Tuesday, September 19, 2006

Some Simple Realities about Your ED Wait

I hear many, many people complaining about how long they have to wait to be seen in the Emergency department. Here is the simple reality about the reasons you might wait, straight from an ER nurse:

1. We can only go as fast as the number of available beds allows. You may not know this, but state-of-the-art emergency rooms happen to be just a skosh expensive to build and equip, and they also take a little time to build. Then you have to staff them. My bedroom-community ER is operating at over 200% capacity because of the massive exodus of people out of the metro area. On a positive note, we are getting a new ER with twice the capacity of our present ER and with a better patient flow design. But that means that when it opens, we will start at 100% capacity. Why did we not build a bigger ER when we knew this? Behold, the simple economics of public funding: The taxpayers demand we build a new ER, but they'll be damned if they spend one dime for it. We can only build what we can afford. Sorry about that.

2. I don't care if a person is from Mexico, China, Haiti, Canada, Pakistan, or Lower Slobovia. I don't care if they are legal or not. I know full well how much it costs to provide healthcare to people who won't pay for it. It pisses me off too. But if they are sicker than you, they get in first. Sorry about that. Does treating illegals make things more expensive for us? Yes, it does. But they are also human beings. That takes precedence over legal status when a person is blue and pulseless. Turning deathly ill persons away because they are of questionable legal status or uninsured ain't in my job description, pal. And think about it: would you want to face me in triage if it was?

3. People using the ER as a family clinic is not a practice exclusive to the uninsured or to Mexican immigrants. More caucasian, English-speaking, insured families follow that practice in my ER than any other demographic. Why? Because they seem to think that if they come to an ER with a toothache or a head cold, they will be seen sooner. After all, we're an ER- right? We must assume that anyone who comes into an ER must certainly have a real emergency- right? Wrong. Take your headcold to the local drug store, buy some Nyquil, some Vick's Vapor Rub, some saline nose spray, and some chicken soup and deal with it. Don't clutter my ER if you aren't bleeding, puking your everlovin' guts out, convulsing, febrile over 102 degrees, or if you don't have a bone sticking out, don't have a kidney stone that feels like it's the size of a cinder block, have not been in a car accident or have not been or are not now blue and pulseless. Those are emergencies. Your ingrown toenail is not. Sorry about that. And no, I will not look at your little Jimmy's splinter or your mother's corns since they are in the room with you anyway. They'll have to go through triage just like everyone else. You can find family price packages at the Ballpark, not in my ER.

4. I am a highly trained medical professional with years of state-of-the-art education (graduated Magna cum Laude) and further years of ER experience behind me. When you come into my ER, you will get the best I have to give, no exceptions. So please do not come ditty-bopping into my ER and tell me you are having a stroke, a heart attack , or kidney stones. I ruled all three of those out when I watched you get out of your car and briskly walk the 100 yards between your car and my door smoking that cigarette and putting it out in the faux-marble birdbath that I put out there with my own frigging money. I ain't buying. Sorry about that.

5. I try to get you in as fast as I can. I really do. Sometimes things happen that make you wait a little longer- a five-car pileup on the interstate; a barbecue explosion; a father of three whose heart has the gall to stop beating while he is playing ball with his kids; a pregnant woman who starts hemorrhaging and goes through six pads in a half hour. If those come through my door, you may have to wait a while longer. Please do not stomp up to the triage station and ask me if I know just how frigging long you have been waiting. Yes, I know how frigging long you have been waiting. I wrote down the time you came in. And when I apologize and tell you that you will have to wait just a little longer, please do not call me whatever filthy name strikes your fancy. Please do not threaten to wait for me outside the ER and beat me to death with a tire iron or cut my throat when I leave. It's been done. Believe me, pal- I have heard them all, even from upper middle-class people who speak marvelous English. I really do care. I wish I could get you in faster, but I can't. On that note:

6. If you can stomp up to my triage station after two or more hours of waiting and be loud and belligerent, then I can instantly deduce that you have the lung capacity and the cardiac capacity to keep that brain of yours perfused for a little while longer. I keep an eye on my triage patients, and I make a point of coming out to the waiting area and checking on folks who have to wait, just to let them know I have not forgotten about them and to recheck a blood pressure or temperature or two. In my ER, if you are really sick, you can bet your ass I will move heaven and earth to get you in. It's like that in almost every other ER in this country. Not all, unfortunately, but nearly all. But you don't hear about those. You only hear about the bad ones. They are not all bad. Most are pretty damn good. I know- I have been a customer in more than one of them.

7. I have studied in hospitals from here to Taiwan and have performed comparative research on the healthcare systems in dozens of countries incoluding America; and I can tell you that all this talk about socialized medicine being superior to American healthcare is by and large a trainload of horsefeathers. They are most certainly not any better than what we have to offer. And the wait is at least as long. There are exceptions, but that's all they are. American healthcare is flawed, but I'd still take my kid to an American hospital first.

I mean no disrespect to anyone when I say this, but it must be said because it is the absolute bottom line, and there is no getting around it: If you want bigger, better, faster, sexier hospitals, then you will have to accept the unsavory fact that you are going to have to pay for them. Ours is a consumer-driven society, and our healthcare reflects that. If you expect Bugatti quality for the price of a Yugo, you are going to be very, very disappointed. That may not be palatable, but it is the truth. Sorry about that.