Go to the ER for every medical issue you have!

[Nika]

When I was on mom's message boards, advice that used to make me cringe was "go to the ER" as a strategy that applied to every medical problem. I though that these women are either uninsured, or not very smart. Why overburden already crowded ERs and wait for hours when a more efficient way is to go to your Dr. or a specialist first?

My son was in the ER once in his life, when grandma closed the metal door on his baby finger. My husband was once with the food poisoning so severe he became delusional from high fever, and I do not remember being in the ER in my adult life. Because I have insurance and internist, specialists, and pediatrician, and when I need care, I get it.

I thought that this is a normal way responsible person deals with illness.

Now I am discovering that I might have been wrong about this.

When we moved to DC area (Arlington -- a county with one of the highest median incomes in the nation) I assumed that my access to healthcare would be similarly good. After all, it is an area with high concentration of money and power, and I would assume attract a lot of medical professionals, same as NYC. But my experience so far is very different.

My husband is having a prolonged stomach issue (not acute, but bad enough and unending for days). He needs to see gastroenterologist.

He had some issues before, but did not deem them bad enough to see anyone. Now it is different.

Ok, so I researched one with good credentials, called her office. March! First appointment is in March. Ok than, time to lower standards. I'll take anyone in the practice. January. but he need care now, not January.

I made dozens of calls, different hospitals, gastroenterology groups, etc. As far away as 1 hr away John Hopkins in Maryland. Asked to be placed on waitlists for cancelations, explained the situation... Advice I got - if you want to see a specialist, you have to go through the ER. That's your best bet. One place pretty much said this was our only option.

Now this is not an imminent life/death or a critical care situation that I naively though ER was for. It is not about needing care in hours. But definitely not weeks/months! But there is basically no access to a specialist without ER.

Prior to this, I got sick and my daughter was a little sick too - I wanted to get her checked out and started to call recommended pediatricians and physicians (I got recommendations in advance from local moms and thought I was prepared), I got same response - no available appointments, go to the ER. I did not think we were "ER sick".

But so far, "you should go to the ER" is a response I've been getting from medical establishments themselves. Granted, not from Docs, but from their reception staff, as I do not have access to Docs anymore.

This seems crazy! Not efficient, plus ER charges are astronomical and unpredictable, than they will also classify you as inpatient when you finally do see specialist, plus you will spend there forever with your "mild pain that lasts close to 5 days" and will be last priority.

I cannot believe that this is what access to care is like here.

When someone from baby forum complained once that she could not get first OB appointment until she was almost 6 month pregnant and was quite distressed about it, I though that was horrific and assumed she was in some poor rural underserved area with crappy welfare insurance or something like that. Even assuming these factors, I thought that situation was horrific and unacceptable.

I had no idea that in one of the richest counties near a large city one can have that much difficulty. And I am insured, educated, reasonably high income, and white, living in a major metropolitan area. How much worse is it for those who are not? How much desperation is out there?

Now I am starting to think that overcrowded ERs are NOT the fault of the patients who are too impatient or stupid to just go to the DR with non-emergency issues, that they are not flooded by the uninsured, but that many are there because it is their only gateway to get care, and it is not due to their lack of responsibility.

Interested in your perspective, especially Disneysteve.

Personally, we are now contemplating a crazy option of flying back to NYC to get medical treatment. It is insane, but may be quicker and cheaper than the ER route and is an option to someone who has resources to do that.

[Thrif-t]

That's nuts! I'm sorry you are experiencing this. I'm in NE Ohio and have no problem getting in to see any doctor I want. We have tons and tons of local choices.

It was interesting to read your post to see what goes on in other areas.

[Joan.of.the.Arch]

Did you have these problems before you could locate a primary doctor?

I've been surprised several times now that my doctor has been able to squeeze me or my husband in for a sudden issue. The only time he sent me to the ER instead of seeing me in his office was when I was having a reaction to a common antibiotic, with my blood pressure dropping and a rash that made me look like a burn victim.

