Much of the current discussion around health care savings ends up being a discussion about the hospital emergency department. And nearly all of it centers on "if only" propositions.
The "if only" list is long. Among other items:
- If only we could prevent patients from choosing the ED rather than their primary care doctor for relatively petty healthcare needs.
- If only patients were attracted enough to patient centered medical homes that they visited them rather than go to the ED.
- And of course, if only we could get people insured, so we could end the flood of uninsured people going EDs because they have nowhere else to go.
Well, none of the strategies used to avoid frequent ED flying seem to work. As we've reported previously, some patients prefer to stay in the ED even when they're hit with a $100-$150 fine for remaining when they're not that sick. The conclusion from all this is obvious: As odd as it might sound to professional ears, patients basically like the ED and want to be there when they're not feeling well.
After all, getting care in the ED is different than receiving care in any other health care environment. In the ED, you can get:
High-intensity care: Yes, patients may wait a long time in some ED settings to be seen by a doctor, but once they've been triaged and put in a bed, they are seen periodically by a wide range of staffers, often including multiple nurses, a phlebotomist, a physician and possibly a tech if imaging is done. Even if you suspect that you don't need all of this help it can be very reassuring.
Expertise: While you may not be very sick, it may not feel that way, and having the experts in emergency medicine at your fingertips for a while may seem far more reassuring than five or 10 minutes of a rushed primary care doctor's time.
A listening ear: Sure, nurses and physicians in the ED may be even more rushed then primary care practitioners, but they do have to pay particularly close attention to you on the off chance that you’re sicker then you appear. ED patients get asked many questions primary care doctors don't ask, and they give patients the feeling—at least until doctors determine that you are not at death's door—that whatever ails you is very important.
A doctor without an appointment: This is perhaps the most attractive feature of the ED. If the hospital has managed to keep wait times reasonable, walking into an ED may be the easiest way to get your needs met, even if they could have been met the next day by your primary care doctor. Sure, this is exasperating for ED staff members who want to keep their focus on the acutely ill, but there's no getting around it—being able to walk right in to a facility bustling with highly trained staffers, equipment and resources is far more satisfying than hitting an urgent care center.
There probably is a solution to the conundrum EDs face in caring for the less acute patients that show up at their door. But as things stand, we haven't found the solution yet, and it's going to take more than a little bit of social engineering to change it.