Denying care in the ED?

[iliacus]

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I've worked as a tech signing in pt's and was always amazed at the reasons people seek care in the ED. Mother's come in with children who have slight fevers and hadn't given any tylenol...Just felt a slight fever and brought them strait in. In the meantime, they give you the stink eye and comment on how long they've waited. Many don't pay...many illegal aliens receive care and are never seen or heard from again. Do you think there will ever come a time when we tell people they can't be seen in the ED? Everyone should receive health care, but not everyone wants to pay for it. Some of you ED's out there...how often do you feel like your time is being wasted with minor stuff?

 

[mikecwru]

I've worked as a tech signing in pt's and was always amazed at the reasons people seek care in the ED. Mother's come in with children who have slight fevers and hadn't given any tylenol...Just felt a slight fever and brought them strait in. In the meantime, they give you the stink eye and comment on how long they've waited. Many don't pay...many illegal aliens receive care and are never seen or heard from again. Do you think there will ever come a time when we tell people they can't be seen in the ED? Everyone should receive health care, but not everyone wants to pay for it. Some of you ED's out there...how often do you feel like your time is being wasted with minor stuff?

It depends on how you define "being seen." I can envision a time where people are turfed to an outpatient clinic if a complaint is not life threatening, provided there were easier access to primary care.

mike

 

[Katee80]

I was once witness to a pt being thrown out of the ED with the doc yelling at her at the top of his lungs. Something to the effect of "You come here all the time for stupid things...this is the last time...I don't want to see you back unless you're dying!!!!!" 😱

She left.

The staff were in shock to say the least including myself.

Must of been a hangnail.

 

[roja]

I have one word: EMTALA

 

[Katee80]

I have one word: EMTALA

Hmmmhmmmm. Green here. WTH does that mean? 😀

 

[roja]

http://www.emtala.com/

 

[docB]

Hmmmhmmmm. Green here. WTH does that mean? 😀

EMTALA is the law in the US that grants everyone all the ER care they can consume without regard to payment.

 

[pinbor1]

I thought that all you had to do was evaluate the patient to rule-out anything emergent. If it was something stupid; i.e. hang-nail or some other bogus reason to visit you could legally boot them out of there if you have the cajones to do so.

 

[stoic]

I thought that all you had to do was evaluate the patient to rule-out anything emergent. If it was something stupid; i.e. hang-nail or some other bogus reason to visit you could legally boot them out of there if you have the cajones to do so.

Problem is that Joe Blow who comes in with a "headache" needs a $1500 CT to r/o SAH before you can give him some Demerol and send him on his way.

 

[Sessamoid]

Problem is that Joe Blow who comes in with a "headache" needs a $1500 CT to r/o SAH before you can give him some Demerol and send him on his way.

:s/Demerol/ibuprofen

or better yet

:s/Demerol/Tylenol

(and it rhymes better!) 🙂

 

[roja]

wow. demorol for headache. No wonder they are coming to your ED. 😉

 

[Sessamoid]

Re: Demerol for migraine headaches

The US Headache Consortium published a report reviewing the current scientific evidence in the treatment of migraines, available here.

In it, they found:

"The results from the studies with meperidine showed that it was not superior to other effective medications (chlorpromazine IV, methotrimeprazine* IM, ketorolac IM, DHE plus metoclopramide IV)."

If anybody comes in saying they absolutely need Demerol for their migraine, I kindly point out that I don't use Demerol for migraines. Furthermore, I also point out that anybody with such a severe headache that other proven migraine medications are not effective probably will require a lumbar puncture to rule out other pathology. Since I've instituted this policy, the elopement and recovery rate of my drug seekers has skyrocketed, much to my satisfaction.

 

[roja]

We don't even have demerol in our ed.

I also will only give IVF and reglan. Occasionally, I throw in some toradol. works like a charm.

 

[docB]

I thought that all you had to do was evaluate the patient to rule-out anything emergent. If it was something stupid; i.e. hang-nail or some other bogus reason to visit you could legally boot them out of there if you have the cajones to do so.

Yes you can in terms of EMTALA. You're still liable for med mal if they have a bad outcome. Ironically hangnails I can do something about so I'll treat them. It's the more vague, probably crap, but could possibly be bad, weak and dizzy, young chest pain, headache, chronic issue stuff that is so painful.

 

[Sessamoid]

Yes you can in terms of EMTALA. You're still liable for med mal if they have a bad outcome. Ironically hangnails I can do something about so I'll treat them. It's the more vague, probably crap, but could possibly be bad, weak and dizzy, young chest pain, headache, chronic issue stuff that is so painful.

