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I would argue that ER in the US has long ceased to be useful, unless the patient is wheeled in by police/paramedics. Last week my daughter fell and cut her fore

by anu7df 5y ago

I would argue that ER in the US has long ceased to be useful, unless the patient is wheeled in by police/paramedics. Last week my daughter fell and cut her forehead in a way that required stitches. We went to the nearest children's hospital (a huge one) ER, got triaged (just some gauze) and waited for a doctor. Gave up at the 4 hour mark and walked out. Went to the nearest urgent care clinic, was seen by a doctor in 10 minutes and we're out in 30 minutes after my daughter got the stitches. I am sure we will get billed an astronomical amount for this, but there were no other options. We have good insurance.

disabled 5y ago
I am so sorry that both you and your daughter had this horrible experience. I hope she is feeling better now, and is on the mend.
- anu7df 5y ago
  Yes. Stitches are healing up nicely and she is doing fine. Thanks!
coding123 5y ago
Nah, urgent care centers are not astronomical bills. Typically $150 to 250. ER are never less than $1000
- jliptzin 5y ago
  He is talking about the gauze at the ER which he will probably be billed at least $1,000 for
padastra 5y ago
Amazing. I agree that the ER was not necessary for your daughter, but am impressed you can extrapolate that one experience to the entire set of patients with heart failure, pneumonia, sepsis, pyelonephritis, appendicitis, intestinal obstruction, gastrointestinal bleeds, electrolyte disorders, fractures, NSTEMIs, and many others who are not wheeled in by police / paramedics but need urgent complex diagnostics and imaging. What deep understanding and wisdom you hold, and with such high confidence too.
- arkitaip 5y ago
  This is after all Hacker News where we provide simplistic and ultimately wrong solutions to problems we don't understand.
  - jfengel 5y ago
    What do you mean? We're hackers. We're masters of the universe. We run the economy and solve problems. Of course something as trivial as health care can't be too hard. After all, they don't even Kaggle. </snark>
- tantalor 5y ago
  > ER was not necessary I don't know how you read that and came to this conclusion. Maybe you aren't a parent?
  - padastra 5y ago
    He described that he was able to go to urgent care for his daughter for a quick fix and the ER was not necessary for them (and the urgent care doctor who saw them must have agreed or they would have been sent back to the ER). What conclusion should I have come to?
    - jcims 5y ago
      People go to the ER because they don't want to fuck around with situations that they know they are insufficiently trained to diagnose. When your child is bleeding out of their face why in the world would you roll the dice at the local strip mall urgent care when there is a giant children's hospital nearby? Why didn't the ER send a nurse out to triage this after 2 hours of waiting to say they could get sufficient help elsewhere? My experience with ERs over the past 20 years largely mirrors that of GPs. Then when we started going urgent care out of frustration we ultimately got inferior care for my wife that delayed a cancer diagnosis by 3-4 months.
      - padastra 5y ago
cableshaft 5y ago
Urgent care doesn't have everything a hospital/ER has. One example is checking for blood clots/markers of a heart attack. I was worried once and went to Urgent Care (trying to save money, my last two ER visits for this exact same check, which was basically me sitting in ER for two blood draws and an X-Ray over 3 hours, which turned out to be nothing, was $1300+ each), and Urgent Care said they could do an EKG but for the rest I'd have to go to ER.
adrr 5y ago
Urgent care won't take anything outside of a minor scrape or cut. Daughter woke up with a 107 fever and was denied at a urgent care and forced to an ER. ER just gave her both Tylenol and Ibuprofin and sent us home after her fever came down.
- jfengel 5y ago
  Urgent care did a great job when I had kidney stones. They took blood work and an x-ray, made a diagnosis, gave me a shot that took care of the problem, and all of it in an hour. A friend had a case of a bad virus and the urgent care did a great job with her too. I'm sure it varies from place to place and need to need, and few of us have the training to tell which. But at least some urgent care centers can do really good work for a lot more than cuts. In your case the urgent care center did the right thing. A fever of 107 could be a lot of incredibly dangerous things, some of which require surgery, and ASAP. I'm glad your daughter required nothing more, but it was absolutely a situation where the urgent care center was not sufficient. You and I can't be expected to know that, and it would be great if we lived with a system that didn't draw such sharp lines in order to reduce cost. The urgent and emergency places should be part of the same system and co-located as much as possible. But that requires a complete rebuild of our system from the ground up.
dragonwriter 5y ago
> I would argue that ER in the US has long ceased to be useful, unless the patient is wheeled in by police/paramedics. Well, in some cases (it varies by time and particular ER) they are less-than-useful for things that don’t urgently require stabilization because they are loaded with cases that do require such stabilization, that's what triage is about. And, yes, lots of them are overloaded. > I am sure we will get billed an astronomical amount for this, but there were no other options. We have good insurance. If it is possible you will be billed an astronomical amount, you have “good” insurance, if at all, only in the sense of preserving a somewhat greater degree largely meaningless choice of providers for which you will be partially reimbursed. Good insurance that has bounded, low out of pocket expense for both urgent care and emergency room visits exists.

