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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 th

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
  A few hospitals now have urgent care and ERs right next to each other, with a triage nurse in front saying which area to go to. That seems like a good system. I obviously agree with you that people can’t be expected to perfectly discriminate which they should go to. The root of my comment was to defend the availability of ER services against someone who literally suggested that ERs were not needed for anyone who didn’t arrive by ambulance or by police, not to argue the specifics of his child’s case for which neither one of us have any real knowledge. I am sorry about your wife’s experience. It contributes to making healthcare discussions so challenging, because there are incredibly emotional, stressful, and unfair situations in each direction (people who got billed tens of thousands on one side; people who were not diagnosed on the other) — including in countries with socialized medicine. I would suggest that your wife would have been best served not by an ER doctor, but by a highly trained and thoughtful primary care physician who could have followed her and understood what she’s going through longitudinally. Sadly, we burden medical students with $200K in debt and then ask them to choose between a high-paying good-lifestyle specialty or a low-paying poor-lifestyle specialty. And then one layer down, the primary issue is it’s hard to pay PCPs more when 99.5% of their visits are for common colds, medication renewals, knee pain, etc. and 0.5% of their visits make huge impacts (e.g. diagnosis of cancer early). Just like trying to discriminate urgent care vs. ER, how does one know which patients to send to an NP who can take care of routine issues, and which to send to a PCP with a better understanding of complex issues including management of multiple specialists’ recommendations.

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
A few hospitals now have urgent care and ERs right next to each other, with a triage nurse in front saying which area to go to. That seems like a good system. I obviously agree with you that people can’t be expected to perfectly discriminate which they should go to. The root of my comment was to defend the availability of ER services against someone who literally suggested that ERs were not needed for anyone who didn’t arrive by ambulance or by police, not to argue the specifics of his child’s case for which neither one of us have any real knowledge. I am sorry about your wife’s experience. It contributes to making healthcare discussions so challenging, because there are incredibly emotional, stressful, and unfair situations in each direction (people who got billed tens of thousands on one side; people who were not diagnosed on the other) — including in countries with socialized medicine. I would suggest that your wife would have been best served not by an ER doctor, but by a highly trained and thoughtful primary care physician who could have followed her and understood what she’s going through longitudinally. Sadly, we burden medical students with $200K in debt and then ask them to choose between a high-paying good-lifestyle specialty or a low-paying poor-lifestyle specialty. And then one layer down, the primary issue is it’s hard to pay PCPs more when 99.5% of their visits are for common colds, medication renewals, knee pain, etc. and 0.5% of their visits make huge impacts (e.g. diagnosis of cancer early). Just like trying to discriminate urgent care vs. ER, how does one know which patients to send to an NP who can take care of routine issues, and which to send to a PCP with a better understanding of complex issues including management of multiple specialists’ recommendations.