How many patients that come to the ER really have an emergency?

Like most of my colleagues I chose emergency medicine for the challenge of taking care of the most critically ill patients or, better yet, the most severe trauma.

I can remember being in medical school and seeing a doctor walk through the hospital with “emergency medicine “ written on his white coat. I immediately thought this guy must be where the action is. When I started my emergency training I looked, with great excitement, towards learning how to care for these most critical patients.

Unfortunately, I quickly found out that only a small fraction of the patients presenting to the emergency room truly fit in the category of what I had imagined emergency medicine to be. There is ongoing debate as to why this is the case. Some reasons are obvious and others involve more in-depth social study.

One common reason that a patient may come to the emergency room without having a true emergency and is a big issue that has faced our country for the last few decades, is lack of health insurance. Many patients cannot find a doctor that will see them because they are unable to pay for their visit and finally have no other choice but to seek care in the ER.

Unfortunately, trying to get care for a chronic issue in an acute setting, like the ER, is usually not the best treatment for that patient. Another group of patients that can fill the ER are those with mental health issues. Again this is a catch 22.

Many people with mental health issues cannot hold a job and therefore cannot afford health insurance, thus not being able to get the care that would allow the above two criteria to be fulfilled. Others are homeless or simply don’t know where to start in getting their healthcare needs met.

In addition, it is not unusual for other physicians to send their own patients to the ER when they simply don’t know what else to do for them or they don’t fit into a specific medical category. While the above is just a short list of patients that are non emergent and why they come to the ER, the problem seems to be much deeper and growing.

I read an article recently where the ER was made analogous to the “New American Church.” While this makes me take pause for my faith and country it does seem to have some truth to it. In days past, those who were homeless, elderly, hungry, having psychological issues, jobless, or otherwise down on their luck and no where else to go would seek refuge and support from their local church. More often we see these folks showing up at the ER for help. This is never more evident than during the holiday season.

There have been many attempts over the last few decades to address this ongoing issue. Unfortunately, the problem is extravagant and multifaceted. I believe we will have to look beyond medicine to find a lasting solution.

While our primary goal in the ER is to keep those who come to us breathing, it is also important to remember we have the opportunity to be God’s hand in other areas of suffering as well.
While we are not all powerful, nor would I want to be, we have the opportunity to help our fellow man in whatever area we can. Sometimes this needs specific medical knowledge. Other times it can be done with no medical training whatsoever.

I hope everyone had a great Thanksgiving!

Ask Dr Berry a question!
(David M. Berry, M.D. is an emergency room physician at Tri-Lakes Medical Center. Contact him at dberrymd@hotmail.com)