Emergency rooms forced to do primary care for uninsured

posted 06:37 AM 10/28
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People who say America lacks universal access to health care have it wrong. The hospital emergency room is our universal health care system.

Patients who lack primary care, who lack health coverage, can come to the local emergency center 24 hours per day, seven days a week. A 1986 law called the Emergency Medical Treatment and Labor Act was intended to protect access to emergency care despite an individual’s inability to pay. This law, without any other mandate to provide universal health service, has created a nation of emergency centers that treat the failures of our health system.

To see the consequences of our social policies, observe the emergency center where physicians and nurses navigate the net result of poverty, unemployment, under-employment without livable wages or benefits and a blooming shortage of primary care.

When public services are cut, the flow of need continues. When our community’s vulnerable citizens cannot find anywhere else to turn, they come to the emergency center.

The emergency center is a very expensive place to treat a case of strep throat, or a child’s ear infection, or offer primary care. Yet for those who see no other alternative, it is better than no care at all.

The physicians and nurses of the emergency center must distinguish those who have a life-threatening condition from those who can wait without medical consequences. Patients with less serious problems might face the longest waits. Emergency care cannot ever operate solely by “first come, first served” without putting patients in serious jeopardy. Yet many expect this simplicity, and every person who suffers wants his or her relief to come quickly, placing the emergency center professionals in a nearly untenable position.

Even well-insured patients and their loved ones often face a dilemma, how do they, without medical knowledge, decide what problems need attention right away and which can wait?

At times patients face frustrated clinicians who wish the patient had understood that they should have come much sooner or they should not have come at all. Collectively we have done a poor job of helping people understand which level of care is right for which symptom.

Patients with chronic illnesses rarely have a proactive plan that spells out when to call or see who about what. Instead, patients have a disconnected gaggle of specialists, each in charge of a section of the body. Virtually all physician offices are closed outside of business hours, as if the body should do its business of getting sick or hurt on a tidy schedule.

Outside business hours, patients are left to do battle with answering services and on-call doctors who probably do not know them, or at times don’t even respond to the pager. The patient is left to decipher the complex and fractured system. The emergency center can appear to be a path of least resistance, an island of predictable care.

To change this pattern, we must have more primary care, and universal access to care.

We must have alternative modes of well-understood care outside business hours, and proactive individual plans for chronic illness management. Until that time, the emergency center will continue to respond to our failures, and to a system designed with specific gaps.

Bless those who work in emergency care for all that they do to serve our most vulnerable citizens.

Pat Justis, a freelance writer, works in public health. A member of The Olympian’s Board of Contributors, she can be reached at pat@patjustis.com.

Comments

Life’s not simple when it comes to health care premiums

posted 11:37 PM 06/09

Make sedentary, overweight smokers pay more for health insurance because they cost more.

Imagine if protective services were set up like health care

posted 11:10 PM 03/31

Here is a radical idea: Everyone has the right to health care, along with education from kindergarten through high school, fire, medic and police protection.