitt would need to have access to hospital records, which it is unlikely that they would grant him. So simply saying that the ER was filled with African-Americans (unsurprising, for the south side of Chicago) gets that point across for him.

    After all, if you look at the other comments people have made, it seems to be a pretty universal understanding.

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  46. ER Doc says:

    Here are some interesting facts from recent studies that are somewhat counterintuitive:

    * People with insurance use emergency departments MORE than people who are uninsured. And it’s not because there are proportionally more people with insurance than without. Recent studies have shown that people with insurance will have more ER visits per person than people without it.

    * ER crowding is often due not to indigent patients seeking primary care in ERs, but it’s due to patients being boarded in the ER. What does this mean? Boarding refers to the practice of keeping patients who are otherwise admitted to the hospital in the ER due to lack of inpatient beds. If you have a 15 bed ER but 5 beds are taken up by admitted patients, you’ve cut your capacity to see new patients by 1/3, keeping patients in the waiting room for much longer than necessary.

    What can be done about this? A few things come to mind from articles that have been recently published: 1) streamline inpatient discharges. This doesn’t mean kick people out of the hospital before they are ready, but it often takes many hours between the time a patient is deemed to be ready to leave the hospital and the time they actually do. This takes up bedspace that should be allocated to the sick ER patient, rather than the recuperating and ready-to-be-discharged inpatient 2) board patients in the hallway on the floor/ward where they are supposed to be admitted rather than in the ER. This has been shown to be a safe alternative, makes space for ER patients to be seen, and creates an incentive for inpatient nurses and physicians to accomplish goal #1 above.

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  47. Karl Bielefeldt says:

    You likely would have been seen in the same amount of time, regardless of what you said that was unrelated to the case at hand. Parents often confuse importance with urgency. Yes, your daughter’s condition was a true emergency, but waiting a few minutes for the paperwork and triage obviously didn’t affect the outcome, and the medical professionals knew it wouldn’t. In fact, slowing down to be cautious can prevent serious mistakes. You yourself didn’t truly believe time was of the essence, or you would have summoned an ambulance.

    By the way, imagine if someone tried to bolster an economics argument they were making by saying they were a physician.

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  48. Kevin says:

    Last year my daughter had the same condition – severe dehydration, and we couldn’t have had a different experience. We took her to her primary care doctor, who referred us to the emergency room. We took her there and were seen almost immediately. There were no long lines – in fact even though they later told us it was a busy day I hardly saw anyone else waiting. This is in Saint Paul, MN (United Hospital if anyone cares).

    Also, #2, I assume you know this and are just being intentionally rude because you can hide behind the internet, but when a person (especially a child or older person) is not able to keep anything down, severe dehydration can indeed be an emergency that “drinking water” will not solve.

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  49. Kevin says:

    #22 Surely his child has a primary pediatrician, but surely that pediatrician’s office is not open 24/7. Severe dehydration can be a very serious condition that cannot necessarily wait until the office opens Monday morning. Besides, if the condition really was severe, the pediatrician’s office is probably not equipped to administer an IV and would have referred them to the emergency room anyway.

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  50. Kim Siever says:

    The one time we had to use the ER with our children (our son swallowed a marble, which had lodged in his oesophagus and he could barely breathe), we had zero waiting time.

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  51. maxicms says:

    If you’re sitting for hours in an emergency room, then one thing’s for sure, the demand for care is high and the supply is low. Obviously the doctors are not merely making you wait for no apparent reason, at least i hope so. So maybe the solution to this problem is to eliminate what seems to be a kind of monopolistic competition of health care. Since firm entry is not so difficult, more people can be attracted to the careers of being doctors since it is clearly profitable. Basically we need to get more doctors in the room to take care of these people that are in obvious need.

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  52. erdoc says:

    When I was a 3rd year resident my 4month old developed a fever and projectile vomiting. I took her to the ER where i worked. By the time we got there, the fever was gone and we were sent home. My insurance didn’t cover the visit, so I ended up paying hundreds of dollars out of pocket. An ER visit is no way to save money.
    I now live in a country with socialized medicine. The care is adecuate, but the waits are tremendous. Most people i know avoid it, preferring to pay a private doctor.

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  53. sarahCMS says:

    In response to JoseAngelCMS, the reason why hospitals require for emergency patients to fill paperwork is to prevent themselves from being sued. Since many people blame hospitals for their irresponsibility of asking whether the patient is allergic to something or whether a patient is drinking some kind of medication, etc. Therefore they make you lose time filling these papers in order to not be responsible for some kind of mistake. What I think can be some good solution is to register your information in all hospitals, therefore if you arrive to an emergency room by simply checking your name in the computer they can be able to “know” about you. But the story about the 80 year old man is truly a miracle. A fact is that if he had waited for the ambulance, he probably would have died, since they last a long time to arrive to where you are, and some other time to attend you in the emergency room.

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  54. Kayla says:

    I understand that you were frustrated but no need to pull the race card. So what if there were African American individuals in the ER. Are they not good enough? Be polite before you publish things like this. I do understand that people just go there because it’s often times quicker than making doctor’s appointments which on their behalf are selfish. Often times you are going to be treated in the order of what the team thinks is the most life threatening at the given moment. Keep in consideration they could be misinformed and we are all human and make mistakes.

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  55. Deborah says:

    When I took my mother into a local Seattle hospital (Swedish in Ballard) because she was having problems breathing and turning purple, they allowed mothers doing pre-natal care checkups to go ahead of her.

    Pre-natal patients in the emergency room. Not in labor or anything.

    At a recent visit to another hospital, this time in Bellingham, my friend had sliced her hand open. It took four hours for them to have a doctor finally look at the injury, then have a nurse dab that wound sealant on.

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  56. Jordan Martin says:

    The problem with socializing health care is that the people that need the socialized health care the most are not educated. I attend Penn and am exactly 1 block from the University of Pennsylvania Hospital. I’ve been there the past year twice for two reasons of differing severity. One a squirrel attack…. (darned thing jumped out of a trashcan on my back) to see if I needed rabies shots and another for a 5 hour bloody nose. Both times I believe I waited the appropriate amount of time: (although I did not think so at the time) about 4 and 2 hours respectively. Both times I waited in the waiting room with people that did not need to be there: those with coughs, those with minor aches, those who wanted to sit inside out of the cold.

    It is just a fact that these problems exist and you must wait. It is good how it is, there is no need to fix it. “Fixing it” costs money, money that we do not have, nor we do not want to spend. Besides, I had a great time staring at the fish in the aquarium…….

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  57. Dan L. says:

    In a sample set of two EDs that I’ve worked in, the prioritization was simple: if it looked like a heart attack or stroke, get a doctor immediately. Otherwise, let the patient wait.

    In both cases, a patient could typically expect to spend 3.5 hours in the ED per visit. This is the mean of the length of stay data discounting visits of 8 hours or more, which were almost always psychiatric patients or cardiac/stroke patients being admitted into the hospital itself.

    Some psychiatric patients ended up staying more than 24 hours in a room in the ED simply waiting to be admitted to a mental health care facility.

    The statistics we gathered weren’t all that good; they spanned only a few days and the times were rounded off by as much as 5 minutes by hurried doctors and nurses. But for what it’s worth, we found that for both these hospitals, one can expect to wait about 1 hour between registration and being put in a room (with triage falling somewhere between). The average visit was about 3.5 hours. Both hospitals devoted resources to a “fast track”/day clinic program for about 10 hours a day. The data for these weren’t quite so consistent, but suggested about 1 hour of wait, 1.5 hours of care.

