What’s a true Emergency?

A week ago a patient sent me the following article, OU Medical Center ER To Charge Fee For Non-Emergency Visits, which is loaded with intrigue. The concept seems great, but fair implementation could be a struggle. As an ER doc I think defining an “emergency” will be the crux and the snag.

Is a festering thorn in a diabetic foot an emergency? Is a “fight bite” an emergency? Is a fever in a kid with no spleen an emergency? How about a schizophrenic who is just starting to hear voices? And the alcoholic just starting to withdraw? What about the slightly wheezing asthmatic who needs an inhaler refill?

The proposed system could evolve into: “You seem pretty nice, and you have insurance, and we have an open room… Emergency!” “You’ve been here 7 times in the last 10 days demanding Dilaudid for the same back pain… Non emergency… Pay us $200 or get lost.”

Of course I’m biased, but I’d rather see OU and other crowded emergency departments offering house calls instead. Many ERs already let patients call in ahead to reserve a place in the queue. Why not dispatch someone, or a nurse/tech, or doc/med student team to their residences instead?

As an aside, I’m an extra strong advocate of house calls for infectious disease or mental health issues, because attracting these patients into one central chaotic location just makes zero sense. ID problems can get worse when leaving the comfort of home, while risking disease transmission. And the last place in the world I want to be when psychiatrically unwell is an ER.

Emergency department crowding is a huge topic. “We need more beds” is the monotonous drum beat that never fades. However, I believe most people prefer their own!



ER, Fee for service

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