[rutgers07]

I work out of an emergency room doing emergency mental health work and what you say is unfortunately all too true. We frequently see many non-emergent cases there (both medical and psychiatric) that truly do not rise to the "emergency" standard Emergency Rooms have. I am aware that sometimes we don't know if it is an emergency until tests are done but the default from primary care physicians in our rural area is just as you said it, "go to the Emergency Room." The ER ends up looking like the bad guy who doesn't want to help, especially when the primary doctor told them we could.

[msomnipotent]

There isn't any urgent care or Minute Clinics or anything near you? I'm planning on popping into my local grocery store to get dinner things and a flu shot today. They also handle smaller medical emergencies and routine.

I have had a problem trying to see my PCP for the last 2 years. I get pushed off onto a nurse or told to go to the urgent care every time. Normally, I don't care. I usually just need things like pills or a shot, but I had to see the nurse 3 times over the span of almost 2 months when I hurt my wrist. My primary usually sent me to a specialist if he couldn't fix me the first time.

[rutgers07]

There isn't any urgent care or Minute Clinics or anything near you? I'm planning on popping into my local grocery store to get dinner things and a flu shot today. They also handle smaller medical emergencies and routine.

I have had a problem trying to see my PCP for the last 2 years. I get pushed off onto a nurse or told to go to the urgent care every time. Normally, I don't care. I usually just need things like pills or a shot, but I had to see the nurse 3 times over the span of almost 2 months when I hurt my wrist. My primary usually sent me to a specialist if he couldn't fix me the first time.

We have an Urgent care center which has helped to divert some patients but the volume of patients we see in the ER keeps growing. Part of the problem here is that there are so few primary care physicians so if they cannot get you in soon they tell you to go to the ER.

[disneysteve]

I will try and respond to this later. We're actually on vacation at the moment but obviously I have some strong opinions and firsthand knowledge about the topics being raised. ER usage, physician access, Urgent Care centers, and all of that are things that I deal with for a living so I'm happy to weigh in and offer some "insider" views. We're getting ready to head out to a local museum and some tourist attractions but I should have some down time later today.

[Like2Plan]

We live in the same metropolitan area as you do (only in Fairfax Co).
Do you have a primary care physician, yet? We get most of our referrals for specialists from our primary Docs. I've done it the other way (looking for a specialist on my own), but it is more difficult to find someone IMHO.
( Don't know if this will help you, but I sent you a PM. )

[Nutria]

+1 for Urgent Care. That's our go-to for ear infections, smashed fingers, etc.

[Nika]

+1 for Urgent Care. That's our go-to for ear infections, smashed fingers, etc.

There is a shiny new urgent care 3 min walk from our house. I went there recently. Won't do it again.

It was not urgent. After I filled all paper work, I was informed Dr. has left will be back in 2 hrs. Than, after I came back, had to wait another 30 min even though there was no one in the office.

But thats not the deciding factor. My main issue is the Dr. was the most condescending I've ever met, not bothering to explain anything or even finish listening to symptoms. (I wasn't rambling on, he took less than half a minute, and there was not even another patient waiting). It was a bad sign when he would not even acknowledge our existence until it was time to ask for reason for visit. Normally, a person introduces themselves...

First he decided it was strep. Rapid test was negative. I did not have strep before, that I remember. He said rapid test is only 60% accurate, so there is still an 80% chance it could be strep. That math did not make sense to me, but ok, I let this one go.

He just walked out and assistant came in to draw blood. Thats how I found out he wanted to draw blood. I want to know what he will be testing for. He went "it will tell me exactly what illness you have". Now I don't need to be a Dr. to know this is a total bs explanation.

He said results will be back tomorrow but he will prescribe antibiotics I can start taking today. I questioned why does he think antibiotics are necessary in my case. He said, fine, we can wait for results than.

I called next day to ask. He said I have an infection. Not strep. "cell count 10,000, I strongly recommend you take antibiotics."

I was already feeling much better (he did not ask, btw). If this is NOT strep, why do I need to take antibiotics? What makes him think that my body is not likely to fight it on its own, or that is bacterial?

He was very trigger happy with antibiotics. I don't take them lightly. Do not like to destroy my good gut bacteria unless this is really necessary. Also, not sure what effect it would have on my nursing daughter and her good bacteria.