    However, when I split the data from one of the hospitals by doctor, I found that this was actually the mean between a few doctors who were treating non-urgent patients over the same span as urgent patients and a particular doctor who would see as many as 45 patients in a single day. A typical time for one of that guy’s patients was 30 minutes wait, one hour care.

    In both states, there was a law requiring EDs to provide care to anyone who came, regardless of insurance status or ability to pay. At both hospitals, uninsured patients made up approximately half of all visits. I’m not qualified to decide what constitutes an emergency, but I would guess that more of half of all visits were non-emergency. They didn’t let me in on all this stuff, but I’m pretty sure both EDs operated in the red.

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  58. Anon says:

    i haven’t read all the criticisms for the plan to get non-emergency patients out of the ER, but my friend had to go to 4 different hospitals – encountering bloated ER waiting rooms and subpar hospital staff. The staff made him wait! He had sickle cell anemia and needed attention!! When they finally treated him, it was too late. He died of complications.

    There has to be some sort of system that monitors people in the waiting room. Critics may say that such a system exists – but apparently it didn’t the hospitals that failed to treat my friend

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  59. HildaCMS says:

    This is most definitely an inefficient emergency room. I mean, the five hours that the other people spent in the waiting room is not acceptable considering there is an emergency to attend to. Maybe it’s a bad specialization on behalf of the University of Chicago people, maybe they are just not caught out to be emergency-attending people. The fact that a nurse was immune to all the things that were told to her was a horrible thing. I mean, she was told that a kid had died from meningitis and that the daughter had the same symptoms and she still didn’t care. The ER has to reorganize itself and know how to distribute its resources (as in doctors and ORs) properly in order to be able to reach an efficient working scale.

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  60. Shannon says:

    ORs are expensive. As an uninsured person, I’ll do the ol’ bathroom surgery way, way before I go to the ER. I’ll have to be dragged there — not because I don’t trust emotionally and physically drained doctors, but because I can’t handle the ridiculous cost of routine care, let alone emergency.

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  61. Avi Rappoport says:

    It really is a tragedy, that ER has to fulfill the functions of routine and urgent care clinics as well as serious emergencies. The system is broken, and that it works at all is due to triage nurses going above and beyond.

    Universal healthcare is the only way to fix it, because we’re wasting huge amounts of money on the infrastructure of payment: accounting, billing, fraud-investigation, frauds themselves, insurance company profits, and the expense of their highly-paid executives.

    I say this having spent 8 hours in ER last year when I broke my foot. It wasn’t fun, but I wasn’t dying.

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  62. Josh says:

    “a place where patients with no health care go to first wait six hours and then get routine care.”

    So the basis for this conclusion is that (1) most of the people there were black, (2) you waited longer than you wanted to, and (3) when you left it seemed like a lot of the same people were still waiting.

    Wow, with reasoning like this, who needs facts.

    I’m assuming – given health care coverage provided to employees by Universities – that you have health insurance. Why didn’t you go to a non-emergency doctor? I’m also curious what your definition is of routine care. I’m glad your daughter is alright, and I’m not going to criticize a parent for being very concerned at his child’s condition, but was this a non-routine situation?

    Doctor’s typically work 8-4 sometimes 8 – 5:30 M-F. If anytime after Friday afternoon someone comes down with pain or discomfort severe enough for them get worried, the emergency room is the only option. Even if you have a primary care physician, many problems require a specialist and it’s hard to make an appointment the same week, let alone the same day.

    You also make the common mistake of equating health care to health insurance. If people are in an ER waiting room and have seen the triage nurse then they are receiving health care – their inability to pay for it and other services is due to a lack of health insurance.

    There are many flaws in the US health care delivery and payment system. However, the debate about what to do does not benefit from illogical comments such as this.

    Lastly, the triage nurse likely has a lot more experience and medical knowledge than the new doctors that usually staff the ER at teaching hospitals. By badgering her you managed to receive treatment faster, not a faster determination that your daughter was not an emergency patient. Unlike others, I can’t find fault with a father trying to provide faster relief for his daughter’s discomfort, however that has nothing to do with the rest of your comment.

    For those who would advocate government single-payer healthcare: do you think government attempts to keep costs down would result in longer lines for those not diagnosed as emergency patients or shorter lines?

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  63. Johnny E says:

    My Mom has great health insurance as a retiree from a Civil Service job. After she cracked some ribs in a fall we took her to the emergency room of a well-regarded hospital in a NY suburb. She sat on a gurney in the noisy emergency room for 5 days before they would give her a room with a bed!!! Other people were waiting longer and there were gurneys with patients stashed up and down the hallwys. Only one doctor was on duty but he rarely examined patients, he just shuffled papers at the main desk. Luckily two of Mom’s doctors were affiliated with the hospital. Can you imagine what would happen to somebody without insurance or an affiliated doctor going to that emergency room? This was during a normal week, no major catastrophes in the region.

    Our health care system is broken!!!

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  64. David says:

    #2 Mike, dehydration is a serious issue especially for children, so it is a little more than a drink of water.

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  65. Robert says:

    A few points:

    1. The people using the ER for regular medical care are NOT doing so on some whim. They are doing so because they do not have health insurance and cannot afford to pay cash (which normally implies a rate of at least double what an insurance company pays.) If they had an alternative do you think they would wait for 6 hours in an ER? Of course not! So when patients are ‘redirected’ and then told they cannot receive care unless they have insurance or pay for it out of pocket they are in effect being denied health care.

    2. Do you not think that if ERs had fewer patients that hospitals would employ fewer doctors and medical professionals so that waiting lists would go back up to 6 hours again???? ERs are very profitable and people who wait there are desperate so hospitals can get away with this. What will force them to do otherwise?

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  66. RJ says:

    It’s interesting that most of the comments seem to be from the patients’ sides but none from the perspective of the doctors and nurses. My mom worked for 25+ years in an ER. Some commenters seem to think that the care providers are heartless or just trying to slow things down to avoid attracting more clients. In reality, those providers are probably swamped with people who really need to be there and are working to save their lives or to stablize them to move them to a different ward. It’s not that they don’t care that you have a sunburn and it hurts, but that there are people who need their attention more. There are only so many nurse and rooms and if you walk in with strep throat you will take a backseat to the woman having a seizure or a heart attack. Dialing 911 to get quick attention seems to be an abuse of the system unless you really are sick. Our small town has two urgent care clinics, one attached to the hospital. Hopefully those attract some of the folks that would otherwise had ended up in the ER. I don’t lay too much blame at the feet of the doctors and nurses. They aren’t running the place, they are just trying to do their jobs and care for the people who need help. Most aren’t in ER work for the money, great hours and weekends/holidays off.

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  67. kaszeta says:

    Around here, the emergency room (and medical care in general) is a classic example of an underserved market. That’s *with* a major hospital (Dartmouth Hitchcock Medical Center) being the major employer here.

    1. Finding a primary care provider that’s even taking new patients is difficult, and if you have one, it can be very difficult to get an appointment in anything approaching a timely basis. If you can’t wait until the next available appointment (often more than a week away), they tell you “Go to the ER.”.

    2. Unlike other areas I live, there just plain aren’t urgent care centers here. It’s your primary care doctor, or the ER. Nothing in between.

    So, if you’ve got an illness or medical condition that can’t wait a week? It’s the ER, since there simply isn’t an alternative. It’s not about money, laziness, insurance, or anything else, it’s the fact that the ER is the *only* place you can go. Sorry, but much medical care isn’t an emergency, but it is urgent (if you wait a week to see a doctor about the flu, for example, you may indeed be dead a week later, and in the meantime you’re infectious).

    Despite that, the ER here is filled with doctors that chide you for filling up the ER, and the insurance company sends chiding notices about how next time you should use your PCP or an urgent care clinic (even though the latter doesn’t exist here). You want me to stop going to the ER? Give me an alternative. We can’t use services that don’t exist.

