One of the goals of the Afforable Care Act was to reduce the use of the Emergency Room (which we are now supposed to call the Emergency Department) as it is very much more expensive than a doctor office visit. The idea was that having regular health insurance would encourage people to have a primary care physician and seek treatment in their office setting. That hasn't happened and the use of EDs (Emergency Departments) has increased rather than decreased. Many of the patients have been referred by their doctor and a significant percentage are Medicaid patients who have been unable to find a private doctor to accept them as a patient.
At first I thought I understood. People don't make the effort to find a doctor and establish a relationship when they are healthy. As we all know, medical problems always take a a turn for the worse at night or on the weekend, certainly there is little or no warning. Trying to get in to see a physician on short notice when you have not been their patient before just isn't going to happen.
While that is all true, there is more going on. It used to be that "your" doctor had an obligation to be available to you 24/7. Some chose to take care of their own patient population personally, quite a burden as they had to be available at all times. Most formed loose associations with other physicians of like specialities and took turns "being on call." Everyone made use of an answering service that knew the schedule. When a patient called Dr. A after hours or on the weekend with a problem, minor or major, the answering service would call the Doctor on Call, Dr. B, who would agree to see the patient in his office. Rarely the seriousness of the problem would require seeing the patient in the Emergency Room. Even then it was Dr. B who met the patient at the Emergency Room and took care of them.
Well, it doesn't work that way anymore. I don't know when the "On Call" system dissolved but, for me, I experienced it for the the first time about six years ago. I had had surgery and developed a post op infection. I saw my surgeon in his office early on a Friday. The problem was handled as a serious situation, blood work was ordered to rule out a very bad infection and a very expensive antibiotic was ordered. I was shocked when, as I prepared to leave, my surgeon said "If things get worse over the weekend, go to the Emergency Room." "I don't call you," I asked. "No, go to the ER," he said.
More recently, when a radiologist scanned a routine post rTSA x-ray and realized mu breathlessness and weakness was due to a collapsed lung, I was told to go to the Emergency Room immediatley even though it was during regular business hours.My orthopedic doctor was alerted but I did not see him until the next morning after being treated in the ER and admitted to the hospital as an inpatiemt. I was in the care of the "hospitalist" and a thoracic surgeon, not my orthopedic surgeon. (He did drop
in to see me every morning at least)
So, even though it is being drilled into us to NOT use the Emergency Room as a doctor's office, even those of us who have a physician and see them routinely, the "system" is directing us to the ER. I wonder if the healthcare administrators understand how it works in the real world.
At first I thought I understood. People don't make the effort to find a doctor and establish a relationship when they are healthy. As we all know, medical problems always take a a turn for the worse at night or on the weekend, certainly there is little or no warning. Trying to get in to see a physician on short notice when you have not been their patient before just isn't going to happen.
While that is all true, there is more going on. It used to be that "your" doctor had an obligation to be available to you 24/7. Some chose to take care of their own patient population personally, quite a burden as they had to be available at all times. Most formed loose associations with other physicians of like specialities and took turns "being on call." Everyone made use of an answering service that knew the schedule. When a patient called Dr. A after hours or on the weekend with a problem, minor or major, the answering service would call the Doctor on Call, Dr. B, who would agree to see the patient in his office. Rarely the seriousness of the problem would require seeing the patient in the Emergency Room. Even then it was Dr. B who met the patient at the Emergency Room and took care of them.
Well, it doesn't work that way anymore. I don't know when the "On Call" system dissolved but, for me, I experienced it for the the first time about six years ago. I had had surgery and developed a post op infection. I saw my surgeon in his office early on a Friday. The problem was handled as a serious situation, blood work was ordered to rule out a very bad infection and a very expensive antibiotic was ordered. I was shocked when, as I prepared to leave, my surgeon said "If things get worse over the weekend, go to the Emergency Room." "I don't call you," I asked. "No, go to the ER," he said.
More recently, when a radiologist scanned a routine post rTSA x-ray and realized mu breathlessness and weakness was due to a collapsed lung, I was told to go to the Emergency Room immediatley even though it was during regular business hours.My orthopedic doctor was alerted but I did not see him until the next morning after being treated in the ER and admitted to the hospital as an inpatiemt. I was in the care of the "hospitalist" and a thoracic surgeon, not my orthopedic surgeon. (He did drop
in to see me every morning at least)
So, even though it is being drilled into us to NOT use the Emergency Room as a doctor's office, even those of us who have a physician and see them routinely, the "system" is directing us to the ER. I wonder if the healthcare administrators understand how it works in the real world.
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