Also, IIRC, nail excisions bill pretty high. 😀

 

[deleted6669]

had a pt today come in with a note from his doc" mr smith has a few abnormal labs, please tune him up"pt in nad expecting admission for "tune up". doc( !@#$% internist) in his office seeing pts. all day.
labs: glucose 304( pts nl value apparently)
cholesterol 450
triglycerides 3000
hba!c 14
nl renal function.
no indication of dka

second pt from same doc (next pt in fact). also nad.
"mrs jones has had chronic nausea and wt loss of 50 lbs over last year. please eval and tx"

basic lab workup done(all neg). pt likely with cancer of some sort.



pts doc promptly received irate phone calls x 2 from me telling him to do his own scut. pts d/c'd from dept with next day f/u with pcp.

 

[USCDiver]

Woah woah woah, I don't think a hangnail warrents a nail excision. Ingrown toenail, maybe, but not a hangnail.

 

[docB]

Woah woah woah, I don't think a hangnail warrents a nail excision. Ingrown toenail, maybe, but not a hangnail.

For anyone that comes to the ER with a nail issue I yank 'em all out all and document 20 procedures. Better billing that way. 😎

 

[Sessamoid]

For anyone that comes to the ER with a nail issue I yank 'em all out all and document 20 procedures. Better billing that way. 😎

 

[stoic]

For anyone that comes to the ER with a nail issue I yank 'em all out all and document 20 procedures. Better billing that way. 😎

Note to self: cancel plans to visit ER while in Vegas for ingrown toe nail.

 

[DeLaughterDO]

Has anyone heard of any steps being taken to provide compensation for this federally mandated care (i.e. EMTALA)? Last I'd heard, we are the only profession mandated by law to GIVE AWAY our services when some schmuck walks in off the street with the "I-haven't-had-a-drink-in-3-hours-and-now-I'm-in-withdrawls" (real pronunciation) blues.

When are they going to rectify this?

Jonethan De.

 

[Apollyon]

I was once witness to a pt being thrown out of the ED with the doc yelling at her at the top of his lungs. Something to the effect of "You come here all the time for stupid things...this is the last time...I don't want to see you back unless you're dying!!!!!" 😱

She left.

The staff were in shock to say the least including myself.

Must of been a hangnail.

I just came from a wedding just outside Ottawa, so Canada is on my mind.

I've never, ever seen anything like this - at all. And I've been doing in and out of hospital emergency services for 13 years.

I thought about your migraines, and the esoteric combinations that work or don't, and how people suggested things that you affirmed didn't work, and, now, I put these two things together, and I wonder if you are anti-emergency medicine.

I am not teeing off on you, or trying to insinuate (or state outright) anything. I was just wondering.

 

[docB]

Has anyone heard of any steps being taken to provide compensation for this federally mandated care (i.e. EMTALA)? Last I'd heard, we are the only profession mandated by law to GIVE AWAY our services when some schmuck walks in off the street with the "I-haven't-had-a-drink-in-3-hours-and-now-I'm-in-withdrawls" (real pronunciation) blues.

When are they going to rectify this?

Jonethan De.

They're not. They think it's great. The poor and the stupid get free care and the gov doesn't have to foot the bill. Suck it up. You're a federally mandated charity. I wonder if we could log our free care and deduct it as charitable contributions?

 

[Febrifuge]

Suck it up. You're a federally mandated charity. I wonder if we could log our free care and deduct it as charitable contributions?

Hey, I'm about as liberal as this place gets, and I actually think that's a good idea. Or how about the value of your uncompensated services comes out of the principal balance of your federal student loans? If we're being generous with the free care, it's only fair to be generous to the people providing the free care.

 

[ERMudPhud]

I've never, ever seen anything like this - at all. And I've been doing in and out of hospital emergency services for 13 years.

I've seen it. During residency we had a frequent flyer, alcoholic pseudoseizures(but very convincing), homeless, who easily racked up over 300 ED visits per year. At one of the community hospitals we rotated through I saw the attending throw her out on to the ambulance dock naked and then throw her clothes out after her. He definately wasn't a roll model as an ED physician. In fact he was pretty much ridiculed and loathed throughout the local EM and EMS community.

 

[EMIMG]

First off, EMTALA just entitles people to a screening exam. Not necessarily treatment.

