Why do we have such long wait times in ER’s?

Hospital bills woman who never saw doctor

I actually linked to this article originally from someone else’s blog.  I have a few things to say about this based on my own professional experiences in a big city, non profit ER where we don’t even ask about insurance information until the pt is already in a room.  The comments that were posted regarding this story on that other blog showed a complete ignorance of what happens when you go to the emergency room.

First of all, if you’re not dying, you’re going to sit for a long time in most ER’s.  The average wait time nationwide to get to a room is 6 hours — and I’m not going to tell you how much longer after that it usually is to see the doctor.

Why, you ask?  Well, a couple of reasons.  The first is since we don’t have any sort of functioning safety net insurance wise — universal health care, requirements for employers to cover ALL employees, caps on what insurance companies can charge and what they can refuse to pay for — that means that people who might otherwise have seen their doctor, or gone to an urgent care, for their minor illnesses and chronic conditions don’t.  They come to the emergency room.  Now, sometimes this is for really stupid stuff:  I triaged in a guy that came to our ER complaining that his hemorrhoids hurt.  Sometimes this is for stuff that really doesn’t belong in an ER:  grandma brought her grandson in because she says he has a fever and has been vomiting:  kid doesn’t have a fever, isn’t vomiting, but he does have a runny nose-and he just got sick today.  Why is this not a primary care physician issue?  Even more importantly, why is this not a take the kid home, give him some chicken soup and let him sleep and get better thing?  Sometimes this is for stuff that, if the person had HAD insurance would never have gotten this serious:  the grandma who probably had a stroke, who was ‘fine’ yesterday, who has high blood pressure and uncontrolled diabetes and can’t afford to see a doctor for the medication refills.  Well, now she’s going to be living in a nursing home, and getting her meds won’t be a problem…too little too late. And a lot more than sometimes, it is because the ‘pt’ is purely a drug seeker and is going to get a $10k workup for a problem they don’t actually have, simply because the doctor is afraid of a lawsuit if he calls a spade a spade and god forbid there’s actually something *finally* really wrong with the pt.  My ER has many patients like that…we see them two or three times a week sometimes, and they get the same tests run on them every time they come in, even when we know they’re full of crap.  And sometimes they also get the drugs they’re hoping for.  Which rewards them and keeps them coming back.

The problem with an ER, is that it is not legally able to turn anyone away.  It has nothing to do with patients with insurance getting treated better — at least not at the facility I work at.  Everyone gets the same treatment.  We have people with great insurance, people with crappy insurance, people with state insurance, people with no insurance, and illegals who not only don’t have insurance but don’t care if they have it.

So.  When you have 50 people or more in a waiting room, 70% of whom should have gone to their doctors (and many of whom think waiting a week to see the doctor is too long) 30% of whom probably actually need to be there, you can see why the wait times are so long.

My second bone of contention with the article is that the person is unhappy about her bill ‘even though she never saw a doctor’ well, girly, I hate to tell you this, but we operate under standing orders — protocols — for certain things.  This means that the medical director, a DOCTOR, has signed his name to a piece of paper that says that if the triage nurse sees ‘this’ then she is authorized by him to take ‘that’ action.  The nurse is the doctor’s eyes and ears.  Secondly, even if this girl never saw a doctor, she was still activating the system — she saw a nurse, a tech, a registration clerk, the radiology techs, and a radiologist read her xrays.  Those people all need to get paid.  I would say that $168 is pretty reasonable.  Secondly, if she already knew the bone was broken, why didn’t she just set up an appointment with an orthopedist?  That’s all we would have done for her in our ED anyway — her bone wasn’t displaced, she got a walking boot, and went to an orthopedic specialist anyway.  For this she needed to sit 19 hours?  Oh, and by the way.  Just because she’s now in the waiting room doesn’t mean she’s no longer the triage nurse’s problem.  EVERYONE in the waiting room is the nurse’s patient…which means that vitals need to be repeated periodically, wounds need to be reassessed, etc.

Third, even if you ARE sick, DO need to be seen emergently, and HAVE been triaged to that level — if the rooms are already full, there is no place to put you.  And if someone else comes in who is even sicker than you are, guess what?  They get to cut in line.  It sucks, but there it is.  The guy who died from a heart attack in the article:  it is standard practice to do a 12 lead EKG on patients who are suspicious for heart attack.  I can’t say for sure that was done on him, I don’t know what his presentation was, but I can tell you if he didn’t have significant EKG changes, he wasn’t going to go back right away.  That also sucks, but there it is.

Our nation’s ER’s are at a breaking point.  Many have, or are, closing down.  Many more will close in the coming years.  The ER is the arterial hemorrhage of a hospital — it’s a public service, it never makes money even at the ritziest facility in the richest part of town.  Please keep that in mind the next time you gripe about the wait times at your local ER, and honestly ask yourself if this is a real EMERGENCY?  Can you truly be seen at an urgent care?  Can you truly wait and see your doctor?  Keep our emergency rooms for emergencies, and wait times will be less — staff won’t be so overworked and under compassionate — and care will be much better.

Thanks for reading the rant.

4 responses

  1. I like rants, when they are written by people who are down in the trenches and who know what they are talking about! Thanks for reminding us what ER’s are really for. I think part of the problem is that doctors, too are so overworked it’s hard to get in to see them, and also that many people don’t know about the urgent care centers.

  2. Thanks for reading! I agree about doctors; it’s ridiculous that they are basically expected to pump through about 40 patients or more in a day in order to pay their insurance, bills, staff, and still make a decent living. How can one possibly know what is going on with pt when you spend maybe 2 minutes actually listening — if that?

    When I was younger I bought into the nonsense that universal healthcare was socialism…then I went to work as a firefighter and realized that my job depended on socialism; that caring for others is the duty of a just and egalitarian society, and that medicine is only a part of that.

  3. I just walked out of the ER after only waiting an hour and a half. I got shocked by my aquarium. You’re supposed to go to the hospital when that happens cause my heart rhythms could be wacked. Maybe I won’t wake up in the morning. But I could not stand waiting any longer in a room full of crazy people. I hate everything that has to do with the medical institution. Everyone who works in it has lost their soul within the first year of schooling.

    • So sorry that happened to you, but that’s what I’m talking about with the problems. Emergency rooms are supposed to be for EMERGENCIES. Not toothaches, colds, chronic conditions, etc.

      We haven’t lost our souls. At least not most of us. Most of us have at least a little bit of a hard time reconciling what we THOUGHT we were going to be doing with what we have ended up doing — being a primary clinic. As well as trying to give good care to those who really truly need the care. It’s not easy, and I know many people who leave after only a few years. It’s sad.

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