    It’s a public health problem, plain and simple.

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  68. GAYLE TAYLOR says:


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  69. and by says:

    Well if you can tell me an objective measure of emergency you are smarter than I am. I have been thinking about this problem for a little while and the best I can come up with is that you will die or be permenently injured if you do not recieve treatment with in an hour. So was his daughters case realy an emergency? I bet it was to him. Do we turn everyone away who does not fit that description to the urgent care or free clinic.
    I brought my son to urgent care for pnumonia and was directed by the Dr. to take him to the ER as soon as possible and not wait for an ambulance since it would take longer, and he was then seen in minutes of arival at the ER.

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  70. Daniel says:

    Your problem illustrates perfectly why the ERs are swamped. Your daughter needed urgent, not emergency, care. Your pediatrician could easily have taken care of her in his office had he been available.

    Every hospital should establish a 24 hour doctor’s office next door that takes walkin patients. Those whose problem is urgent but not an emergency can be sent over there.

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  71. Anonymous UChicagoan says:

    John, Kayla,

    He said it was full of African Americans because if he’d said “the emergency room was full of poor people” someone would have objected that you can’t see poor. Thing is, here you kind of can.

    Hyde Park (where UChicago is situated) is on the south side of Chicago, which is an overwhelmingly African American region. While Hyde Park itself is pretty close to the national average, all of its southern and western surrounding neighborhoods have median family incomes around $20,000, and they are at least 90% African-American. Keep in mind, the UChicago hospital essentially defines the southwest tip of Hyde Park. It’s unfortunate, but not inaccurate, for University of Chicago students and faculty to use the terms “black” and “poor” nigh-interchangeably when talking about the surrounding neighborhoods.

    Yes, not all poor people here are black, and not all black people here are poor, but the correlation is obvious after a casual stroll down any street in the neighborhood. Don’t get me wrong – I think that’s awful and I’m all for broad-sweeping social programs to try to address it. But you’ve got to acknowledge the reality of a problem before you can address it. And the reality is that to anyone living in the UChicago community, Levitt’s word choice clearly communicated what he meant.

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  72. Matthew R. says:

    Why would anyone think that socialized medicine would change any of this? Has anyone dealt with a government agency ever in their lives? Have you not had to fill out forms, wait in line, deal with non-motivated employees, and receive mediocre service? Go to the Post Office on a Saturday — that’s the future of socialized medicine in this country. All the compassion of the IRS, the customer service of the DMV, and the cost-efficiency of the DoD.

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  73. Mickey says:

    Use fake blood. They respond to blood. Preferably out of the mouth or something.

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  74. jimbino says:

    Sorry, but the way healthcare is financed virtually forces me and others to take advantage of the emergency room for routine care.

    In my case, though having fully funded Medicare since its inception and now paying taxes that fund the local emergency room, I will have to turn down Medicare coverage when offered it for the first time when I turn 65 this year.

    The reason is that I live 4 to 6 months every year at my home in Rio de Janeiro, where Medicare under parts A, B and D are unavailable to me, as they are to every retired American expatriate. I would be a consummate fool, having paid medicare premiums to then pay privately for my care and prescription drugs here in Brazil. To add insult to injury, our laws prevent me from taking my dirt-cheap drugs bought prescription-free in Brazil into the the USSA.

    A solution to the problem is for the Medicare system to offer me a lump-sum buyout of my claim to Medicare benefits that I’ve paid for for over 40 years and to liberate the importation of drugs from wherever.

    I don’t expect that to happen, so look for me in the waiting room and remember that it is the misguided policies of the American government that will put me there.

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  75. griff says:

    I have a feeling that socialized medicine (or giving free, fair and equal access to healthcare to all, as we in the UK like to think of it) doesn’t produce a very different Emergency care experience.

    UK governments are particularly judged by voters on healthcare waiting times, so they try hard to provide (or give the appearance of providing) a good service based on clinical need. So I don’t think the general system has a major effect on who is treated after how long. And triage based on medical need is a universal constant.

    I think it comes down to what the demand is from ‘non-critical’ users. There’s a lot of effort in managing demand in the UK (and much hot air on debating what adequate resource is).

    Some initiatives:

    Drop in centres at commuter locations for medical advice/minor treatment
    National helpline for advice
    Changing hours worked by ‘regular’ doctors practices
    Minor procedures at doctors offices

    (All above hotly debated as working/diverting effort/a con trick)

    Also Paramedics on hand to triage as Ambulance arrives (weed out non-urgent cases) and the like.

    Most interestingly we have publicity telling people not to call ambulances for minor ailments. A lot of people today have no real experience of illness or pain and truly believe a cut finger may be life threatening or perhaps they see it as their right to have tratment?

    Then of course the majority of Emergency room treatment evenings and weekends is down to drink, drugs and associated violence. Maybe that’s an issue best managed outside of hospitals (are US hospitals overrun with drunk young people in ERs every weekend??)

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  76. Maureen says:

    I’d like to see a study that assesses how many insured versus uninsured people with non-emergent conditions seek treatment in the emergency room. I don’t think that we are only talking about the poor uninsured, although that might be more prevalent in urban emergency rooms. I think what we are also seeing is a problem with acute and primary health care in general.

    I have great insurance and work for a major university with one of the best medical schools in the country. Nonetheless, I had to wait three weeks to see an acute care specialist. Frankly, if you are still sick after three weeks, then “acute” does not describe the situation. I didn’t go the ER because I could get an appointment in a couple of weeks with a primary care doctor, but had I actually been sick, I would have ended up there, waiting with the masses.

    The last time I was in the ER for a very intense bout of food poisoning, I saw people who were likely uninsured, but also people just like us, but who were there seeking primary or acute care.

    My point is that the problem is deeper and more complex than putting an adjoining clinic next to the ER for the uninsured. We need to find out who is going to ER for what and with what type of insurance if any, and why they aren’t going elsewhere.

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  77. James B. says:

    After I was bitten by the bat on a Sunday morning, my first stop was to the local urgent care clinic. They informed me that they didn’t carry the Rabies vaccine, and only one hospital in Northern Delaware did. I went to their ER and even though I was only a 1 on their 1-10 pain scale I had to wait less than an hour for treatment that time and the for my four subsequent visits for the rest of the vaccine.

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  78. Mike says:

    Apologies for my earlier rude characterization of the daughter’s illness. I understand the issue, and in my anger was definitely trying to trivialize it, because I’m so utterly disgusted to hear someone practically bragging about how they lied to someone in an ER.

    The guy is an economist, so I don’t care if, in his opinion, his daughter’s condition was more of an emergency than that of the other people waiting. His opinion means nothing; it’s the job of the ER staff to decide what order patients get seen. I can only hope that they didn’t alter their judgment due to his lies.

    I don’t know the symptoms of meningitis, so if I have a child someday and he or she is suffering from those symptoms and I have to take him or her to the ER, and this guy gets in after me and lies about his daughter’s condition so that she can jump in front of my kid in line… I’m speechless here, I don’t even know what to say. What an awful thing to do.

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  79. Eric M. Jones says:

    Steven’s comment about there being all African-Americans in the emergency room was not covert racism; it was just to point out that the people there were all the same race–Homo sapiens–and the same general ethnicity as our president.

    Had there been people of different races there, such as H. habilis, H. neandertalensis, H. heidelbergensis, H. Aferensis, and especially H. australopithicus, then probably a very long wait could have been expected.