Next, not all hospitals need to follow EMTALA guidelines. In fact, EMTALA is just set up for hospitals that accept monies from the federal government in terms of Medicare (I believe also Medicaid). If there are any hospitals out there that don't accept this type of reimbursement, then theoretically, they don't need to abide by EMTALA.

 

[Sessamoid]

First off, EMTALA just entitles people to a screening exam. Not necessarily treatment.

It requires treatment necessarily for medical stabilization, which can be complex, costly, and often requires admission. For non-emergent problems, it's often nothing more than a prescription, which as was pointed out in the listserv is so trivial an amount of work that you might as well do it anyway, free or not. In reality, you end up treating everybody.

Next, not all hospitals need to follow EMTALA guidelines. In fact, EMTALA is just set up for hospitals that accept monies from the federal government in terms of Medicare (I believe also Medicaid). If there are any hospitals out there that don't accept this type of reimbursement, then theoretically, they don't need to abide by EMTALA.

Find me more than a dozen hospitals in the country that don't receive federal monies through Medicare and/or Medicaid. Hell, I can't even think of one. The fact is that federal health care is such a large part of the system that no hospital can stay afloat without federal money, making EMTALA a de facto requirement for all hospitals.

 

[roja]

Okay, I know this issue can be frustrating... but really, we all signed up for this. Its not like you didn't know this kind of thing happens in the ER. Unless you plan on lobbying, or directly doing something to change it... whats the point of complaining?

 

[Sessamoid]

Okay, I know this issue can be frustrating... but really, we all signed up for this. Its not like you didn't know this kind of thing happens in the ER. Unless you plan on lobbying, or directly doing something to change it... whats the point of complaining?

Complaining makes me feel better. 🙂 Anyway, I didn't think I was complaining in my post, just clarifying some points I thought were misrepresented. Anyway, if you belong to ACEP or AAEM you are already doing something via their PACs and legislative efforts.

On your point of us signing up for this: How many of us really understood everything about this when we went into it?. And by "it" I'm not talking only of emergency medicine, but medicine as a whole. Everybody makes the decision with imperfect and incomplete information. When you decided on a specialty, did you understand just what percentage of your patients would be "negative income?" Even now, you can't know how much of your future work will be negative income, as the circumstances will undoubtedly change between now and your entry into the physician marketplace.

 

[roja]

Complaining makes me feel better. 🙂 Anyway, I didn't think I was complaining in my post, just clarifying some points I thought were misrepresented. Anyway, if you belong to ACEP or AAEM you are already doing something via their PACs and legislative efforts.

On your point of us signing up for this: How many of us really understood everything about this when we went into it?. And by "it" I'm not talking only of emergency medicine, but medicine as a whole. Everybody makes the decision with imperfect and incomplete information. When you decided on a specialty, did you understand just what percentage of your patients would be "negative income?" Even now, you can't know how much of your future work will be negative income, as the circumstances will undoubtedly change between now and your entry into the physician marketplace.

Actually, my point wasn't directed at anyone specific. it was just a general comment. I agree venting does at times makes one feel better. 🙂

In terms of signing up, I have little empathy for residents and anyone who came out of residency in the last 5-7 years in terms of bitterness regarding this issue. If you truly went into medicine without an understanding of what medicine as a whole is like, then you made a grave error. Granted it is an error that many make, in many fields. I did it myself in the film industry. I loved school and hated the reality of working in the industry. I had not delved into what a career would be like. So, before I invested 6 years in schooling and at least 3 in residency, I made damn sure I knew the ins and outs, the good and bad of medicine before I choose a career in medicine. And prior to choosing a specialty, I did exactly the same thing. If you go blindly into a specialty, then, as callous as it sounds, I think you deserve what you get. You should have prepared yourself better.

This point was illustrated at one of our confences (an 'airing' out session) when a number of residents were complaining about nursing staff, techs, consult services (your typical ER complaints). And one of the residency directors pointed out, you know what, you CHOOSE to go into this field. Sitting here complaining does no good. Unless you have something productive to add in, stop complaining. Suck it up. You picked this specialty.

Regarding PACS, my own personal philosophy is that indirectly giving money to a PAC is NOT actively doing something. Unless you are on the committee that is directly lobbying adn you are formulating policy... but I know this is my own bias. 🙂

 

[Apollyon]

Find me more than a dozen hospitals in the country that don't receive federal monies through Medicare and/or Medicaid. Hell, I can't even think of one.

I thought I heard in the past few years that one of the Harvard hospitals (either MGH or the Brigham, or maybe both) doesn't take MediCare money, 'cause they don't need to, so they can do whatever the hell they want to.

