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The ER has become a sanctuary for society’s unmet needs

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Re: The ER has become a sanctuary for society’s unmet needs

#41

Post by repiret »

denimnerd42 wrote: post #3

On the flip side.. as someone who pays their bills, the ER has become the #1 priority to avoid. I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. I'll sew my child up before I take them to a pediatric ER and I'll order the antibiotics from India or…

Others have pointed these things out individually, but I wanted to say them all in one place:

An urgent care is well suited to needing a couple stitches or a cast. At the ER, you're also paying for:

* A facility and staffing equipped to handle serious trauma and critical illness.

* (In the US) A facility that legally cannot turn away people for inability to pay. Exacerbated by being in a national medical system where lots of people can't pay for basic care, so they go to the ER to receive it.

If you don't need those things, then don't go to an ER if you can help it. Some large hospitals essentially operate an urgent care with the same waiting room as the ER in order to lower their costs, but I've only seen that at the largest of hospitals, and I've been to at least one large hospital that didn't work that way.

Re: The ER has become a sanctuary for society’s unmet needs

#42

Post by dividefuel »

lm28469 wrote: post #28
denimnerd42 wrote: post #3

On the flip side.. as someone who pays their bills, the ER has become the #1 priority to avoid. I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. I'll sew my child up before I take them to a pediatric ER and I'll order the antibiotics from India or…

I've always been told ER is for _emergencies_, I'd never go there for a 2nd degree burn or a small cut. Emergencies as in "if I don't go there _now_ I might suffer _grave_ long term consequences" not as in "ouchie it'll be painful until I get it looked at tomorrow"

I agree that the ER should just be for emergencies. The problem is that there isn't anywhere else where you can get same-day care for many types of needs.

My spouse has some minor heart issues. She wasn't feeling well one day and went to urgent care, but urgent care didn't have the equipment to assess her and rule out any major concerns. Urgent care suggested seeing a cardiologist, but they also said she should go to the ER. Of course seeing a cardiologist on the same day, or even within a week, is virtually impossible. After talking about it, we decided to go to the ER because of the literal life-threatening consequences of ignoring a potentially big issue. We go to the ER, and she waits for hours for them to run some basic tests. The tests come back negative, and the ER medical staff treated her like she shouldn't be in the ER.

And they aren't wrong... but what's the alternative? When there's a 90% chance you're OK, but a 10% chance of a serious issue, and you have nowhere else to go to rule it out? Urgent care tells you to go to the ER, but you can't weigh how much that's them covering their own liability VS genuine medical advice. Then you go to the ER and they wonder why you're at the ER.

Re: The ER has become a sanctuary for society’s unmet needs

#43

Post by alexpotato »

This bugs me every time I read about free clinics and/or ER costs.

It seems most Americans with limited or no healthcare is:

1. Go to the ER and pay $X000

2. Wait in line at a free clinic for 9+ hours and maybe/maybe not see a doctor

This seems like a gigantic need for a middle ground to be filled.

I know that CVS and WalMart have done things like the $60 Physician's Assistant visit at retail locations but that always seems as though it's only available in a small percentage of locations.

Are the fixed costs of having even 2-3 doctors so high that this just not an economic option at anything less than $X000 per visit?

I would also imagine that if you take a Total Cost of Ownership approach, it's in society's best interest to subsidize some of this cost. I'm basing this on past articles/studies that show that some huge portion of medical care costs go to issues that were largely left unaddressed at first presentation.

P.S. As I wrote this, I thought of Urgent Care providers but even those seem high cost for folks with no healthcare.

Re: The ER has become a sanctuary for society’s unmet needs

#44

Post by denimnerd42 »

pcwalton wrote: post #33
denimnerd42 wrote: post #3

On the flip side.. as someone who pays their bills, the ER has become the #1 priority to avoid. I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. I'll sew my child up before I take them to a pediatric ER and I'll order the antibiotics from India or…

> I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. In the US, this is what urgent care is for. If there's an urgent care clinic in the area, you should absolutely not go to the ER for that kind of stuff. The price of the ER reflects the fact that i…

Of course.. and that's what happens most of the time but it's not that simple still. I've found urgent care experiences are highly variable even between same location. The ER is more a guaranteed thing with set standards.

Re: The ER has become a sanctuary for society’s unmet needs

#45

Post by Rebelgecko »

denimnerd42 wrote: post #36
lm28469 wrote: post #28

Earlier quoted context omitted.