    But as far as people of different ethnicities go…it’s those darned Irish a-muckin’ ev’rthin’ up: “Don’t panic now, love, but one of me clackers has gone right up inside me…. You wouldn’t give the ambulance a call there? I’m in quite a lot of pain. All that beer from last night is really tugging on the old fartstrings, lads. Just so you know.”

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  80. problem solver says:

    there is only one solution-

    broaden the concept of the hospital- to three aims.

    1) treatment for major problems (surgery) etc.
    2) teaching
    3) emergency (real ones–the asap kind-
    4) health and well-being of all individuals who need care and cannot afford it-

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  81. missing says:

    should be 4 aims–the fourth is missing at the moment from all hospitals- as far as can tell.

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  82. Cecelia R. says:

    Of course for more than half the week most primary care doctors and specialists are not available, i.e., all the time outside of their practice’s normal office hours. So, insurance or no insurance, where are you gonna go during those hours?

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  83. Jamie says:

    Two years ago, two of my three children went a total of 5 times to the ER in the space of three weeks. In each instance, their crises occurred either in the middle of the night, in the middle of a weekend, or in the middle of an ice storm during regular business hours. Our doctor’s office was closed in every case; the on-call MD, whom we finally realized we could talk to by going through the answering service, told us in every case to head straight for the ER. So we did.

    We outwaited a lot of people because my kids’ issues were not apparently life-threatening – just horribly painful in one kid’s case and serious but not as immediately serious as an ABC problem in the other’s (he too was dehydrated to the point of needing an IV, and unable to keep anything down that was given by mouth). Four out of five ER visits resulted in the boys’ being admitted overnight.

    Our insurance is great; we would have preferred to go to an urgent care clinic (or to our regular doctor’s office, if it had been open) and be admitted, if necessary, from there, as happened once when we lived in TX rather than PA. But at the time, there wasn’t one urgent care clinic for at least an hour around us. So we exercised the preferential option for the medically desperate and hit the ER, knowing that we might be junking up the process but seeing no other possibility for receiving care within 24 hours. Frustrating. Since then, at least one urgent care clinic has been started nearby (by my neighbor, actually).

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  84. hal says:

    Some of the ED problems are systemic. Well, face it, most of them are. Beginning with the industrial assembly line model of processing incoming patients.

    If my grocery store chain can take job applications over the internet and from automated touchscreen kiosks in the lobby, why can’t the ED have conscious, functioning, incoming patients (or their SO or parent) do either?

    Why can’t my insurance status, or lack thereof, be determined along with my identification scanned? If the highway patrol can scan my driver’s license to write a traffic citation, why can’t the hospital read my ID or insurance card?

    And why can’t the computer power be turned to getting people self-diagnosed or at least triaged quickly? 200 people a day measure their vital signs in the local pharmacy’s blood pressure and pulse machine. Add a few bells and whistles and they can get pulse, temperature, etc. Add a touchscreen and they can tell you what the problem is.

    Why are lines longer and less managed than at Disney theme parks? Disney knows something about managing access and wait times.When my local McDonald’s experiences a surge, they send a person out to take advance orders so the kitchen can be working on them before I arrive at the counter. Why does the ED have to wait until the patient finally graduates through the golden portals before learning anything about their condition?

    But, as several have pointed out, the reward for efficiency in the ED is more patients (based on reputation) and more uninsured patients at that. Hospitals are not incentivized to lose money faster.

    And one of the reasons Steven’s daughter’s relatively easily cured problem took so long was the numbers of possibilities that had to be ruled out to settle on simple dehydration. The addition of fake symptoms also complicated it.

    And the unavailabilty of his regular pediatrician may have been a factor in being at the ED. I just canceled next Thursday’s doctor appointment that I set last week. It was the earliest I could be seen for upper respiratory infection with wheezing pneumonia and bleeding sinuses, the culmination of 5 weeks illness. And it was’t even my regular doctor but an office colleague (mine has no unscheduled appointment time until late May). Why did I cancel? Because like the other grandfather, I treated myself and am finally recovering, after concluding there was nothing a doctor could do for me (or would, either). Or, I could have become much sicker, in which case my insurance would have eaten a stratospheric bill. Or, if I were uninsured, the hospital and ambulance service (government) would eat a huge bill. Anything wrong in this picture?

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  85. ruralcounsel says:

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

    Well, let’s take the AG Holder’s word at it’s face value and presume we want an honest discussion involving race. Here (obviously) “African-American” was meant as a placeholder for “poor and uninsured.”

    Both were probably factually correct, though I’ll concede Steven didn’t appear to poll them about their incomes, and at 9 a.m. on a Sunday, there aren’t too many doctors offices open for business. I assume you are shying away from the statisitcal correlation between them. It isn’t PC to point out the correlation, particularly in an urban environment with a large percentage of African-Americans with below average standards of living. I think you’d have to be willfully ignorant of reality to deny it, however.

    So, are you accusing Steven of being insensitive, racist, or for just inadequately discussing the statistical correlation? Or do you think it insulting, because you think there is more than correlation, but causation? (Which I would consider racist.)

    My guess is that you just feel that it is gratuitous. Maybe so. But then again, it was a descriptive passage, and he was painting us a picture with words. Certainly it conveys the feel of an urban American hospital, as opposed to a sparkling uncrowded suburban one. When we start censoring reality, we know we’re running scared. The Attorney General isn’t all wrong; we are cowardly about race.

    For what it’s worth, my famly has a story from the 1930’s when my uncle was injured one weekend, and my grandfather took him to the local hospital’s emergency room. They were in dirty overalls, since they’d been gardening or something. The ER nurse was taking forever to help them, and so my grandfather, who was a reasonably prominant businessman in the community, snagged a doctor whom he knew. The doctor helped them, and proceeded to criticize the nurse. The nurse’s reply was that they “just looked like a bunch of farmers.”

    The poor and disenfranchised will get less attention and care. It’s a sad old world.

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  86. Seth Levy says:

    I recently went to the University of Miami ER and reached a similar fate. After checking in with sever abdominal pain (the same pain I felt when I had internal bleeding due to a previously ruptured spleen) I had to wait for 14 hours to see a doctor. After seeing a doctor I stayed in the ER for about 6 more hours. When I came back out, I saw some people who were still waiting from the night before.

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  87. mike says:

    emergency rooms kind like a monopolied good,so the result is definite although the way differs

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  88. a.l. says:

    I wonder if Steven’s visit to the UChicago emergency department occurred during the winter months. I had the misfortune of going there once, about this time of year, and saw the same thing — at least 30 African-Americans in the waiting area, as well as a handful of visibly ill or injured people in one corner of the waiting area. I would be willing to bet that at least two-thirds of these people were not actually seeking health care — whether emergency or routine — but were merely unfortunate homeless people seeking a place to get out of the severe weather. (This is not being racist; it’s just a fact that homeless people in Hyde Park are mostly, if not all, African-American.) I’m excited about the university’s Urban Health Initiative, but perhaps this is another piece of the puzzle to be considered.

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  89. TS says:

    To #21–Are you seriously encouraging those who may not have a life threatening injury or illness to call 911 for transport for better “customer service”? This is one of the problems already facing emergency services.

    To the author and others- the majority of people presenting to the emergency department are there for urgent/emergent care and NOT “routine care”. Also, the public needs to be aware that it is NOT a first come first serve, it is a triage system that allows physicians and nursing staff to care for the most critically ill (which can take hours) prior to caring for the less acute. Everyone thinks their illness is emergent (that is why they present to the EMERGENCY department). It is the emergency department’s expertise that categorizes them based on presenting complaints, vital signs, etc… Unfortunately, the majority of educated persons believe they are above this system. They try to manipulate it, just as the author did, by lying about symptoms and therefore making the staffs job more difficult trying to sort out the truth.