 

[margaritaboy]

It is my personal view that some issues and situations merit complaints or even downright anger or outrage, regardless of whether or not you knew about it before you entered the field.

It may sound odd, but I think anger can be the motive force for bureaucratic change. It is one thing to complain without action, but complaints and anger that are vented appropriately may actually help.

Some things about this field I knew about before hand at least in part, and some things no doubt I don't have clue about yet. But I never want to give up my right to be outraged and complain. Hopefully I'll remember to vent them in a constructive manner.

 

[roja]

It is my personal view that some issues and situations merit complaints or even downright anger or outrage, regardless of whether or not you knew about it before you entered the field.

It may sound odd, but I think anger can be the motive force for bureaucratic change. It is one thing to complain without action, but complaints and anger that are vented appropriately may actually help.

Some things about this field I knew about before hand at least in part, and some things no doubt I don't have clue about yet. But I never want to give up my right to be outraged and complain. Hopefully I'll remember to vent them in a constructive manner.

Never said anger wasn't justified. My point was that complaining with no action is kind of like bitching about politics when you don't vote. If you aren't trying to fix it, shut up! okay, I'm not that severe because sometimes you jsut have to vent, but if its a chronic thing...

 

[Katee80]

I just came from a wedding just outside Ottawa, so Canada is on my mind.

I've never, ever seen anything like this - at all. And I've been doing in and out of hospital emergency services for 13 years.

I thought about your migraines, and the esoteric combinations that work or don't, and how people suggested things that you affirmed didn't work, and, now, I put these two things together, and I wonder if you are anti-emergency medicine.

I am not teeing off on you, or trying to insinuate (or state outright) anything. I was just wondering.

I'm sooooo not anti-EM. I grew up around doctors and nurses! Unfortunatly I've needed to go to the ER on numerous occasions which increased my chances to witness "bad" situations which not only involved myself as you can see from my last post. I probably should have told a few great stories. They're not all bad so sorry I gave the impression I was anti-emergency medicine. I hope to join the ranks in 5 years!

I get great care for migraines from my PCP (non narcotic care) and 95% of the time I get treated wonderfully at the ER as well.

I told the honest truth when I told you about the doc at our ER here in the nation's capital. Let's just say I openly cringed when he walked into my cubicle. But you know what?.......he ended up being an awesome doctor/person.

😀 How was the wedding?

 

[Apollyon]

😀 How was the wedding?

Lovely!

 

[docB]

Okay, I know this issue can be frustrating... but really, we all signed up for this. Its not like you didn't know this kind of thing happens in the ER. Unless you plan on lobbying, or directly doing something to change it... whats the point of complaining?

Complaining in this forum serves to educate the legion of lurking med students and residents as to the point of view of a practicing EP. Griping with colleagues also serves as brain storming about solutions and passing on tricks to deal with all this crap. We must not quit worrying about these things as that will just let the forces who want to make things worse for us succeed. Heck, if we don't watch it we could even end up with a med mal lawyer in the white house.

 

[roja]

Complaining in this forum serves to educate the legion of lurking med students and residents as to the point of view of a practicing EP. Griping with colleagues also serves as brain storming about solutions and passing on tricks to deal with all this crap. We must not quit worrying about these things as that will just let the forces who want to make things worse for us succeed. Heck, if we don't watch it we could even end up with a med mal lawyer in the white house.

If you go back and look at the original post, what I was mentioning was complaining without action. Sitting around griping is not the same thing as raising concerns and trying to come up with solutions.

I also stated that venting at times is also appropriate.

And I NEVER advocated sitting there and just waiting for things to happen... in fact, I think I made the analogy of if you don't vote, don't complain about politics.... ACTION is necessary.

 

[margaritaboy]

Never said anger wasn't justified. My point was that complaining with no action is kind of like bitching about politics when you don't vote. If you aren't trying to fix it, shut up! okay, I'm not that severe because sometimes you jsut have to vent, but if its a chronic thing...

Word.

