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July 24, 2008
Hospital Drama
by Max Zimbert
With increasing scrutiny falling on emergency room treatment and care, Real Health gives you the lowdown on when to go and when to wait for an appointment
Earlier this year, when a surveillance tape revealed Edith Isabel Rodriguez’s emergency room trauma in Los Angeles’s Martin Luther King Jr.-Harbor Hospital, America was shocked. Rodriguez had been to the ER three times in three days—each time after receiving prescription drugs for abdominal pain. She was admitted a fourth time and sat in a wheelchair writhing in pain for 45 minutes while the staff did nothing. She was coughing up blood while her boyfriend pleaded with 911 to send an ambulance—or anything—to take care of her. She died in the waiting room.
Unfortunately, this tragedy is not an isolated problem—a similar incident of neglect resulted in the death of a woman in Brooklyn this past June.
Obviously, these are different realities from the mostly happy endings and dedicated docs we see on medical programs such as ER and Grey’s Anatomy. The reality is that U.S. emergency rooms suffer from neglect, overcrowding and increased wait time, which can have disastrous outcomes. Wait times in emergency rooms grew 36 percent between 1997 and 2004, according to a June report by the journal Health Affairs. Also, those suffering from heart attacks—one of the most critical medical emergencies in ERs—waited a median of 20 minutes, up 150 percent from eight minutes in 1997.
So what’s to blame? “This is not an emergency department issue, it is a health care system issue,” says Linda Lawrence, MD, the president of the American College of Emergency Physicians. With decreasing funding and lack of resources, hospitals around the country are closing down, which exacerbates the overcrowding at other city hospitals.
Studies show that the majority of the estimated 6 million African-American adults who are uninsured, along with the other 40 million uninsured Americans, are more likely to use ER docs for their primary health care physicians. When people use the ER as a catchall medical resource, they make the problem worse.
This just isn’t an issue for the uninsured. Data show that people with insurance are visiting the ER even more, up 10 percent between 1998 and 2003, according to the American Hospital Association (AHA). Even President George W. Bush bought into the hype when he addressed a small audience last July in Cleveland. “People have access to health care in America,” he said. “After all, you just go to an emergency room.”
“Patients feel they can go to the emergency room 24/7 and they will always be taken care of,” says Melissa Barton, MD an emergency physician in Detroit’s Sinai-Grace Hospital. “We can handle the sore throat, the sprained ankle, a major car accident or the massive heart attack, but we have a clinic to send the person to follow up. We have to have a bed to put the patient in.”
Individuals who use the ER as their primary source of health care or misuse the ER will likely:
- Pay more for health care than when visiting a doctor’s office or clinic
- Spend more time in the ER than in a doctor’s office or clinic
- Face the increased likelihood of seeing a doctor who has never seen them before.
To alleviate, but not cure, the problems, some hospitals have created “fast track lanes” to treat non-urgent emergency room visits and ease overcrowding. Walk-in clinics also serve as alternatives. “Walk-in clinics to deal with an earache and conditions that may not be acute are becoming a more established part of emergency rooms,” says Jonathan Newman, MD, a chief medical resident at New York-Presbyterian/Columbia Hospital.
But sometimes you must go to the ER. Barton says make that 911 call if you are experiencing the following:
- Trouble breathing
- Chest pains
- Difficulty talking, which could be a symptom of a stroke
- Excessive bleeding
Until structural changes to the system, such as universal or even affordable health care are implemented, all of our experts believe the best way to avoid the ER is to see a doctor or a health care practitioner for regular health checkups—even if it means waiting months for that clinic appointment. “You need someone who knows you,” Newman says. “If there is an issue you think may or may not be urgent, have someone you can contact for medical information. That is the most important relationship to develop.”
Learn more about navigating the health care system at acep.org and aha.org.
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