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  90. Chance says:

    I have to echo the comment above about calling an ambulance. I’ve sat in an ER in intense pain for upwards of 7 hours waiting for a doctor, while ambulance after ambulance rolled people in for immediate treatment. Being close to the front desk, I could overhear how serious or NOT serious some of these “emergancies” were. I had to call an ambulance one time myself, and when I got there I was at the front of the line.

    I don’t plan to game the system, but I can put 2 + 2 together like anyone else, and I’m betting many people do call an ambulance for exactly this reason.

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  91. Susan in WA says:

    It’s a little like running in a big race. You have to lie about your actual time in order to get placed in the correct starting category, because everyone does it.

    Turns out the triage nurse was correct in her evaluation. However, having had the traumatic experience of losing a child to meningitis probably caused extra anxiety. On the other hand, many others (whatever their color–what’s up with that reference?) may feel the same way about their condition or the condition of their loved one.

    I bet you live in or near a city where there are other alternatives on a Sunday morning to the emergency room. And I bet you have the resources, including health insurance, to avail yourself of them.

    I have needed the emergency room a few times for emergencies that were not life threatening. We live a couple of hours from any off-hours health care, but only 45 minutes from an emergency room. So when my baby needed daily blood tests all weekend, or my teenager had his head cut open or extreme stomach pains in the middle of the night, we were happy go and wait in order of need to be served. The care might not be fast enough to suit a worried parent, but it is usually fast enough.

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  92. D.S. says:

    #76 and many others- it is disheartening to see the thread of comments blaming ED overcrowding on the uninsured, and those with non-urgent complaints. A recent review article in JAMA: (JAMA. 2008;300(16):1914-1924), found that data does not support the assumptions that uninsured patients are a primary cause of ED overcrowding, that uninsured patients present with less acute conditions than insured patients, or that uninsured patients seek ED care primarily for convenience.

    For better or worse, our ED’s serve as a safety net for our communities, and the initiative by the University of Chicago hospital to treat only those with insurance is immoral and borderline illegal.

    There are many causes for ED overcrowding, and many people are looking for solutions to these problems. Before they can be addressed, however, common misconceptions about those who seek emergency care must be addressed.

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  93. S says:

    #11, I’m also Canadian. I think a point that is lost on critics is that people who show up at emergency rooms genuinely believe that their case requires immediate attention before they can go on with their day-to-day existence. The patients don’t go wait in line for hours because it’s fun. The problem is in both triage and throughput. Investment in services like phone consultation/triage and neighborhood satellite clinics coupled with targeted public transit would alleviate a lot of the ER issues in a public or private system (btw, we have services like this in Canada, they work fairly well and some are private). I also have never waited in ER for anything important like bleeding or difficulty breathing. I have also always been provided with ice or immobilization during triage.

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  94. Kevin Scaldeferri says:


    I think there’s an assumption that if you walk in to the ER your condition is probably not so severe that you can’t fill out a basic form first. OTOH, the two times I’ve been involved in accidents and come to the ER in an ambulance, I’ve gone straight to an examining room and the paperwork always gets deferred until sometime later.

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  95. Andy says:

    # 92. It you are so concerned about common misconceptions — why don’t you stop spreading them yourself! The University of Chicago Hospitals has no program or initiative to treat only those with insurance. It has a program where patients who show up in the emergency room without the need for urgent care are referred to the local clinics who at the end of the day can manage them much better; and this is done irregardless of the patient’s insurance status. It turns out that, the article in JAMA aside, many of the patients at the University of Chicago ER are either uninsured or underinsured, and many do not have the need for urgent care — hence the controversy. The program helps to direct all individuals without urgent conditions to community health centers. Because most of these patients are underinsured, the University of Chicago critics then want to claim that the program is biased against the poor.

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  96. Sara says:

    My dad’s a private practice family doctor and a provider from his office is ALWAYS on-call, 24/7. He’s practiced for over 30 years in two different states and it’s always been this way. Patients call a nurse-staffed answering service, which calls him. So how come so many of the above commenters are lamenting how family practice doctors aren’t available nights and weekends?

    Sure, he sends people to the ER, but he also tells people when they are safe to wait until the morning.

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  97. GingerB says:

    Did she have a temperature?

    I have managed-care coverage, the kind most people try to avoid. They have a phone number you call for urgent care on weekends.

    I will say that they can spare you sitting in a ER with humanity with some of the questions they’ll ask. They’ll even call back in a few hours if they’ve told you to try this or that instead of coming in.

    For future reference – Popsicles are good for kids who’re dehydrated and throwing up. They suck on them slowly so they’re less likely to come back up. The sugar in them will perk almost any kid up.

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  98. Mark says:

    Maybe part of the reason why health care professionals demonstrate this “apathy” is because people like Mr. Levitt think that their problems, and the problems of their families, are more important than any other. Why would you lie about your child’s symptoms in an attempt to get preferential treatment? Not only were you lying, but you were teaching your daughter that lying is okay as long as it is og benefit to you. Mr. Levitt, thanks for demonstrating why our ERs are a mess. It is because of people like you.

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  99. ER_MD says:

    As a practicing ER doc, I hate it when the WR gets full of people. It’s just a disaster waiting to happen. I work very hard and often see 30+ patients a day in a 8 hour shift. The place is like a bus depot, with tons of people coming in all trying to get their ticket either into the hospital or back home. The ER’s are the one last place where people can seek care. The only definition of “emergency” I’ve come to is any situation that overwhelms a person’s ability to cope. My ER sees 220 patients a day (mostly insured, mostly non-emergent), we have 9 docs every day, and we still can’t keep up. Since we streamlines out process, our patients wait 30-50 minutes, get out in about 2:30 hours. As we’ve gotten more efficient, all that’s happened is more people have come and we can’t keep up. Our hospital fills up on a regular basis and we end up with patients in our hallways and every nook and cranny we can stuff them into.
    I have wondered why it’s so messed up and then it dawned on me. The healthcare problem is an economic one, how can we spread the resources? The ER’s become so full because the clinics can’t keep up with the demand when their reimbursement is so low from insurance. They capitulate and tell people to “just go to the ER.” They can’t keep up with the demand when to keep the doors open they have to see a patient every 15 minutes. A typical PCP will have 5-6,000 patients in their practice.
    People get sick of waiting for 3-4 months for a clinic appointment, so they look for a faster alternative and game the system (like the author) by going to the ER.
    No one is opening a national chain of free clinics cause they cannot make any money here and to get anyone to staff it they would have to pay salaries they couldn’t afford.
    If you continue to allow insurance and Medicare to dictate how much thing are worth, you will always get shortages (it’s a price ceiling). People want the very best care (which is expensive) but don’t want to pay for it. Hospitals and doctors can’t help themselves and they buy the best technology (which is expensive) to compete with each other.
    Trying to fix it by going to a single payer would simply ration resources which is exactly what University of Chicago is trying to do. Hospitals aren’t typically money makers like pharma companies are. They often live on the ragged edge. It’s like trying to fund you local public school. It largely depends on who the demographic is.
    It bothers me that U of C has done this. People will get hurt. At the end of the day it’s all about the patients. Somehow we need to fix how we pay for healthcare. Fundamentally it’s a problem of economics, but from my perspective, it’s a daily crisis.

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  100. Jason says:

    ER_M.D. Do you know something that the rest of us don’t? What exactly has the University of Chicago done that will result in people getting hurt? The program helps people with non-urgent problems get appropriate care from a primary care physician, a physician that can attend to all of their problems on a long-term basis. How is it that allowing these patients to be seen by an overworked ER doc such as yourself and who is only going to see them for a few minutes not result in people getting hurt? Seems to me that what you do is a lot more dangerous than what the U. of C. is proposing.