 

[k's mom]

Ok, pardon my ignorance, but has a model ever been tried where an EM is attached to a clinic with nurse triage and 24/7 family physician coverage? Essentially, so that clients who only need tylenol, or antacid can be seen, but not waste ED space and resources? It seems like federal funding would be more available to the "clinic" (especially in high-volume centers), leaving the ED to deal more effectively with trauma care. Low-income clinics can cost a lot of money to run, but if resources were shared with a hospital (specifically the floor space!), it could save the clinic and the ED some serious money. It could( again, hypothetically,) also help clinics staff volunteer services more easily, since physicians, nurses and medical students who are interested could volunteer more easily, any hour of the day. On an earlier thread, someone was complaining about people coming into the ED in the middle of the night to get a prescription filled because it was more convenient to their schedule. WTF? It seems to me that this arrangement would deter some of the idiots who only want conversation, a fancy test, and a bed (let the drunks sit in a plastic clinic chair with their IV, instead of taking up a bed while they sober up). More essentially, it will help soothe the fears and EDUCATE the patients who really do think a 3:00 am ED visit is warranted for a "slight fever" in their child. This might also encourage more follow-up care, since the FP seeing the patient could arrange an appointment time, instead of the ED physician saying "See your FP in two weeks."...yeah, right.
I think the EDUCATION part is most important..and a FP is (should be, at least) much more equipped to deal with patient education, than an ED physician who may have critically ill patients to attend to.

 

[iliacus]

Hey, I'm about as liberal as this place gets, and I actually think that's a good idea. Or how about the value of your uncompensated services comes out of the principal balance of your federal student loans? If we're being generous with the free care, it's only fair to be generous to the people providing the free care.

Wow, here's an idea I can get behind! When people do not seek out a primary care physician and use the ED for their runny noses, "spider bites," febrile children aren't you in essence providing medical care for the underserved? Emergency medicine should qualify for programs like HPSP. I'm venturing way out of my knoweldge base and understanding of the financial aspects of medicine, but it seems to me that EP's provide as much care to the poor and underserved as any FP in some back woods clinic.

 

[docB]

Ok, pardon my ignorance, but has a model ever been tried where an EM is attached to a clinic with nurse triage and 24/7 family physician coverage?

I know that some of the Kaiser hospitals in CA are trying this and it sounds like a great idea. Here are the downsides:
-If you are providing clinic level care you have to bill like a clinic which is less than an ER. Consequently you have to see a high pt volume to make up for the lower billing. For this reason many of these fast track set ups have to close at night and the pts bounce right back to the ER. They do help while they are open.
-You are throwing an FP into an environment where he will loss one of FP's greatest assets; continuity. Most of my problems in the ER are social problems that I can't solve in one visit and neither will the FP. The FP could try to absorb all of these pts into his practice but that won't work because you're basically selecting for the uninsured with social problems, not a fun crowd and not a good way to build a practice.
-Since American medicine is like Burger King where you can have it your way lots of patients would refuse to go to the clinic side and demand treatment in the ER which defeated the whole system. It's tough to deny them because you know that any bad outcome will = lawsuit.

I think that setups like these are part of the solution but not the whole solution.

 

[Sessamoid]

Ok, pardon my ignorance, but has a model ever been tried where an EM is attached to a clinic with nurse triage and 24/7 family physician coverage? Essentially, so that clients who only need tylenol, or antacid can be seen, but not waste ED space and resources?

I'm pretty sure it's been tried, and failed. Many EDs have a "fast track" designed to handle the brunt of such cases. But your proposal doesn't answer the basic question, which is "who is going to pay for all this care?" Currently the physicians and hospitals simply eat the cost of providing the care. Putting a separate clinic is only going to cost the hospital more money.

Federal funding doesn't grow on trees. To fund this idea, other clinics will have to lose funding. Which clinics do you propose we close to provide for clinics adjacent to emergency departments in most hospitals in the country? Do we borrow more and add to the federal debt to do this, and if so where does it get paid off? Do we increase taxes to do it? Personally, I'd be happy to pay slightly higher taxes to not provide any free medical care anymore, but I suspect that the average citizen isn't going to be crazy about the idea since they don't benefit from it.

Or how about the value of your uncompensated services comes out of the principal balance of your federal student loans?

An interesting idea (one which I'd benefit from greatly), but again where does the money come from? Your loans are owned by somebody, usually a bank or Salliemae or whatever. That entity is going to be mighty unhappy if the gov't just decides to make that asset simply disappear by fiat. Without compensating them, that's just stealing from the rich corporations to give to the rich physicians.

 

[Su4n2]

docB,
pardon the MS2ignorance but what is wrong with saying, "I am sorry sir, but this is not an emergency, please malke an appt with the clinic tomorrow"
forthings like 1. hi, i am 18 , i think inhave infertility/pregnant/ets or
2. things that are obvious that the patient has waited a long time for b-4 coming in.

i mean when i call my PCP when i am sick he makes a judgement call and says wither come in today or this isn't emergent, make an appt.