I've always been told ER is for _emergencies_, I'd never go there for a 2nd degree burn or a small cut. Emergencies as in "if I don't go there _now_ I might suffer _grave_ long term consequences" not as in "ouchie it'll be painful until I get it looked at tomorrow"

Well we're not only talking about adults but also talking about children here. At 9pm you get a small AND deep cut requiring stitches. It won't stop bleeding if you take pressure off. what do you do? At 9pm your family member accidentally drops a kettle of of hot but not life threatening water on your child and they get a large blister on their chest, what do you do? These are probably not serious situations but the…

Why not an urgent care?

Re: The ER has become a sanctuary for society’s unmet needs

#46

Post by denimnerd42 »

Rebelgecko wrote: post #45
denimnerd42 wrote: post #36

Earlier quoted context omitted.

Well we're not only talking about adults but also talking about children here. At 9pm you get a small AND deep cut requiring stitches. It won't stop bleeding if you take pressure off. what do you do? At 9pm your family member accidentally drops a kettle of of hot but not life threatening water on your child and they get a large blister on their chest, what do you do? These are probably not serious situations but the…

Why not an urgent care?

Fine in theory, but the experiences I've had leave something to be desired. Ideally, I want to see doctors I have relationships with, aka my PCP, to facilitate and advise. But they are not interested in that.

Re: The ER has become a sanctuary for society’s unmet needs

#48

Post by MR_Bulldops »

kixiQu wrote: post #10

> Increasingly, the staff of the ED who have always upheld the proud notion of being the one place where the doors are always open to anyone who needs care at any time, have felt besieged. Yeah, okay. At another nearby "nonprofit" local hospital, not atypically: ( https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonpro... ) > The centerpiece of this program were a series of scripts, like theatrical scripts, that…

> Yeah, okay.

What's with the attitude? Do you think it's ED staff that created those training documents?

Do you think ER physicians who spent years jumping through hoops to get accepted into medical school, then spent 4 years in medical school followed by 4 years working 100 hour weeks for minimum wage as a resident do all of that so they can gouge patients for money?

Do you think RNs who jump through years of hoops and school, who sign up to help people during the worst times of those people's lives get off by upselling them on treatment?

There is a massive amount of misplaced vitriol toward medical providers that should instead go towards hospital admins and their profiteering ways.

Re: The ER has become a sanctuary for society’s unmet needs

#49

Post by Rebelgecko »

thatcat wrote: post #32
yamtaddle wrote: post #26

Earlier quoted context omitted.

After recently paying a fuck-ton for some stitches at an ER for a case that was a little hairier than urgent cares were willing to take on, but not at all life threatening, but also not something that could wait for a regular doctor... yeah, I'm seriously considering learning to apply sutures and buying a kit or something. I hate having to do "go, or don't and just hope it's OK?" when the best choice is clearly to go…

A butterfly kit is a decent compromise that doesn't really require training. https://www.amazon.com/Sutures-Waterproof-Butterfly-Hospital...

The link isn't working for me, but FWIW buying medical supplies on Amazon is usually not the best option. Poorly made counterfeits abound and thanks to inventory comingling it doesn't necessary matter which seller you buy from.

Re: The ER has become a sanctuary for society’s unmet needs

#50

Post by twodave »

yamtaddle wrote: post #26
denimnerd42 wrote: post #3

On the flip side.. as someone who pays their bills, the ER has become the #1 priority to avoid. I'd prefer not to pay 5000 or 6000 total - $3000 to a hospital and $3000 to an ER doctor agency for a small 2nd degree burn or small cut requiring stitches, or any other issue I may have been taken there in the past for. I'll sew my child up before I take them to a pediatric ER and I'll order the antibiotics from India or…

After recently paying a fuck-ton for some stitches at an ER for a case that was a little hairier than urgent cares were willing to take on, but not at all life threatening, but also not something that could wait for a regular doctor... yeah, I'm seriously considering learning to apply sutures and buying a kit or something. I hate having to do "go, or don't and just hope it's OK?" when the best choice is clearly to go…

During a vacation a couple years ago I dropped a glass in the sink while washing it and reflexively tried to catch it. My hand made contact just as it was shattering in the bottom of the sink, resulting in a really nasty, irregular gash that immediately began bleeding badly. I ended up wrapping it in paper towels and driving myself to the nearest supermarket (~15 minutes), where I bought some anti-septic and super glue. I looked pretty funny walking around the store with my hand wrapped up and raised in the air, and I sounded pretty funny as I applied the anti-septic and screamed profanities from inside my car in the parking lot. But with my hand glued back together I was able to pretty much go back to doing normal things within the hour. There's a scar, but it's actually a bit difficult to distinguish from the natural lines in my hand. Total bill: ~$10.

My wife was of course not amused. The kids thought it was cool, though.

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