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  101. Eric M. Jones says:

    Simply Google, “When should I go to the emergency room”? There you will find guides to doing the right thing. Dehydration is treatable at home but can get to be an emergency.

    Call 911 or get to the ER in case of::

    Repeated attacks of chest pain or pressure with sweating, pain in the jaw or arms
    Unexplained loss of consciousness
    Not breathing (!) or difficulty breathing
    Suspected poisoning or overdose
    Unexplained partial blindness.
    Penetrating wounds, especially of the torso and head.
    Coughing up blood
    Vomiting blood or something that looks like coffee grounds Severe injuries, such as suspected broken bones, head injuries or uncontrollable bleeding
    Seizures or convulsions
    Numbness or paralysis of an arm, leg or one side of the body
    A sudden, severe headache, especially if there is neck pain or a change in consciousness at the same time
    An unexplained change in mental ability, such as not recognizing familiar people

    You should pay some sort of penalty if you go to the ER or even a doctor for a cold or flu (for now), a bruise or a sprain (within limits), general malaise of long duration, stomach pain after eating hot peppers, non-bloody diarrhea of short duration, burns without charing or bleeding, cuts and scrapes treatable with over-the-counter products. Don’t ask for much help if you want to continue smoking cigarettes. Make sure you are up to date on vaccinations, drink plenty of fluids whether or not you are thirsty. Take a multi-vitamin and an aspirin every day.

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  102. Tracey-West Virginia says:

    I read all of your comments and most had some good solutions, most were correct that alot of ER patients do have insurance and some do not and many that do have insurance have state funded medicaid, are poor and do not have “emergencies”.

    In my instance, I had state medicaid, but no PCP because the HMO that is runs the state medicaid plan is not accepted by ANY physician in the county in which I live. I even had an outreach worker who gave me LISTS of physicians to call who she said accepted my HMO to call and they wouldn’t. If I had a medicaid card and NO HMO, several physicians would have taken me as a new patient. Finally, I found a physician that would take my HMO at a clinic in another county.

    However, she will not see me at her main office in the county in which I live, the 5th largest in the state with a population of over 86,000 according to 2007 census.

    I visted the hospital once for an MRI; I then went to the ER to get a referral for a PCP-the Express Clinic that ordered the MRI couldn’t find a neurologist to see me, after looking for two weeks;the wouldn’t give me any more medicine for severe pain because they are not a long-term treatment center and suggested I go to the ER; they gave me pain meds and a referral for a PCP and a Neuro, to read my MRI, which at this point, we know something is wrong, otherwise they wouldn’t have made such a big deal about getting me in to see someone, nor called me less than 45 minutes after I left the MRI facility at the hospital saying I needed to see and Neuro.

    Called the doctor the next day, they supposedly HAVE to see you at least once and well, the Dr to whom I was referred was not actually the one on call that night. Got the correct Dr and they wouldn’t take my insurance but his partner would see me for free.

    Got a referral for a neuro, parnters with HK, the neuro who did my first back surgery and they want $150 to read my MRI and unless I have a “straight” medical card, one with no HMO.

    I started crying and said HK didn’t charge me anything before when I got a referral from the ER and he did my surgery and I had the same insurance, I don’t have that kind of money and suddenly, they will call my PCP and get an approval for my to see HK at least to read the MRI. I don’t have one. I just am seeing this other Dr., he is not listed on my card. However, my outreach worker at my HMO got an approval because she knew whaat I was going through.

    BTW, I am in the hospital right now, I had to have a PLIF and laminectomy, this is day 5; I had a tear and was leaking spinal fluid; HK did my surgery because he knew I needed it badly on my lower back . . . I had the MRI for my shoulder and neck problems; in 6 months, I have to have ANOTHER surgery. I have severe stenosis, which usually occurs in people aged 65 and over.

    Back to the ER’s . . . while in the ER, I see people who come in with “migrains”, “neck pain”, “back pain” who are seeking pain medications. They are more than willing to sit there for 6 hours for 20 narcotic pills. This prevents me from getting vital medicine that I need if I go anywhere else, unless I carry my my MRI reports around with me proving I am not pill shopping. Rural WV and KY are both notorious for these addicts who snort and shoot anything they can get their hands on.

    On Feb 13, 4 people from KY were arrested returning from FL with $23,000 in pills and today, two men from OH wee arrested at a hotel with a sacj of hydrocodone pills they bought in FL for $2000

    On Feb 4 44 (yes, Forty-four) people were arrested in Mingo Co WV and among the seized drugs were:
    137 Alprazolam tablets
    264 Oxycodone tablets
    336 Hydrocodone tablets
    38 MDMA (Ecstacy) tablets
    125 Diazepam tablets

    and the list goes on and on. When the users can’t afford to go the dealers, the go to the ER.

    Even if they can’t get their pills, the ER docs HAVE to treat them for their presenting symptoms and either admit them to the BHU unit and detox them or give them IV meds for a couple hours to lower their blood pressure, stop their shakes, vomiting, aching and sinus problems.

    In the meantime, other doctors are prescribing pills by the hundreds, accepting cash payments for their services (one was arrested recently in nearby Marietta OH); the dealers are buying them up, getting hundreds of people hooked on these addictive prescription drugs (don’t forget the kids raiding mom and dad’s medicine cabinets too) and you people are arguing over whose fault it is that an ER is clogged with patients??

    There really is no ONE answer to whose fault it is. The person who didn’t think they would get hooked? What about someone who used their prescription legally but suddenly doesn’t have any medication and can’t deal with the symptoms and doesn’t have anywhere else to go? Or a person who worked for 17 years with no health insurance and one night, was so sick that violent coughing caused a ruptured disc causing them to lose the use of their leg and they have no insurance and have to go on state aid and quit work because they could risk losing control of their bladder and bowels and permanant damage to their leg? (I never did gain all the use of left leg back, even after 6 months of P/T).

    Or maybe the guy that injured his back at work, but W/C says it wasn’t work related, it was normal wear and tear and he can’t afford to go to a dr and has NO insurance, it is very obvious that at age 45, he can no longer do his job but he has to buy pills illegally so that he can, so the dealer stays in business.

    The girl that injures her knee at work, has to have surgery and goes back to work to her job making $7.00/hr and has no insurance now, no doctor and has to do the same thing to work her job working in a kitchen, 29 hours a week.

    This is the real world and we can’t pull strings and it’s only because I have a small child that I get state medicaid and was able to have surgery . . . I can’t work and make money to go and buy those pills to get by in this messed up country.

    Their only hope right now is that our Governor is looking at expanding Medicaid with stimulus money to aid working adults with no children who make less than 50% of federal poverty level and eyeing at expanding to 100% of federal poverty level.

    To answer your question, ER’s never stopped being ER’s.

    Compare it to Gas Stations. Just like gas stations didn’t stop being gas stations when they quit pumping your gas for you and washing your windshield off and started selling beer, chips and added ATMS and fired their mechanics; they still sell gas, if that is what you need.

    If you are in a car accident, as I was in July, I was transported by ambulance, didn’t wait in the waiting room, got x-rayed right away, had 5 people working on me and the ER went back to being an ER.


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  103. Chris says:

    “It’s stupid to call an Emergency Room one, when doctors are not ready to attend in case of an emergency. Doctors never appear and nurses are never ready to look at the people with any type of emergencies. The first thing they ask is for them to fill in a set of paperwork, when there are some patients who’s emergency doesn’t allow them to write.”

    #24, it’s all about triage. Spend some time in an ER, and you’ll see that the true emergencies are dealt with at incredible speed. “Boo hoo, my chest hurts = 3 hours in the waiting room.” ST elevation in II, III and avF, and the cath lab has been called before the ambulance even pulls into the bay.