by anu7df 5y ago

disabled 5y ago

I am so sorry that both you and your daughter had this horrible experience. I hope she is feeling better now, and is on the mend.

anu7df 5y ago
Yes. Stitches are healing up nicely and she is doing fine. Thanks!

coding123 5y ago

Nah, urgent care centers are not astronomical bills. Typically $150 to 250. ER are never less than $1000

jliptzin 5y ago
He is talking about the gauze at the ER which he will probably be billed at least $1,000 for

padastra 5y ago

Amazing. I agree that the ER was not necessary for your daughter, but am impressed you can extrapolate that one experience to the entire set of patients with heart failure, pneumonia, sepsis, pyelonephritis, appendicitis, intestinal obstruction, gastrointestinal bleeds, electrolyte disorders, fractures, NSTEMIs, and many others who are not wheeled in by police / paramedics but need urgent complex diagnostics and imaging. What deep understanding and wisdom you hold, and with such high confidence too.

arkitaip 5y ago
This is after all Hacker News where we provide simplistic and ultimately wrong solutions to problems we don't understand.
- jfengel 5y ago
  What do you mean? We're hackers. We're masters of the universe. We run the economy and solve problems. Of course something as trivial as health care can't be too hard. After all, they don't even Kaggle. </snark>
tantalor 5y ago
> ER was not necessary I don't know how you read that and came to this conclusion. Maybe you aren't a parent?
- padastra 5y ago
  He described that he was able to go to urgent care for his daughter for a quick fix and the ER was not necessary for them (and the urgent care doctor who saw them must have agreed or they would have been sent back to the ER). What conclusion should I have come to?
  - jcims 5y ago
    People go to the ER because they don't want to fuck around with situations that they know they are insufficiently trained to diagnose. When your child is bleeding out of their face why in the world would you roll the dice at the local strip mall urgent care when there is a giant children's hospital nearby? Why didn't the ER send a nurse out to triage this after 2 hours of waiting to say they could get sufficient help elsewhere? My experience with ERs over the past 20 years largely mirrors that of GPs. Then when we started going urgent care out of frustration we ultimately got inferior care for my wife that delayed a cancer diagnosis by 3-4 months.
    - padastra 5y ago

cableshaft 5y ago

Urgent care doesn't have everything a hospital/ER has. One example is checking for blood clots/markers of a heart attack. I was worried once and went to Urgent Care (trying to save money, my last two ER visits for this exact same check, which was basically me sitting in ER for two blood draws and an X-Ray over 3 hours, which turned out to be nothing, was $1300+ each), and Urgent Care said they could do an EKG but for the rest I'd have to go to ER.

adrr 5y ago

Urgent care won't take anything outside of a minor scrape or cut. Daughter woke up with a 107 fever and was denied at a urgent care and forced to an ER. ER just gave her both Tylenol and Ibuprofin and sent us home after her fever came down.

jfengel 5y ago
Urgent care did a great job when I had kidney stones. They took blood work and an x-ray, made a diagnosis, gave me a shot that took care of the problem, and all of it in an hour. A friend had a case of a bad virus and the urgent care did a great job with her too. I'm sure it varies from place to place and need to need, and few of us have the training to tell which. But at least some urgent care centers can do really good work for a lot more than cuts. In your case the urgent care center did the right thing. A fever of 107 could be a lot of incredibly dangerous things, some of which require surgery, and ASAP. I'm glad your daughter required nothing more, but it was absolutely a situation where the urgent care center was not sufficient. You and I can't be expected to know that, and it would be great if we lived with a system that didn't draw such sharp lines in order to reduce cost. The urgent and emergency places should be part of the same system and co-located as much as possible. But that requires a complete rebuild of our system from the ground up.

dragonwriter 5y ago

> I would argue that ER in the US has long ceased to be useful, unless the patient is wheeled in by police/paramedics. Well, in some cases (it varies by time and particular ER) they are less-than-useful for things that don’t urgently require stabilization because they are loaded with cases that do require such stabilization, that's what triage is about. And, yes, lots of them are overloaded. > I am sure we will get billed an astronomical amount for this, but there were no other options. We have good insurance. If it is possible you will be billed an astronomical amount, you have “good” insurance, if at all, only in the sense of preserving a somewhat greater degree largely meaningless choice of providers for which you will be partially reimbursed. Good insurance that has bounded, low out of pocket expense for both urgent care and emergency room visits exists.