Wednesday 10 June 2015

In Emerg not all patients are equal.

                 Think of the emergency Department of any busy hospital.  Crowded with people, some seriously ill and some with (medically) no right to be there, at all.  You are patient number ten in order of presentation.You have a history of a previous heart attack ten years ago and just started feeling weak and unwell.  You are seventy, and your neighbour drove you to the hospital and dropped you off because your husband is away for the day associated with a part-time job he has and she doesn't want to leave you in the house as you are feeling weak..  The triage nurse asks you if you have any chest pain and when you say no that you just feel a little woozy, assures you that the doctor will see you eventually, after the nine ahead of you are seen.
                  Of the nine patients ahead of you, there are three coughing adults who are concerned that they have the flu, a man with low back pain that he has had for months but getting worse so he thought he should come in on the way home, a kid with a sore throat and another with an earache, a hockey injury, a nosebleed, a migraine headache and a person who needed a refill for a pain prescription.   An hour and forty minutes later you feel weak, lose your sense of balance and are sliding off your chair when the patient next to you catches you and calls the nurse.  You are placed on a stretcher and wheeled into the examining room where you are seen promptly by the doctor and treatment instituted immediately.   
                  What's wrong with this picture?
                  Patients with most of the above complaints should not be in an emergency department at all.   Most of these problems should be dealt with by the patient's family physician, which is how things were managed in the past.  This allowed the emergency room physician to direct his efforts to emergencies.  Unfortunately, through gross administrative mismanagement and failure to adequately understand the structure of the health care system, the administridiots have once again undermined an adequate if not ideal system.  A shortage of family doctors, restrictions which make it difficult for family physicians to get established where they wish and a shortage of residency training positions in family medicine ensure that there will be no solution to these problems in the foreseeable future.  The situation will to get worse as the population increases and in the meantime anyone unfortunate enough to need the services emergency rooms were created to provide will wait times that are unacceptable and sometimes unsafe.

Since you might end up in an absurdly overcrowded ER some time, perhaps you have some views on this?

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