    Come to the ER with a stupid complaint and get ready to wait five hours. We’ve got sick people to treat, not dumb people to coddle.

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  104. LJD says:

    I live in Toronto. Universal healthcare, (so there aren’t uninsured people using ER for regular care). But, the wait times in ER can be horrible. Actually, this has been in the news a lot lately. The province has pledged to set an 8 hour maximum on ER waits. From what I understand, a lot of people go to ER for non-emergencies, but obviously it is not an insurance issue. I know that a lot of people don’t have family doctors, but I would think that most of these people would still go to a walk-in clinic for a non-emergency issue. I assume most people don’t really know what constitutes a medical emergency, and that the lack of availability of after-hours clinics is also an issue, but I don’t know. In general, our healthcare system seems to be plagued with problems, particularly long wait times in every area of the system.

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  105. SN says:

    I had the misfortune to visit an ER twice in my life, the last one being on a vacation this past August. The hospital was the Maine General in Waterville Maine. The visit was very fast, nurses, receptionist extremely courteous and responsive and I saw a doctor within 20 minutes, a certain Dr. Clarq. Although, I was not in a serious state, it was just a bad allergic reaction, I was impressed. Maybe it was small town charm.
    The problems at UC seem to be perennial though. The ER problems reported by the Chicago Tribune are also echoed in private by residents many of whom I had conversations with. Coupled with recent layoffs in the hospital, I doubt that anything UC can buy any goodwill right now.

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  106. Bret says:

    As the remaining catchment of the Healthcare System (lack of), EDs provide a service that is unavailable anywhere else (24/7/365). However, as the CDC points out, visits have nearly doubled over the past decade – but the number of available EDs has decreased. The typical arguement is that most of these are not ’emergent ‘ patients – however, the non-emergent percentage has actually decreased to about 12-14% over the same time period.

    In general, most EDs continue to care for a greater number of patients than capacity was designed – and despite this growing issue change remains unpalpable. No healthcare provider likes the idea of patients languishing in a waiting room or hallway – however, without a substantial public outcry the situation will continue to worsen.

    The greatest challenge will be a change (or mandated change) in the American mindset – the “me now” consideration. EMTALA limits ability to send patients out without a medical-screening exam (and liability limits this further) – especially for patients that call their physicians and are told they can be seen later that day or tomorrow “but if you think you need to be seen, you should go to the ED”. It is a one-stop-shop with a high level of resources available. It is a complex issue or expectations that will be difficult to overcome.

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  107. Miss Sadie says:

    The notion that the University of Chicago is delivering poor, uninsured or underinsured patients to “appropriate” medical settings is a myth. When you need medical care and a local clinic costs $45 per visit and that approximates what you might earn in one day before taxes, you don’t really have an option but to go to the ER. The U of C earns substantial tax benefits for its status as a non-profit, community hospital, and in exchange for that is supposed to treat the local community. The local community is not Beverly Hills, 90210, it is a poor neighborhood where many people have no insurance or Medicaid. A Washington Post article last August asserted that the U of C earned five times in tax breaks what it provided to its neighbors in charity care. Now who’s gaming the system?

    As long as people continue to blame patients for the problems in emergency departments, the problems will continue. The system needs reform, not the people who too often have nowhere else to turn but their local ER.

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  108. Adrien says:

    Maybe we ought to realize that the hospital is just another facet of this service-oriented economy and that we ought to take the same personal responsibility with respect to our health as we ought to with our diet.

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  109. Timothy says:

    As an Doctor in the Emergency department I need to make it clear, the VAST majority of people I see every day need urgent or emergent care, they are not coming for Routine visits! This is a myth that medical research and direct knowledge have proven is not true. Access to Rotine care is a huge issue in this country but this is a small part of the Emergency Department overcrowding issue. The real issues lie in the lack of inpatient and critical care beds in hospitals. People are kept in the Emergency Department waiting for inpatient beds which prevent us from seeing any new patients, thus people wait in the waiting room. The University of Chicago issue is related to the fact that beds in the hospital are being reserved for profitable procedures rather than sick poor,unisured or underinsured community members who need emergent care. This issue will not be fixed with walk in or routine care clinics. Please keep that in mind.

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  110. Sam says:

    Miss Sadie, Your comments are not based upon an understanding of the program. On the South side Chicago there are several community based primary care clinics. These clinics have recently been established are partially subsidized by the state of Illinois. The cost structure of these clinics are such that they can provide care to Medicaid patients and still remain financially solvent. Unfortunately these clinics are currently underutilized — they would actually like to see more patients, even Medicaid patients.. The University of Chicago with state approval is simply directing patients who would be better served by these clinics. The University of Chicago also provides physicians and other staff to help out in some of these clinics. To me this program is not only reasonable, but actually forward thinking. The patients when because they have a home-base to received long-term care and don’t have to rely on the emergency room, the community clinics win because they get more patients from which they can make more money, and the University of Chicago wins because they have fewer non-urgent cases in their emergency room and can spend more time treating the more urgent cases.

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  111. barb says:

    First, after reading all of the comments and the article it is clear that the greater issue is the overcrowding of the emergency departments, not that someone with a dehydrated and ill child would bring them in. I have utilized the emergency department only three times in my life- and in each case it was something major, involving broken bones, stitches and special studies, like ultrasound or xrays.

    I can;t speak for the author of the article, but I can tell you that the hospital where I work gets a large influx of indigent, and lower income people who have learned that the ED is their access to health In many cases this is a generational pattern, and these patients neer learn to establish with a primary doctor. Our hospital has begun charging $75.00 cash up front to be seen if you arrive in the ED and want to be seen. Certainly that is a bargin considering the actual cost of staffing the ED and having the larger concentration of diagnostic technology available. Right now the cost to the hospital is appx $350 for the visit. Primary care costs for the same visit are at least 1/3 of that ED Cost.

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  112. Ben Tanner, RN, MSN, CNS says:

    I’m an ER nurse and paramedic in California. I also work in a homeless clinic.

    The substitution of a big hospital’s ER beds for community health centers and smaller ERs shows how broken our health care system has become.

    ACEP’s criticism of the University of Chicago is that their ER has been effectively divided into two systems, one for the insured and one of reduced size for the uninsured. In some ERs, patients with privilege, private insurance, or better advocacy skills can jump the line. The University of Chicago has gone a step further and institutionalized line-jumping and cut services to Chicago’s South SIde residents.

    The University states in its Urban Health Initiative that it is “developing partnerships….to help make the best use of resources in underutilized hospitals.” ACEP calls this “patient dumping,” – illegal if a hospital has a service and turns people away, but legal if it discontinues that service and turns people away permanently.

    The other side of this issue is the use of clinics. The advantages to free clinics are obvious – which is why the Obama administration announced $155 million for community health centers on March 2nd. If placed correctly in a community, they can serve as complements to existing Emergency services, but may be misused as stand-alone hospitals if not well distributed. They should not serve as substitutes for the comprehensive service that only an ER can provide. It is important to pair the services close by to each other to relieve strain on each type of care that is felt if hospitals or clinics stand alone.

    Chicago’s South Side needs both kinds of service. A properly funded and staffed ER with sufficient beds to support those who can and cannot pay ought to be a basic function of all hospitals. Community health centers can complement ERs and potentially draw down the need for inpatient beds for emergency patients.

    We’re all in this mess together. We need all of the above. We need reform.

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  113. mapgirl says:

    Oh and another thing. If you do not hear what a patient is telling a triage nurse, then you don’t know what is wrong with them. Just because someone is coughing and sniffling, they may need a nebulizer to prevent an asthma attack that could kill them. So stop thinking people are in the ER for nothing. They could have something else wrong with them you cannot perceive with your eyes.

