psychiatric services, emergencies, and the ER....

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And no, er docs cannot do the mental health assessment themselves because they are busy treating asthma exacerbations, MIs, sore throats, abdominal pain, etc....they are not mental health workers.

Clearly you have some romantic notion that everyone else is busy saving lives. The reality is most of what comes to the ER is complete dross and is not in any way shape or form an emergency. I did my ED rotation at an academic center so I can only assume it would be much worse in a community hospital with no trauma, no provisions for seriously ill patients. For every STEMI there are 10 sprains, for every asthma exacerbation, 10 people with the cold, for acute abdomen about 10 people with mild gastroenteritis. Then add in all the malingerers, drug seekers, chronic pain patients, and abnormal illness behavior, and the drunks picked off the street. Quite frankly 'bizarre behavior' is more appropriate for medical evaluation than most.

That said, I don't think it is usually appropriate for someone who had SI to be waiting in the ED for 10 hours. But 'altered mental state', 'bizarre behavior', first 'panic attack' - yes it is not unreasonable for them to be seen in the ED. Where would you rather they go? We still occasionally get patients who are frankly delirious who have been 'medically clear' so the system is not foolproof as it is, we would have far more organic stuff coming through. Also I don't think it is ideal for someone established with a community mental health center to come to the ED and there should be other provisions if they need admission.

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Clearly you have some romantic notion that everyone else is busy saving lives. The reality is most of what comes to the ER is complete dross and is not in any way shape or form an emergency. I did my ED rotation at an academic center so I can only assume it would be much worse in a community hospital with no trauma, no provisions for seriously ill patients. For every STEMI there are 10 sprains, for every asthma exacerbation, 10 people with the cold, for acute abdomen about 10 people with mild gastroenteritis. Then add in all the malingerers, drug seekers, chronic pain patients, and abnormal illness behavior, and the drunks picked off the street. Quite frankly 'bizarre behavior' is more appropriate for medical evaluation than most.

That said, I don't think it is usually appropriate for someone who had SI to be waiting in the ED for 10 hours. But 'altered mental state', 'bizarre behavior', first 'panic attack' - yes it is not unreasonable for them to be seen in the ED. Where would you rather they go? We still occasionally get patients who are frankly delirious who have been 'medically clear' so the system is not foolproof as it is, we would have far more organic stuff coming through. Also I don't think it is ideal for someone established with a community mental health center to come to the ED and there should be other provisions if they need admission.

1) while mild asthma exacerbations are not an emergency, the difference is that the ER does have SOMETHING TO OFFER in the form of treatment for this. They have nothing to offer the depressed dude. And no, a turkey sandwhich doesn't count. Nowhere in this thread have I made mention of emergencies vs non-emergencies, but rather medical vs psychiatric.

2) the 'provision' for a lot of people who are established with cmhcs is to come to the ER when they are in crisis. That's what many are told.
 
Sometimes not....in community hospitals many ER groups bill patients directly rather than have an hourly salary. These patients generally are either no pay or medicare/aid, and sometimes even the govt insured ones don't often pay because of the nature of the care provided in ER.

Wrong - most DON'T. And it seems you have the idea backwards - why would a group directly bill (fee for service) the no pay/MedicAid crowd? That doesn't make sense.

Fee for service works in areas with a good payor mix, and low MedicAid/no pay - not the other way around. The fee for service are the ones that, comparatively, get paid handsomely.
 
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Vistiral, Every thought of transferring to Medicine or GOing to another program? I'm starting to think your'e in the University of Washington St Louis.
 
Wrong - most DON'T. And it seems you have the idea backwards - why would a group directly bill (fee for service) the no pay/MedicAid crowd? That doesn't make sense..

ummm...because you may(depending on the payer mix) make for it by recouping more money than contracted hourly wage rates billing the patients who have good insurance. I know ER physicians who work in both systems. Obviously with ER's that have the highest % of medicaid and uninsured populations ER physicians are going to want to work per hour.
 
Vistiral, Every thought of transferring to Medicine or GOing to another program? I'm starting to think your'e in the University of Washington St Louis.

Im not at WashU....my program is fine. And Im done in 5 months anyways. Most of the other residents I work with are pretty decent. Unlike most psych programs, it is almost all allopathic american grads. I wouldn't do a medicine residency because that wouldn't be very much fun.
 
Im not at WashU....my program is fine. And Im done in 5 months anyways. Most of the other residents I work with are pretty decent. Unlike most psych programs, it is almost all allopathic american grads. I wouldn't do a medicine residency because that wouldn't be very much fun.

If you considered grinding through 40 patients on a Saturday "fun", I truly do admire your enthusiasm for being a psychiatrist despite all the negativity you preach.
 
If you considered grinding through 40 patients on a Saturday "fun", I truly do admire your enthusiasm for being a psychiatrist despite all the negativity you preach.

I'm not sure that grinding through 40 patients on a Saturday represents safe and effective psychiatric practice.
 
If you considered grinding through 40 patients on a Saturday "fun", I truly do admire your enthusiasm for being a psychiatrist despite all the negativity you preach.

better than that 40 medicine patients
 
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