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. 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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  2. 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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  3. 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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  4. 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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  5. 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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  6. 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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  7. 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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  8. 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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