I did not bother saying any of this to him. If you don't trust your Dr., there no point in arguing with him, you should find one you trust. Or at least that was what I thought because I was used to having that luxury. LOL

[Like2Plan]

Prior to this, I got sick and my daughter was a little sick too - I wanted to get her checked out and started to call recommended pediatricians and physicians (I got recommendations in advance from local moms and thought I was prepared), I got same response - no available appointments, go to the ER. I did not think we were "ER sick".

This goes back a few years because our DS is an adult now, but when we looked for a pediatrician's office we picked a very large practice that was about 5 mins from our house. They could make appointments fairly close in, but they also had walk in clinic hours on the day of--in cases where an appointment would not have worked.

You could end up with a different Dr than you normally saw on those short notice visits, but all of DS's records were in the same place.

Anyway, some practices we looked at were smaller, but not as flexible so it pays to shop around and learn how the practice is set up.

[Nutria]

There is a shiny new urgent care 3 min walk from our house. I went there recently. Won't do it again.

It was not urgent. After I filled all paper work, I was informed Dr. has left will be back in 2 hrs. Than, after I came back, had to wait another 30 min even though there was no one in the office.

But thats not the deciding factor. My main issue is the Dr. was the most condescending I've ever met, not bothering to explain anything or even finish listening to symptoms. (I wasn't rambling on, he took less than half a minute, and there was not even another patient waiting). It was a bad sign when he would not even acknowledge our existence until it was time to ask for reason for visit. Normally, a person introduces themselves...

...

That's a bummer. The UC near us is great.

[disneysteve]

Now I am starting to think that overcrowded ERs are NOT the fault of the patients who are too impatient or stupid to just go to the DR with non-emergency issues, that they are not flooded by the uninsured, but that many are there because it is their only gateway to get care, and it is not due to their lack of responsibility.

Let me comment on this first.

ER usage is high for a variety of reasons.

1. Uninsured patients who either know they'll never pay the bill or apply for charity care and get it covered that way. This has lessened a lot since the ACA started since millions of previously uninsured people now have insurance.

2. Even though the ACA brought insurance to millions, it didn't decrease ER usage. In fact, it actually increased. Now that people have coverage, they're more apt to seek care that they may have put off previously.

3. Some people are just impatient. I can't tell you how many times a patient called my office because they were sick. We told them to come over in an hour or two and they never showed up. We found out later that they just went to the ER instead. I'm quite sure they waited longer to be seen at the ER than they would have waited at my office so that really makes no sense to me.

4. Some people go to the ER because it's convenient. I have a lot of patients who live in walking distance of the hospital but need to take a bus to get to my office. Guess which one they tend to choose?

5. Some people don't have a PCP. This is especially true for younger people. They have no chronic health problems like high blood pressure or diabetes and see no reason to establish themselves with a primary. When they really need care, they go to the ER.

6. And some of it is definitely availability. If someone calls their doctor and is told to come in tomorrow at 9am, they often decide to go to the ER instead.

7. Regarding specialty care, that's definitely part of it too, along with testing as well. For example, a patient comes to see me with right upper abdominal pain after eating. I suspect it could be gallstones so I order an ultrasound. However, their insurance requires prior authorization for ultrasounds which takes 3-4 days (or more). They can't wait that long so I end up sending them to the ER where the ultrasound will be done stat.

On one hand, the insurance companies tell us doctors to decrease ER usage but on the other hand, they put barriers in place (like prior authorizations) that force us to use the ER when we'd rather not.

[disneysteve]

There is a shiny new urgent care 3 min walk from our house. I went there recently. Won't do it again.

It was not urgent. After I filled all paper work, I was informed Dr. has left will be back in 2 hrs.

If you encountered an urgent care that had no provider for 2 hours, I would report that to your state medical board. There's no way they should have their doors open as an urgent care when they have no provider on site. That's irresponsible and possibly legally negligent. That would be like showing up at the ER only to be told there was no doctor available.

[LivingAlmostLarge]

I think it depends where you are. Where we used to live on the East coast the UC was terrible. Even the ER we would tend to take 3-5 hours on average. Now where we live it's ridiculously fast. We are usually in 10-15 minutes and they know us from coming in. They are so great and really wonderful and know our names. Fantastic. I can't sing their praises enough and so much easier than even our pediatrician who was so booked. The UC near us was fantastic.