Tuesday, October 28, 2014

Emergency rooms

I received many texts last night.  A member of my extended family was in the emergency room.  It may have been as simple as vertigo induced by a virus and dehydration.  Or it may be something more.

My sister is an oncology nurse.  She advised me to stay home.  There were already three family members in attendance.  My sister did a great job keeping the rest of us posted.

I do not like Emergency Rooms

Unfortunately I have enough exposure to emergency rooms to have opinions.  My best estimate is that I have spent 60 hours in emergency rooms in the last five years.  The one I like least is the one attached to the largest hospital in Lansing, the one that is close to downtown.  Perhaps it was the circumstances:  the patient (not me)  was being seen for a "penetrating trauma to the thoracic region 50 mm to the left of his sternum."

The patient I was with received pretty high priority.  There were other patients parked in the hallways.  By appearance (dirty feet) and aroma they were street people.  My guess is that they preferred to sleep on a hospital gurney than to sleep at the mission.  Of course, the mission has a curfew and will not let you in if they detect any kind of substance abuse.  The emergency room does not have those restrictions.  They are obliged to treat you if you complain about serious symptoms.  There is no penalty for lying.

My friends who drive ambulances are beyond angry with these fakers.  One lady has "chest pains" every day.  She gets a high-speed ride to the hospital where it is diagnosed as an anxiety attack.  In the dark humor of EMTs, they tell me that they know the cause of the anxiety before they pick her up.  Her vodka bottle is empty.  The hospital pays for a cab ride home.  She has the cabby stop at the package store...since it is on the way.

My other friends tell me that the busiest day for the ambulance is when "the checks" go out.  The high speed ride into the downtown hospital. A miracle healing passing through the E-room doors. Then across the street to Stober's Bar.  A $500 taxicab ride that exposes the public and the EMT's to the risk of a two-way, high-speed ambulance sortie across town....so the entitled person can get drunk.  Chest pains.  The trip is not optional.  Losing a driver's license is not an inconvenience to these people.

The "system" tolerates this abuse for reasons.
  • At the present time we can afford it.  The number of traffic accidents, fatal and otherwise, is not enough to intrude on our sensibilities.  A robust triage process ensures that legitimate patients receive care quickly.
  •  The cost structure of these services are, for the most part, fixed cost.  Stripping this "clientele" away would speed up service to legitimate patients but would likely not reduce the staffing of E-rooms or pull any ambulances or EKG machines out of service.

We are entering a post-Ebola world.  I doubt that the system will be able to tolerate this abuse much longer. 

The solution?

The real world has limits.  No more chocolate chip cookies after the bag of chocolate chips is empty.

My ambulance driver friends would LOVE a Peter-and-the-Wolf rule.  Two false alarms in a row and then you (address/phone number) are ignored.  That is one more failure than Hungry Howie Pizza allows.


  1. That IS starting to happen in some places... Finally...

  2. Hello Old NFO:

    Thank-you for your comments.

    One other factor that enables this abuse is the fact that the cost is diluted and un-linked.

    If the abusers were to forcibly take $500 from random people, at some point they would run into somebody who would object vigorously.