 

[ERMudPhud]

Ok, pardon my ignorance, but has a model ever been tried where an EM is attached to a clinic with nurse triage and 24/7 family physician coverage?

Several hospitals in Denver do exactly this and have for years although without 24/7 coverage. It works for them for several reasons. First, as city or state institutions their malpractice caps make them nearly immune from being sued. Every time someone gets mistriaged it does result in some bad press not much more. Second, with the patient population they serve patient satisfaction isn't that high of a priority since many of their patients have no where else to go.



As for the posts about just telling patients sorry this isn't an emergency after the EMTALA required "screening exam", if you do have a bad outcome smart attornies are now suing for both malpractice and EMTALA violations-alleging an inadequate screening exam. The EMTALA suit apparently results in the case being moved to a federal court where local caps on malpractice awards may not apply plus it puts extra pressure on the physician to settle since the EMTALA fines aren't covered by malpractice insurance.

 

[margaritaboy]

docB,
pardon the MS2ignorance but what is wrong with saying, "I am sorry sir, but this is not an emergency, please malke an appt with the clinic tomorrow"
forthings like 1. hi, i am 18 , i think inhave infertility/pregnant/ets or
2. things that are obvious that the patient has waited a long time for b-4 coming in.

i mean when i call my PCP when i am sick he makes a judgement call and says wither come in today or this isn't emergent, make an appt.

EMTALA (Emergency Medical Treatment and Active Labor Act) states that every patient that comes to an ED with a complaint must recieve a medical screening exam to determine if the have an emergency medical condition. So although sending patients home, or refering them to outpatient clinics does happen, it only occurs after they've been triaged and given the appropriate medical screening exam and determined to be stable or not have an emergency medical condition. Thus, those patients can still slow things down.

Also, even if a patient clearly does not have an emergency medical condition that warrents care under EMTALA, doctors can still be held liable by malpractice laws. So, many docs will over work a patient just to cover all possible bases and increase their legal defensibility.

 

[Febrifuge]

Sometimes, walking to (or usually from) work, I just idly wonder how much trouble I would get into if the next time a patient asks me how long it will be, I say something like:

"Well, sir, you see, that's the problem. If this was a visit to your regular doctor, we--"

"But I don't have a regular doctor. I just come here."

"Yeah, we know. You've been here 23 times in the last year. Anyway, if this was a visit to a clinic, they could draw some blood, look you over, and send you home with an appointment to come back in 4 weeks, and they could call you later with the lab results."

"So why can't you do that here?"

"Because this is an EMERGENCY DEPARTMENT, sir. This is a place where the job is to figure out what you've got, and if it's likely to kill you anytime soon. If we don't see anything particularly wrong with you, I mean aside from your chronic medical issues, which are many and well-documented, we still have this thing we need to take into account. You came in to the emergency department. We assume that means you feel you have an emergency happening. And we want to respect that. So if we haven't found an emergency, that means either you don't actually have one, or we haven't found it yet. So we take some time and make sure we look reeeeeal carefully. We do this because we would never want to suggest you're full of crap and came in here with the intent of wasting everybody's time. No, no, no. Never. Perish the thought."

 

[docB]

You came in to the emergency department. We assume that means you feel you have an emergency happening. And we want to respect that.

You're totally right. I've heard of many cases where the plaintiff made a point of saying that the patient knew they had an emergency which is why they went to the er, "so why didn't you realize they had an emergency doctor."

 

[Febrifuge]

I'd love to see a little placard out in the triage area, explaining the difference between Emergency Medicine and clinic-based Family or Internal Medicine. Something more friendly and informative than the subtext of "This Is Not A Free Clinic."

 

[docB]

I'd love to see a little placard out in the triage area, explaining the difference between Emergency Medicine and clinic-based Family or Internal Medicine. Something more friendly and informative than the subtext of "This Is Not A Free Clinic."

As it is we have the EMTALA mandated placards out there that basically say that it is a free clinic. Everyone should take a look around their ER and read them they say in several languages that you have the right to care without regard to the ability to pay. How that doesn't = free clinic I don't know.

 

[Sessamoid]

"Yeah, we know. You've been here 23 times in the last year.

23 times? That's nothing. We had one legendary system abuser in residency who had almost 300 ED visits in one calendar year. And that wasn't counting visits to other hospitals in the city. And when I say legendary, I mean he was part of a feature on 60 Minutes about people who abuse the emergency medical services system.