    I was recently in an urban ER with a friend who looked perfectly fine till he had a spasm and would scream in pain. So to the average person we looked like we were wasting time and space. However, once my friend was examined, he was admitted immediately.

    You just can’t know what is wrong with the person in the waiting room without an examination so don’t judge people for being there or not.

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  114. unique_name says:

    If patients PAID for emergency room services, demand would meet supply, and service quality would be high.
    If I have an accident, I’m willing to pay costs. But the current system makes me wait behind people trying to get something for free.

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  115. Dianne says:

    When Will Emergency Rooms Go Back to Being Emergency Rooms, you ask? I have your answer – when people such as yourself stop abusing the way the emergency system was intended to be accessed, used, and run.

    Yes, I am speaking to you, Sir. I am an ER Nurse, and what you did during your daughter’s visit to the Emergency Department was deceptive, unethical, and falls into the category of “demanding special treatment”.

    What makes you think that your daughter deserved to be seen ahead of the 30 other “African-American” people in the waiting room – based on what you do for a living?!

    A Triage Nurse is a highly experienced and trained RN that places patients in order of acuity based on a nationally standardized ESI leveling system based on presenting complaint, symptoms, vital signs, medical history, etc.

    The fact that you lied about her symptoms to get her seen before other people whose presenting complaints/symptoms you knew nothing of is so morally reprehensible that I find it hard to believe you have the audacity to admit to it in such a public forum.

    What if there was someone sitting in that waiting room who had been waiting in pain for hours, and you lied to get her seen in 40 minutes? You should be ashamed of yourself (but quite obviously you are not, or you would not be admitting it so publicly).

    Although lethargy, vomiting, and not eating or drinking are certainly uncomfortable symptoms, they do not necessarily constitute an emergency. Her final diagnosis of “dehydration” only reinforces that statement. I am almost certain she could have waited to see her primary care physician the next day, and saved you the trip to the ER.

    The Emergency healthcare system in America is under severe strain – almost to the point of collapse – and it is people such as yourself (the non-emergent/ “we deserve special treatment”/liars), who are just as guilty as the “drug-seekers”, and the “frequent flyers”, for ensuring that the national average of EIGHT HOURS for an ER visit will only continue to rise.

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  116. unique_name says:

    What’s unethical, is providing a “free” service paid for by someone else. Since cost no longer rations goods and services, it’s replaced by shortages. The author does not mention whether he paid, or was getting free medical care like the other “customers”.

    I don’t see how Dr. Levitt can be demonized when most likely most of the ER patients there were trying to get something for nothing.
    Aren’t they all “guilty?”

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  117. Jodie says:

    I am an ER nurse in a smaller facility. Every person that comes into the ER thinks their situation is “emergent” when in reality it can wait a few hours or until the clinic opens up. Granted there are real such emergencies out their but a lot of our ER clientel is non-emergent. I have many people come in who tell me that they do not have insurance so they are unable to utilize the clinic because they can’t pay the copay, which is truly sad. Those who are on Medicaid regularly abuse the system bringing themselves and their children in for miniscuel illnesses that can be handled in a clinic. There was a study that recently came to light in Texas where patients with Government assistance ran up over I think it said $3 million dollars worth of medical expenses. That is outrageous. It makes me very angry to hear that as there are people out there who truly do need care and won’t come in becasue they can’t afford it. The system is completely wrong.
    As for Edwards comment: “Regarding the comment from Mike, I don’t think he has had the pleasure of having a loved one horribly ill and withering in front of you, while nurses routinely ignore your presence. You need to get their attention any way you can. I worked at a hospital for five years in the 80’s and have three doctors in my family – I know it does not have to be this way.”
    Nurses do not “ignore you”, you get treated based on your level of severity. We know by looking at you if you are okay to wait or if you need immediate attention. If you call an ambulance it does not mean that you will be seen any sooner if your condition is non emergent. It is disgusting how abused the ER is. Yes there are really sick people that need to be their but most of the time it is stuff that could be handled in a clinic. Unfortunatly it’s now a one-stop shop for drug seekers to get their fix, for the uninsured to get medication refills, and for the non-emergent to take time away from those who really need to be treated. It’s pretty disgusting when you have a person in the next room who is coding and have patients who are non emergent chew your back side off because they had to wait. Sorry I guess maybe we should have used our services and resources immediatly on you and let that person die. I’m shocked at how uncaring and selfish people can be. If you have to wait in the waiting room for awhile and tell me you’ll just come back later, then you probably do not need to be utilizing the ER. This topic really upsets me because in this day and age people want a quick fix and they do not want to wait they need instant gratification. Antibiotics can take at least 72 hours to begin to work and after the 1st day if there is no improvement where do they end up? That’s right in the ER. People who do not work in an ER have no idea how much time and resources get burned up on people who do not need to be there. Our healthcare system needs a major overhaul and society needs to be educated more on what constitutes an ER visit.

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  118. Audra says:

    I’m loving all the comments about free clinics, Who is going to pay for theese so called free clinics? I understand that E.R. wait times can be frustrating,And several people abuse the system on a regular basis, however knowing the inner workings of the E.R first hand, I feel like I need to say that the people who work in most emergency rooms genuinly care for other people, and try to do their best. over crowding and under staffiing are are a huge part of the delay! I guess if you don’t like it don’t go!

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  119. GB says:

    This man is college professor and he had a very good point to make. I don’t think he would waste his time not to tell the truth to the readers, so please don’t question his intergrity here. He did a good job to share his story to many whom he can relate to out here and I will always appreciate column like this

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  120. john jameson says:

    3 points –

    (1) 95% of children who come to ERs with vomiting do not need an IV. There are simple dissolving oral medications that work for 99% of vomiting AND oral fluids are more appropriate and are transmitted to the appropriate body compartments BETTER than intravenous fluids. THIS has been borne out in multiple studies and is reflected in gastroenteritis guidelines by the American Academy of Pediatrics that state that the vast majority of children with vomiting do NOT need intravenous fluids.

    Like many parents, your pushiness may have caused your child to undergo an unnecessary procedure (IV line placement) because you knew what was best (moreso than the medical experts).

    (2) 2nd point: Lethargy is a term that is overused used by NON-physicians to describe the majority of vomiting and febrile children brought in to doctors. To a physician, lethargy is a subjective term that means they are unresponsive to communication and are barely arousable. 99% of children of children described as lethargic by parents are simply tired and fatigued.

    If you child was truly lethargic, he/she would have undergo a CT of the head and had a spinal tap AND would have been admitted to the intensive care unit. Good thing your pushiness did not cause the medical team to do these procedures.

    (3) I hope your lies to the medical staff did not cause the delay in care of somebody with a stroke, heart attack, perforated appendix or other life threatening emergency.

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  121. mary browning says:

    To the person who chided the parent, saying “don’t you have a family doctor to call”, you must be joking. Just try getting around the being put on hold by a doctor’s office staff and actually speaking with him or her. If you do, the doctor won’t say just come in now and I will see you, but mostly they will say to go to the emergency room.

    The old fashioned concept of a “family doctor” is a joke. The only doctor that I have that will actually see you quickly is my dermatologist.

    To clean out that emergency room for real emergencies, let’s have real universal health care including functioning clinics.

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  122. Lucy says:

    I’ve always had great, prompt ER care. But I have a really sick child. I assume those languishing in the ER have conditions less severe than my son’s. I hope those left waiting do not begrudge our being rushed to the front of the line. Maybe the nurse could tell from looking at Sophie that she could wait longer than some others.

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